Allogeneic Hematopoietic Cell Transplantation for Patients With Mycosis Fungoides and Sézary Syndrome: A Retrospective Analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
- 10 October 2010
- journal article
- research article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 28 (29), 4492-4499
- https://doi.org/10.1200/jco.2010.29.3241
Abstract
Purpose: To analyze the outcome of allogeneic transplantation for mycosis fungoides and Sézary syndrome (MF/SS) in terms of nonrelapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) and to identify factors associated with the outcome. Patient and Methods: Sixty patients with MF (n = 36) and SS (n = 24) who received a first allogeneic hematopoietic cell transplantation (HCT) from a matched related (mRD; n = 45) or unrelated donor (mUD; n = 15) between 1997 and 2007 and who were registered in the European Group for Blood and Marrow Transplantation database were analyzed: 37 men and 23 women, median age 46.5 years (range, 22 to 66 years). Forty-four patients had TNM stage IV, and 40 patients were at advanced phase at transplantation. Forty-four patients received reduced-intensity conditioning (RIC) regimens, and 25 underwent T-cell depletion (TCD). Results: Allogeneic transplantation in MF/SS offers an estimated OS of 66% at 1 year and 54% at 3 years, primarily driven by donor type, disease phase, and type of conditioning. RIC decreased NRM (relative risk [RR] = 4.7; P = .008) without increasing REL, leading to a higher OS (RR = 2.8; P = .03). Advanced-phase disease increases REL (RR = 3.0; P = .03) and reduces PFS (RR = 4.4; P = .002) and OS (RR = 3.5; P = .023). Recipients of mRD allogeneic HCT had better PFS (RR = 2.7; P = .006) and OS (RR = 4.0; P = .001) than their mUD counterparts. The risk of REL increases with TCD (RR = 3.2; P = .005). Some patients who experience relapse can successfully undergo rescue treatment with donor lymphocyte infusions. Conclusion: Allogeneic transplantation is a valid therapeutic alternative for high-risk patients with advanced-stage MF/SS. Our data also suggest the existence of a clinically relevant graft-versus-lymphoma effect in MF/SS.This publication has 23 references indexed in Scilit:
- Cutaneous lymphoma incidence patterns in the United States: a population-based study of 3884 casesBlood, 2009
- Long-term outcomes of patients with advanced-stage cutaneous T-cell lymphoma and large cell transformationBlood, 2008
- Primary cutaneous lymphoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-upAnnals of Oncology, 2008
- Review of the Treatment of Mycosis Fungoides and Sézary Syndrome: A Stage-Based ApproachJournal of the National Comprehensive Cancer Network, 2008
- Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)Blood, 2007
- EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndromeEuropean Journal of Cancer, 2006
- WHO-EORTC classification for cutaneous lymphomasBlood, 2005
- Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomasBritish Journal of Dermatology, 2003
- Twenty-year trends in the reported incidence of mycosis fungoides and associated mortality.American Journal of Public Health, 1999
- Mycosis fungoides and Sezary syndrome [see comments]Blood, 1996