Allogeneic Hematopoietic Stem Cell Transplantation in Patients with Prolymphocytic Leukemia

T-prolymphocytic leukemia (T-PLL) is a rare lymphoid neoplasm with particularly poor prognosis. B-prolymphocytic leukemia (B-PLL), although no longer recognized as a distinct entity by the World Health Organization (WHO), comprises conditions with unfavorable outcome as well. Both diseases most frequently affect patients in the 7th decade of their lives. Allogeneic hematopoietic stem cell transplantation (alloHSCT) significantly improves outcomes for selected PLL cases as shown by several, mostly retrospective, analyses. In this article, we provide a review of existing PLL analyses, followed by a summary of cases treated at our center. We describe outcomes of six T-PLL and three B-PLL cases receiving alloHSCT at our institution between 2015 and 2022. Despite a post-transplant 4-year cumulative relapse incidence of 61% in our T-PLL series, median OS was 78 months, because relapse therapy was remarkably successful. All B-PLL patients are alive and relapse-free with a median follow-up of 54 (range, 11 – 74) months. A poor pre-transplant Karnofsky performance score (<= 80) and an HCT Comorbidity Index (HCT-CI) of >= 3 were significantly associated with post-transplant mortality. The comparatively favorable outcomes in our case series underline the increasing value of alloHSCT in PLL in the current era, as it offers a prospect of cure in selected patients with otherwise very poor prognosis.