Allogeneic Stem Cell Transplants May Be Best Option for Cutaneous T-
Cell Lymphomas
Two recent reviews suggest that allogeneic stem cell transplants may
be curative for a significant fraction of patients with cutaneous T-
cell lymphomas (CTCL) such as mycosis fungoides/Sezary syndrome.
Mycosis fungoides and Sezary syndrome are the most common forms of
CTCL. Sezary syndrome has a leukemic form involving circulating
Sezary cells. Mycosis fungoides can also evolve to a tumor stage with
involvement of lymph nodes. Survival is determined by stage of the
disease and some patients with localized disease can survive for
decades while patients with systemic disease have an average survival
of 3-4 years. Treatment consists of both topical and systemic
therapies. Treatment modalities include psoralen and ultraviolet A
radiation (PUVA), interferon alfa, local radiation therapy, electron
beam therapy, bexarotene, topical chemotherapy, extracorporeal
photochemotherapy, bexarotene, dinileukin diftitox, alemtuzumab, and
the usual chemotherapy given for non-Hodgkin'
none of these therapies are curative. High-dose chemotherapy with
autologous stem cell support is feasible in patients with CTCL, and
there is evidence of significant palliation but most, if not all,
patients ultimately relapse. One potentially curative approach to
refractory disease is an allogeneic stem cell transplant. However,
allogeneic stem cell transplantation with intensive regimens is
associated with a high treatment related mortality and data on
allogeneic stem cell transplants with reduced intensity regimens is
limited due to the rarity of this disease.
Researchers from Barcelona recently reviewed the literature on
autologous and allogeneic stem cell transplantation for primary
cutaneous T-cell lymphoma.1 They reported that high-dose chemotherapy
with autologous stem cell transplantation induced complete remissions
but most patients relapsed. In contrast, they reported that two-
thirds of allogeneic recipients were in long-term complete remission
at 3 years. These results are attributed to a graft-versus lymphoma
(GVL) effect.
A second review by researchers from the University of Pennsylvania
concluded that allogeneic stem cell transplantation deserved further
consideration as curative therapy for patients with cutaneous T-cell
lymphoma.2 The authors described a case report of a patient who
achieved a sustained complete response after an allogeneic stem cell
transplant from an HLA matched sibling despite having 99% lymphoma in
the peripheral blood.
The largest series of patients undergoing autologous or allogeneic
stem cell transplant for T-cell lymphomas (not exclusively cutaneous
T-cell lymphomas) was reported by the ABMTRR.3 The 3 year overall and
progression-
transplant in 64 patients. Eighteen patients received an allogeneic
stem cell transplant with a e year overall and progression-
survival of 39%.
Comments: CTCL in advanced stages is a disease with a very poor
prognosis. Autologous stem cell transplantation can produce complete
remissions but relapses appear to occur in most cases. Results could
possibly be improved by improved pre and post-transplant therapies
and would be the treatment of choice for older patients or those with
significant co-morbidities. Allogeneic stem cell transplants need to
be further investigated, especially with reduced intensity regimens
in older patients with co-morbidities. It would appear that a GVL
effect may be necessary for true cure of CTCL.
Related News:
Interleukin 12 Active in Mycosis Fungoides (11/07/2006)
Campath® Alemtuzumab) Effective in Patients with Mycosis
Fungoides/Sezary Syndrome who have Failed Previous Therapy
(05/27/2003)
Reference:
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1 Duarte RF, Schmitz N, Servitje O, et al. Haematopoietic stem cell
transplantation for patients with primary cutaneous T-cell lymphoma.
Bone Marrow Transplantation. 2008; Epub ahead of print on January 7,
2008.
2 Introcaso CE, Leber B, Greene K, et al. Stem cell transplantation
in advanced cutaneous T-cell lymphoma. Journal of the Academy of
Dermatology. 2008;Epub ahead of print on February 5, 2008.
3 Fegler S, Prince HM, Pearce R, et al. The role of high-dose therapy
and stem cell rescue in the management of T-cell malignant lymphomas:
a BSBMT and ABMTRR study. Bone Marrow Transplantation. 2007;40:443-
450.
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These materials may discuss uses and dosages for therapeutic products
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before administering any drug, therapy or treatment discussed herein.
Neither the editors nor the publisher accepts any responsibility for
the accuracy of the information or consequences from the use or
misuse of the information contained herein.
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