Role of upfront autologous stem cell transplantation (ASCT) in adults with T‐NHL in first complete remission (CR1): A systematic literature review and meta‐analysis

Introduction: There is currently no consensus on the role of upfront ASCT for patients with T cell Non-Hodgkin lymphomas (T-NHL), especially in patients who have achieved complete remission (CR1) following induction chemotherapy. To date, no randomized control trials (RCTs) exist and available data is conflicting, especially with regards to T-NHL subtypes that might benefit. A systematic review and meta-analysis of all comparative studies (randomized, non-randomized and observational) was hence performed to address this question. Methods: A comprehensive, systematic search (from 1/2000 to 2/2022) of MEDLINE/PubMed, EMBASE and Cochrane databases was performed. PRISMA and Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Studies were screened based on predefined inclusion/exclusion criteria, and were critically appraised for outcomes of interest [progression free survival (PFS) and overall survival (OS)]. Quality of studies was assessed using Newcastle-Ottawa Scale. Hazard ratios (HRs) and corresponding 95% Cis were calculated, and the meta-analysis was performed using the random-effects model. Test for heterogeneity was performed using I2 statistic. Results: Of 3297 unique records, 17 studies (prospective = 6, retrospective = 11) were included. Median follow up in these studies ranged from 22 to 94 mths. Ten studies compared upfront ASCT versus No ASCT in patients with complete remission (CR1), while in 7 patients achieving either PR1 (first partial remission) or CR1 were included[MS1]. Of these, 9 studies included only transplant eligible patients. The T-NHL subtypes included in the studies were also heterogenous, with nodal T-NHLs, in particular Angioimmunoblastic T-NHL (AITL) being amongst the most common subtypes. Results: from the meta-analysis showed that PFS in T-NHL patients who underwent ASCT benefited (HR 0.64, 95% CI: 0.46–0.89, I2 = 74%) compared to not undergoing ASCT; however similar benefit was not observed in OS (HR 0.67, 95% CI: 0.36–1.23, I2 = 89%). Sensitivity analyses including only studies with patients transplanted in CR1, and studies involving transplant eligible patients showed similar findings. In the studies that evaluated patients with the AITL subtype, ASCT showed a significant benefit in PFS and OS, compared to not undergoing ASCT (PFS = HR 0.19, 95% CI: 0.11–0.32, I2 20%; OS = HR 0.27, 95% CI: 0.09–0.81, I2 88 (Figure 1). Keyword: stem cell transplant No conflicts of interests pertinent to the abstract.