Long-term Remission After Allogeneic Hematopoietic Stem Cell Transplantation for Refractory Cutaneous T-Cell Lymphoma

Guitart, Joan; Wickless, Scott C.; Oyama, Yu; Kuzel, Timothy M.; Rosen, Steven T.; Traynor, Ann E.; Burt, Richard K.

doi:10.1001/archderm.138.10.1359

Cited by 78 publications

(36 citation statements)

References 17 publications

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“…More aggressive regimens, including allogeneic bone marrow transplantation, for patients with aggressive types of CTCL including advanced stages of MF and SS are currently under investigation. 179,180 Recently, studies have started to investigate gene and protein expression profiles in different types of cutaneous lymphoma. It is expected that these studies will not only contribute to a better understanding of the molecular pathways involved in the development and progression of these lymphomas, but will also provide new molecular targets for diagnosis and therapeutic intervention, and ultimately to more refined classification schemes.…”

Section: Discussionmentioning

confidence: 99%

WHO-EORTC classification for cutaneous lymphomas

Willemze

Jaffe

Burg

et al. 2005

Blood

3,491

4,355

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Section: Discussionmentioning

confidence: 99%

WHO-EORTC classification for cutaneous lymphomas

Willemze

Jaffe

Burg

et al. 2005

Blood

3,491

4,355

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“…Similarly the suppressive effects of low dose cyclophosphamide or fludarabine on Treg cells might not selectively target Treg-like neoplastic T-cells vis-á-vis normal Treg cells [80][81][82]. At the present time, a non-myeloblative allogeneic bone marrow transplantation with the intent of generating a graft-versus-lymphoma effect may provide the best therapeutic option to gain long-term survival in these patients [83][84][85][86].…”

Section: Discussionmentioning

confidence: 97%

Expression of T-plastin, FoxP3 and other tumor-associated markers by leukemic T-cells of cutaneous T-cell lymphoma

Capriotti

Vonderheid

Thoburn

et al. 2008

Leukemia & Lymphoma

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Peripheral blood cells from 28 patients with leukemic cutaneous T-cell lymphoma including 25 patients with Sézary syndrome were evaluated for expression of regulatory T-cell-associated markers (FoxP3, CD25, CTLA-4, neurophilin-1), T-cell activation markers (CD28 and its ligands B7.1 and B7.2) and NK cell-associated markers (NKG2D and its ligands MicA and Mic-B) using real-time quantitative polymerase chain reaction. T-plastin served as a positive genetic marker, and its expression correlated to blood tumor burden. More than 90% of samples had transcripts for CD28 and Mic-B, but less than 30% of samples expressed FoxP3, CTLA-4 and CD25. Expression of Mic-B by neoplastic cells could provide another mechanism to inhibit anti-tumor immune responses. FoxP3 expression correlated with a poor prognosis. Although the underlying mechanisms accounting for this correlation remain unclear, the expression of the Foxp3 and CTLA-4 regulatory elements indicates that a subset of leukemic cases displays a regulatory T-cell phenotype.

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“…Indeed, the prior reports of durable remissions, with at least equivalent mortality rates, with 'full-intensity' conditioning incorporating total body irradiation (TBI), are compelling. [15][16][17][18] Thus, we would recommend that a TBI-based full-intensity allograft should still be considered in such patients. Nonetheless, one further strategy worthy of exploration may be planned auto-SCT for disease de-bulking, followed by reducedintensity allo-SCT, an approach that has proven promising in other diseases.…”

Section: Discussionmentioning

confidence: 99%

Graft-versus-lymphoma effect in refractory cutaneous T-cell lymphoma after reduced-intensity HLA-matched sibling allogeneic stem cell transplantation

Herbert

Spencer

Grigg

et al. 2004

Bone Marrow Transplant

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Summary:Cutaneous T-cell lymphomas (CTCL) are rare diseases that, in their advanced stages or in transformation, have a poor prognosis. Autologous stem cell transplantation (Au-SCT) after high-dose therapy has yielded disappointing results. Allogeneic transplantation (allo-SCT) provides the potential advantage of an immune-mediated graftversus-lymphoma (GVL) effect. Reduced-intensity allo-SCT potentially offers a GVL effect, but with diminished toxicity related to the induction regimen; however, published experience with this approach in CTCL is limited. We report a series of three patients (age 35-49) with advanced, refractory (n ¼ 2) or transformed (n ¼ 1) CTCL who underwent reduced-intensity allo-SCT in the context of active disease. All three survived the peritransplant period and, despite later having disease relapse, all exhibited evidence of a GVL effect. Relapses of the disease were in the context of immune suppression for graft-versus-host disease (GVHD), and when immune suppression was reduced, responses were regained. A comparison is made of these results to those in a review of the published literature to date. We conclude that while a GVL can be achieved for CTCL with reduced-intensity allogeneic transplantation, the clinical benefits are short lived and novel approaches are required to obtain sustained remissions.

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Long-term Remission After Allogeneic Hematopoietic Stem Cell Transplantation for Refractory Cutaneous T-Cell Lymphoma

Cited by 78 publications

References 17 publications

WHO-EORTC classification for cutaneous lymphomas

WHO-EORTC classification for cutaneous lymphomas

Expression of T-plastin, FoxP3 and other tumor-associated markers by leukemic T-cells of cutaneous T-cell lymphoma

Graft-versus-lymphoma effect in refractory cutaneous T-cell lymphoma after reduced-intensity HLA-matched sibling allogeneic stem cell transplantation

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