Outcomes of Allogeneic Hematopoietic Cell Transplantation in T-cell Prolymphocytic Leukemia: A Contemporary Analysis from the Center for International Blood and Marrow Transplant Research

Leveraging machine learning for predicting acute graft-versus-host disease grades in allogeneic hematopoietic cell transplantation for T-cell prolymphocytic leukaemia

Orphan diseases, exemplified by T-cell prolymphocytic leukemia, present inherent challenges due to limited data availability and complexities in effective care. This study delves into harnessing the potential of machine learning to enhance care strategies for orphan diseases, specifically focusing on allogeneic hematopoietic cell transplantation (allo-HCT) in T-cell prolymphocytic leukemia. The investigation evaluates how varying numbers of variables impact model performance, considering the rarity of the disease. Utilizing data from the Center for International Blood and Marrow Transplant Research, the study scrutinizes outcomes following allo-HCT for T-cell prolymphocytic leukemia. Diverse machine learning models were developed to forecast acute graft-versus-host disease (aGvHD) occurrence and its distinct grades post-allo-HCT. Assessment of model performance relied on balanced accuracy, F1 score, and ROC AUC metrics. The findings highlight the Linear Discriminant Analysis (LDA) classifier achieving the highest testing balanced accuracy of 0.58 in predicting aGvHD. However, challenges arose in its performance during multi-class classification tasks. While affirming the potential of machine learning in enhancing care for orphan diseases, the study underscores the impact of limited data and disease rarity on model performance.

Autologous hematopoietic cell transplantation for T-cell prolymphocytic leukemia: a retrospective study on behalf of the Chronic Malignancies Working Party of the EBMT

Not available.

Prolymphocytic Leukaemia: an Update on Biology and Treatment

PURPOSE OF REVIEW

This review summarises the recent advances in knowledge regarding the biology and treatment of prolymphocytic leukaemias.

RECENT FINDINGS

Both B-PLL and T-PLL are genetically complex, and the molecular landscape of these diseases has been well characterised recently. Diagnostic criteria for T-PLL have been refined with the publication of the first international consensus criteria, whereas the diagnosis of B-PLL has been thrown into question by the most recent WHO classification. Treatment advances in B-PLL have relied heavily on the advances seen in CLL that have then been extrapolated to B-PLL with just a few case reports to support the use of these targeted inhibitors. Despite increased knowledge of the biology of T-PLL and some elegant pre-clinical models to identify potential treatments, unfortunately, no improvements have been made in the treatment of T-PLL. Unmet need is a term oft used for many diseases, but this is particularly true for patients with prolymphocytic leukaemias. Ongoing improvements in our understanding of these diseases will hopefully lead to improved therapies in the future.

Clinical analysis of prolymphoblastic leukemia: the rare hematological malignancy in the elderly

OBJECTIVE

To discuss and analyze the clinical and prognostic characteristics of rare prolymphocytic leukemia (PLL), in order to provide new references for the clinical diagnosis and treatment and basic research of PLL.

METHODS

The clinical data of 8 patients with PLL admitted to the Department of Hematology in Fujian Medical University Union Hospital from January 1, 2011 to May 31, 2023 were collected and retrospectively studied, and the clinical treatment and prognosis were analyzed. Meanwhile, the latest literature from PubMed was retrieved to systematically discuss the research progress in the diagnosis and treatment of PLL.

RESULTS

In this study, of the 8 patients with PLL, 6 were males and 2 were females; the ages ranged from 52 to 80 years, with a median age of 70.5 years. The immunophenotypes were divided into B-PLL (7 cases) and T-PLL (1 case). Morphological, flow cytometric, cytogenetic and molecular biological tests of bone marrow cells were performed in all patients. Among them, 1 case refused chemotherapy after diagnosis and died in a short time, the other 7 cases received standard chemotherapy. Among the 7 patients, one patient died of severe infection caused by myelosuppression after chemotherapy, one patient died within 3 months after chemotherapy; two patients died of progression at 4 and 7 months after chemotherapy. A total of 3 patients achieved complete remission (CR) after chemotherapy, and 1 patient underwent allogeneic hematopoietic stem cell transplantation without disease progression or recurrence.

CONCLUSION

PLL is a rare lymphoid malignancy with an extremely poor prognosis, which tends to occur in the elderly, and the clinical manifestations of PLL lack specificity. Chemotherapy combined with targeted drugs or epigenetic drugs may benefit PLL patients. Hematopoietic stem cell transplantation should be performed after CR is obtained to improve the prognosis to the greatest extent.

T-Cell Prolymphocytic Leukemia: Diagnosis, Pathogenesis, and Treatment

T-cell prolymphocytic leukemia (T-PLL) is a rare and aggressive neoplasm of mature T-cells. Most patients with T-PLL present with lymphocytosis, anemia, thrombocytopenia, and hepatosplenomegaly. Correct identification of T-PLL is essential because treatment for this disease is distinct from that of other T-cell neoplasms. In 2019, the T-PLL International Study Group (TPLL-ISG) established criteria for the diagnosis, staging, and assessment of response to treatment of T-PLL with the goal of harmonizing research efforts and supporting clinical decision-making. T-PLL pathogenesis is commonly driven by T-cell leukemia 1 (TCL1) overexpression and ATM loss, genetic alterations that are incorporated into the TPLL-ISG diagnostic criteria. The cooperativity between TCL1 family members and ATM is seemingly unique to T-PLL across the spectrum of T-cell neoplasms. The role of the T-cell receptor, its downstream kinases, and JAK/STAT signaling are also emerging themes in disease pathogenesis and have obvious therapeutic implications. Despite improved understanding of disease pathogenesis, alemtuzumab remains the frontline therapy in the treatment of naïve patients with indications for treatment given its high response rate. Unfortunately, the responses achieved are rarely durable, and the majority of patients are not candidates for consolidation with hematopoietic stem cell transplantation. Improved understanding of T-PLL pathogenesis has unveiled novel therapeutic vulnerabilities that may change the natural history of this lymphoproliferative neoplasm and will be the focus of this concise review.