Autologous stem cell transplantation in NK/T-cell lymphoma: Prognostic impact of EBV-DNA in a multinational cohort-A study by the EBMT Lymphoma Working Party.
(2025) HemaSphere — Vol. 9, n° 8, p. e70184 (2025)
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Berning, Philipp 
Shumilov, Evgenii
- Abstract
- Natural killer (NK)/T-cell lymphomas (NKTCLs) are rare, aggressive lymphomas prevalent in East Asia and South America. Despite improvements, largely due to asparaginase-based therapies, outcomes for advanced disease remain poor, and the role of autologous stem cell transplantation (auto-HCT) remains controversial. This study evaluated real-world outcomes of auto-HCT in NKTCL patients across Asia and Europe. We included 130 adult NKTCL patients undergoing auto-HCT between 2011 and 2022 using data from the European Society for Blood and Marrow Transplantation (EBMT) registry and South Korean registry data. Median age was 51.3 years; 66.9% were male. Most patients (95.1%) had an Eastern Cooperative Oncology Group (ECOG) score 0-1; 65.3% had Stage III-IV disease. One prior therapy line was reported in 53.1%, and ≥2 lines in 46.9%. Asparaginase-based regimens were used in 79.5% pretransplant. Responses at auto-HCT included complete (59.7%), partial (27.9%) remission, and stable/progressive disease (12.4%). Epstein-Barr virus (EBV)-DNA in the peripheral blood was reported in 37.3%. With a median follow-up of 4.6 years, 3-year overall survival (OS) and progression-free survival (PFS) were 63.8% and 47.6%. Relapse and NRM rates at 3 years were 46.7% and 5.7%. Patients in complete remission had improved 3-year OS (75.2%) compared to PR (52.8%) and stable/progressive disease (32.0%) (P = 0.007). Detectable EBV-DNA in the blood at auto-HCT was associated with poor outcomes (3-year OS: 26.7% vs. 78.1% in patients with undetectable EBV-DNA; P < 0.0001). Patients achieving complete remission and undetectable EBV-DNA in the blood before auto-HCT had a favorable survival, suggesting auto-HCT may be a treatment option in selected high-risk patients. This is the largest multinational cohort evaluating prognostic factors for auto-HCT for NKTCL.
Citations
Berning, P., Ngoya, M., Kim, W. S., Shumilov, E., Wu, D., Huang, H., Cairoli, A., Tucci, A., Dachy, G., Gounot, R., Wilke, A. C., Scheid, C., Dreger, P., Lopez Lorenzo, J. L., Bloor, A., Romejko-Jarosinska, J., Gadisseur, A., Schroers, R., Reményi, P., et al. (2025). Autologous stem cell transplantation in NK/T-cell lymphoma: Prognostic impact of EBV-DNA in a multinational cohort-A study by the EBMT Lymphoma Working Party. HemaSphere, 9(8), e70184. https://doi.org/10.1002/hem3.70184 (Original work published 2025)