Evaluation of haematopoietic stem cell transplantation in patients diagnosed with cutaneous T‐cell lymphoma at a tertiary care centre: should we avoid chemotherapy in conditioning regimes?

Ritchie, S.; Qureshi, Iman; Molloy, Kevin; Yoo, Jinseon; Shah, Farida; Stevens, Andrea; Irwin, Clive; Chaganti, Sridhar; Scarisbrick, Julia

doi:10.1111/bjd.18541

Cited by 11 publications

(8 citation statements)

References 7 publications

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“…Allo‐HSCT can offer a cure in some patients but comes at a price, including the likelihood of relapse, GvHD, or infection 15,62,80 and risk of death 126 . Further research is required into the optimal conditioning regimens and the best timing of HSCT following systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, symptom relief via methods such as anti‐pruritic medication and emollients may be used. Allogeneic haematopoietic stem cell transplantation (allo‐HSCT) may be indicated in a small number of eligible patients and is the only curative option 8,14–16 . Therefore, the goals of therapy are to improve or clear lesions and to control symptoms across all affected disease compartments (skin, blood, lymph nodes, and viscera), to minimise the risk of progression 17 and to avoid treatment‐related toxicity 18 …”

Section: Current Management Of Ctclmentioning

confidence: 99%

“…Allo‐HSCT is recommended for advanced‐stage disease in the updated 2017 EORTC guidelines, 20 whereas it was not recommended in the previous version 61 . While allo‐HSCT is potentially curative, 15,16 there is still much work to be done in understanding the optimal conditioning regimens, the best moment to recommend HSCT, and how prior systemic therapies will affect the transplant outcome 15,62 . Furthermore, allo‐HSCT is only available in limited, specialist centres, making it not easily accessible.…”

Section: Current Management Of Ctclmentioning

confidence: 99%

“…Patients with Stage IIB–IV disease have a very poor median OS, ranging from 3–5 years 9 . Although allo‐HSCT is a curative treatment option for patients with CTCL, at least half of patients who receive this treatment relapse within 1 year, 15,62,80 and graft‐ versus ‐host disease (GvHD) can lead to severe morbidity and death 81 . Additionally, further investigation is needed into factors affecting outcomes after allo‐HSCT, such as the optimal conditioning regimens as well as patient selection and the best time for transplantation during the disease course 81 …”

Section: Advanced Diseasementioning

confidence: 99%

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The changing therapeutic landscape, burden of disease, and unmet needs in patients with cutaneous T‐cell lymphoma

2020

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Summary Cutaneous T‐cell lymphomas (CTCLs) have a chronic, relapsing course, and the most common subtypes are mycosis fungoides and Sézary syndrome. The disease causes visible skin alterations and can also cause alopecia, pruritus and pain, all of which can impact patients’ health‐related quality of life (HRQoL). The goal of treatment is to reduce symptoms and prevent disease progression. However, treatment recommendations are often based on low levels of evidence due to the lack of well‐designed randomised clinical trials and treatment guidelines, and approved drugs vary considerably across different countries and regions. Currently, available treatments rarely lead to durable remissions and eventually become less effective, meaning patients often require multiple therapy changes. Skin‐directed therapies (SDTs) are first‐line treatments for early‐stage CTCL, whereas systemic therapies may be needed for early‐stage disease that does not respond to SDT or for advanced‐stage disease. However, patients can experience significant side‐effects with these treatments or may be unable to tolerate them. Hence, there is an unmet need for effective therapies with good safety profiles for the treatment of early‐ and late‐stage CTCL. Here, we review current treatment guidelines, investigational and approved treatments, the impact of CTCL on patients’ HRQoL, and the treatment of pruritus.

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Section: Discussionmentioning

confidence: 99%

Section: Current Management Of Ctclmentioning

confidence: 99%

Section: Current Management Of Ctclmentioning

confidence: 99%

Section: Advanced Diseasementioning

confidence: 99%

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The changing therapeutic landscape, burden of disease, and unmet needs in patients with cutaneous T‐cell lymphoma

2020

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“…Although the ideal conditioning regimen for HSCT in CTCL patients is unknown, recent studies suggest that RIC reduces the mortality rates seen with myeloablative conditioning regimen (MAC) with equivocal efficacy and should be therefore recommended in eligible patients undergoing alloHSCT ( 11 , 20 , 28 ). A less intensive approach with non-myeloablative preparative regimen using total lymphoid irradiation (TLI) and anti-thymocyte globulin (ATG), without chemotherapy, is currently investigated in a phase−2 clinical trial (NCT00896493) with promising preliminary results ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

Long–Term Disease Control After Allogeneic Hematopoietic Stem Cell Transplantation in Primary Cutaneous T–Cell Lymphoma; Results From a Single Institution Analysis

et al. 2020

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Background: Allogeneic hematopoietic stem cell transplantation (alloHSCT) has been proposed as curative approach for advanced cutaneous T–cell lymphomas (CTCL). Currently, there is no established consensus for the management of disease relapse after alloHSCT. Results: Ten patients, previously treated with multiple lines of systemic treatment, received alloHSCT. Six patients had achieved partial response (PR, N = 5) and complete response (CR, N = 1) prior to HSCT. Post—HSCT, seven patients ( N = 7) relapsed after a median time of 3.3 months (0.5–7.4 months) and were subsequently treated with radiotherapy (RT, N = 1), RT and adoptive T-cell transfer with EBV specific cells ( N = 1), R-CHOP ( N = 1) and interferon alpha−2a combined either with donor lymphocyte infusion ( N = 1) or with brentuximab—vedotin ( N = 1). One patient ( N = 1) achieved PR only after reducing the immunosuppression. Two patients relapsed again and received interferon alpha−2a and brentuximab—vedotin, respectively. After a median follow-up time of 12.6 months (3.5–73.7 months) six patients were alive (60%) and four had deceased, three ( N = 3) due to CTCL and one ( N = 1) due to GVHD. Conclusion: Disease relapse after alloHSCT can be controlled with available treatments. For most patients who ultimately relapsed, reduction of immunosuppression and interferon alpha−2a either administered alone or in combination with another systemic agent were preferred. Although interferon alpha−2a, similarly to immunosuppression reduction, may be beneficial for the achievement of graft–vs.–lymphoma effect, the risk of simultaneous worsening of GVHD must be carefully evaluated and taken into consideration.

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Cutaneous T‐cell Lymphoma

Gru

Rooke

Molloy

et al. 2021

The Peripheral T‐Cell Lymphomas

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Evaluation of haematopoietic stem cell transplantation in patients diagnosed with cutaneous T‐cell lymphoma at a tertiary care centre: should we avoid chemotherapy in conditioning regimes?

Cited by 11 publications

References 7 publications

The changing therapeutic landscape, burden of disease, and unmet needs in patients with cutaneous T‐cell lymphoma

The changing therapeutic landscape, burden of disease, and unmet needs in patients with cutaneous T‐cell lymphoma

Long–Term Disease Control After Allogeneic Hematopoietic Stem Cell Transplantation in Primary Cutaneous T–Cell Lymphoma; Results From a Single Institution Analysis

Cutaneous T‐cell Lymphoma

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