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Allogeneic stem-cell transplantation (allo-SCT) has promising results, but data remain scarce. In this single-center retrospective analysis of 100 patients with ATLL from north America (67 acute, 22 lymphomatous), 17 underwent allo-SCT and 5 autologous SCT (ASCT), with a median follow-up of 65\u00a0months. Post-transplant 3-years relapse incidence (RI) and non-relapse mortality (NRM) were 51% and 37%, respectively, and 3-year progression-free survival (PFS) and overall survival (OS) were 31% and 35%, respectively. ASCT 1-year RI was 80% compared to 30% in allo-SCT (<jats:italic>p<\/jats:italic>\u2009=\u20090.03). After adjusting for immortal-time bias, allo-SCT had significantly improved OS (HR\u2009=\u20090.4, <jats:italic>p<\/jats:italic>\u2009=\u20090.01). In exploratory multivariate analysis, patients achieving first complete response and Karnofsky score\u2009\u2265\u200990 had significantly better outcomes, as did Black patients, compared to Hispanics, who had worse outcome. In transplanted patients, 14 died within 2\u00a0years, 4 of which ASCT recipients. Our data are the largest ATLL transplant cohort presented to date outside of Japan and Europe. We show that allo-SCT, but not ASCT, is a valid option in select ATLL patients, and can induce long term survival, with 40% of patients alive after more than 5\u00a0years. \n<\/jats:p>","DOI":"10.1007\/s44228-023-00032-y","type":"journal-article","created":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T23:21:02Z","timestamp":1679872862000},"page":"78-91","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Outcome of Stem Cell Transplantation in HTLV-1-Associated North American Adult T-Cell 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