EBMT 2025 | The EBMT consensus guidelines for alloSCT in T-cell lymphoma

Yes, thank you for your question. And first of all, as we all know, that PTCL is a difficult-to-treat disease. And a patient, especially a patient with relapsed/refractory disease, have a worse outcome. And patients who are relapsing have a median survival rate of less than six months and about three to four months of progression-free survival. And patients in the relapsed setting who received allogeneic transplant are doing better than those who are not. That’s why the only curative approach for those patients is allogeneic stem cell transplantation. 

And for that, we aimed in our work to harmonize the practice of allogeneic transplant, to provide for all physicians a standard on how to manage those patients, is our first aim for that, and 29 experts from Europe and the United States, have worked together to draw these guidelines. 

For first-line patients after the first line of chemotherapy, there is no indication for allogeneic stem cell transplantation, and these data are based on the AATT trial. Unfortunately, in the first line, allogeneic transplant will be an investigational treatment. And autologous stem cell transplantation is considered as a standard, however, there is no randomized trial that shows an advantage on overall survival over chemotherapy alone. 

However, for the majority of PTCL in the relapsed or refractory setting, allogeneic transplantation is the standard of care, and doctors should be aware of that. They should look at first for HLA typing and search for a donor, and for chemo-sensitive patients in this setting, they will go directly to allogeneic. What we should know is that doctors shouldn’t wait to obtain complete remission. If patients are chemosensitive in CR, PR, or stable disease after one line of salvage treatment, they should go with allogeneic transplant and don’t wait until complete remission. 

However, for patients who are progressive, we can propose to them another second-line treatment or clinical trials with the objective to put them on the track for allogeneic transplant. And again, we recommend that no more than one or two lines of salvage treatment before allo. Don’t wait for complete remission, and for sure, this is for fit patients. 

These recommendations are for patients with the major entities such as T-cell lymphoma, ALCL, or with PTCL-NOS. However, for the rare disease PTCL, like hepatosplenic lymphoma, EATL, or extranodal NK T-cell lymphoma, there is a recommendation to go with allo in the first line in chemo-sensitive, with some caveats for EATL – there is no firm recommendation to go to allo in first complete remission, and those patients may benefit from autologous stem cell transplantation in complete remission, and if they fail after the first-line chemotherapy, complete remission, partial remission, or stable disease, in this case, those patients should go to allo transplant.

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