Allogeneic hematopoietic stem cell transplantation in Primary Cutaneous T Cell Lymphoma

Abstract

In our retrospective study, 16 patients affected by advanced cutaneous T cell lymphoma (CTCL) underwent allogeneic hematopoietic stem cell transplantation (HSCT). Two patients (12.5%) were in complete remission (CR), nine (56.3%) in partial remission (PR), and five (31.2%) with active disease. The patients were transplanted from an HLA-identical (n = 7) from a mismatched (n = 1) or haploidentical (n = 1) sibling, from matched unrelated donor (n = 5), or from a single cord blood unit (n = 2). Conditioning regimen was standard myeloablative in 6 patients and at reduced intensity in 10. Seven patients died from non relapse mortality (NRM) and four patients relapsed or progressed, three of them achieved a second CR after donor lymphocyte infusion (DLI) or chemotherapy plus DLI. To date, with a median follow-up of 76 months (range 6-130), nine patients are alive, eight in CR, and one with active disease. Overall survival (OS) and disease-free survival (DFS) at 1 and 10 years are 61% (95% CI 40-91%) and 54% (95% CI 33-86%), 40% (95% CI 22-74%), and 34% (95% CI 16-68%), respectively. The time from diagnosis to transplant seems to influence negatively both OS (log-rank p < 0.04) and DFS (log-rank p < 0.05). Our results confirm on a long follow-up that CTCL appears particularly susceptible to the graft versus lymphoma (GVL) effect, so that allogeneic HSCT represents a possibility of cure for advanced CTCL. The timing of HSCT in the clinical course of disease remains an open issue.

Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas

“…Ten years later, in a retrospective study on patients with a median time from diagnosis to allo-HSCT of 46 months (range 9-309), authors compared OS in patients with time from diagnosis to transplant below 46 months versus above 46 months. The patient group with time from diagnosis to transplant < 46 months had a longer OS at 1 year ( P < 0.04) [ 12 ]. These results, although derived from retrospective studies, suggest that allo-HSCT should be considered early in the course of the disease.…”

“…The results of a recent meta-analysis might represent the best evidence supporting the use of allo-HSCT as an effective treatment for CTCL [ 8 ]. Prolonged remissions with allo-HSCT suggest a graft-versus-lymphoma (GVL) effect [ 9 , 10 , 11 , 12 ]. On the other hand, HSCT is associated with a non-negligible high morbidity and treatment-related mortality rate.…”

Novel Immunotherapies for T Cell Lymphoma and Leukemia

“…In allo-HCT the entire hemopoietic and immune system of the patient is substituted with one derived from an HLA-matched donor(45). This strategy has demonstrated to be the only curative option for a subset of TCL(46-48), however treatment-related mortality and late graft versus host complications could impact long-term quality of life (46-48). For eligible patients with aggressive TCL subtypes, allo-HCT represents an option in the relapsed/refractory setting (46-48).…”

“…However, efficacy of this procedure in this context is rather limited, especially in highly aggressive diseases, with ORR of 15-29% (52). In PTCL, DLI has demonstrated anecdotal activity, but in some cases at the cost of high-grade GVHD (46). …”

Cutaneous T Cell Lymphoma: Ready to Enter the World of Allogeneic Transplant?

“…A graft-versus-lymphoma effect has been demonstrated by achieving remission after allogeneic transplant following the withdrawal of immunosuppression or donor lymphocyte infusion [3]. These patients should not be precluded from transplant because of residual disease; however, a shorter duration from diagnosis to transplant [4] and better response to treatment with less residual disease before allogeneic transplant [5] are associated with better post-transplant outcomes. These findings indicate the importance of decreasing the disease burden with newer treatments and consideration of allogeneic transplant earlier in the disease course.…”