Allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with
T cell acute lymphoblastic leukemia (T-ALL) in second or later complete remission
(CR) and high-risk patients in first CR. Given its relative rarity, data on outcomes
of HCT for T-ALL are limited. We conducted a multicenter retrospective cohort study
using data from 208 adult patients who underwent HCT between 2000 and 2014 to describe
outcomes of allogeneic HCT for T-ALL in the contemporary era. The median age at HCT
was 37 years, and the majority of patients underwent HCT in CR, using total body irradiation
(TBI)-based myeloablative conditioning regimens. One-quarter of the patients underwent
alternative donor HCT using a mismatched, umbilical cord blood, or haploidentical
donor. With a median follow up of 38 months, overall survival at 5 years was 34%.
The corresponding cumulative incidence of non-relapse mortality and relapse was 26%
and 41%, respectively. In multivariable analysis, factors significantly associated
with overall survival were the use of TBI (HR, 0.57; P = .021), age >35 years (HR,
1.55; P = .025), and disease status at HCT (HR, 1.98; P = .005 for relapsed/refractory
disease compared with CR). Relapse was the most common cause of death (58% of patients).
Allogeneic HCT remains a potentially curative option in selected patients with adult
T-ALL, although relapse is a major cause of treatment failure.