Patient characteristics and outcomes of T-cell prolymphocytic leukemia: A population-based analysis from the NCDB.

Abstract

e18608 Background: T-cell prolymphocytic leukemia (T-PLL) is a rare, aggressive T-cell leukemia with poor prognosis and limited treatment options. It is resistant to conventional chemotherapy, but alemtuzumab, a CD52 monoclonal antibody, shows over 80% efficacy, though most patients relapse within 12 months. Studies are limited by small cohorts with sparse data. Using the National Cancer Database (NCDB), we aimed to analyze patient characteristics, transplant selection predictors, and survival in T-PLL. Methods: We conducted a retrospective cohort analysis of T-PLL patients aged 18 or older from the NCDB (2004–2020). Collected variables included demographics, socioeconomic and insurance status, healthcare center type, and year of diagnosis. Continuous data were reported as medians with interquartile ranges, and categorical data as frequencies and percentages. Multivariate logistic regression was conducted to examine the predictors of receiving autologous stem cell transplant (ASCT) in CR1 . Multivariate Cox regression analysis was performed to evaluate predictors of survival. Overall survival (OS) was evaluated using Kaplan-Meier and log-rank test. Results: We identified 585 patients with T-cell prolymphocytic leukemia (T-PLL) who met the inclusion criteria. Median age was 66.4. Majority were males (58.5%), non-Hispanic whites (74.5%), and treated in an academic center (50.6%). Nine patients (1.5%) received auto SCT as a consolidative treatment. Multivariate logistic regression did not identify clinical or socioeconomic predictors of receiving auto-SCT. Receiving transplant did not improve OS (HR = 0.70, 95% CI [0.52–0.93], p=0.65). In the multivariate Cox regression analysis, patients who identified their race as others had a 48% higher risk of death compared to non-Hispanic White patients (HR = 1.48, 95% CI [1.02–2.14], p = 0.04), and patients without a high school degree (9.1%–15.2%) had a 39% higher risk of death compared to those in ( >15.3%) education level group (HR = 1.39, 95% CI [1.03–1.87], p = 0.03). Patients diagnosed in the periods 2008–2011had a 42%(HR = 0.58, 95% CI 0.44–0.77, p = <0.01) and 2016–2020 had a 30% (HR = 0.70, 95% CI 0.52–0.93, p = <0.01) lower risk of death, respectively, compared to those diagnosed in 2004–2007. Conclusions: ASCT is not commonly utilized as a consolidative strategy in T-cell PLL after induction. Only nine patients (1.5%) received ASCT in our cohort. Due to this low number, we could not identify predictors of auto-SCT in first line. Race, education and year of diagnosis affected survival. Demographics. Variable Frequency(%)/ Median (IQR) Age 66.36(13.02) Male 342(58.46%) Race Hispanic 24(4.10%) Non-Hispanic Blacks 81(13.85%) Non-Hispanic Whites 436(74.53%) Others 44(7.52%) Facility Type Community cancer program 13(2.28%) Comprehensive community cancer program 171(29.95%) Academic/research program 289(50.61%)