title: 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.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hematology, ICO-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain. rduarte@iconcologia.net
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Duarte
authors.forename: Carmen
authors.initials: C
authors.lastname: Canals
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.forename: Ian H
authors.initials: IH
authors.lastname: Gabriel
authors.forename: Reyes
authors.initials: R
authors.lastname: Arranz
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Augustin
authors.initials: A
authors.lastname: Ferrant
authors.forename: Guido
authors.initials: G
authors.lastname: Kobbe
authors.forename: Franco
authors.initials: F
authors.lastname: Narni
authors.forename: Giorgio Lambertenghi
authors.initials: GL
authors.lastname: Deliliers
authors.forename: Eduardo
authors.initials: E
authors.lastname: Olavarría
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods; D016208:Databases, Factual / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009182:Mycosis Fungoides / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012751:Sezary Syndrome / Q000473:pathology / Q000601:surgery*; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult