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.
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.
Duarte
Rafael F
RF
Department of Hematology, ICO-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain. rduarte@iconcologia.net
Canals
Carmen
C
Onida
Francesco
F
Gabriel
Ian H
IH
Arranz
Reyes
R
Arcese
William
W
Ferrant
Augustin
A
Kobbe
Guido
G
Narni
Franco
F
Deliliers
Giorgio Lambertenghi
GL
Olavarría
Eduardo
E
Schmitz
Norbert
N
Sureda
Anna
A
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