title: Allogeneic stem cell transplantation for advanced cutaneous T-cell lymphomas: a study from the French Society of Bone Marrow Transplantation and French Study Group on Cutaneous Lymphomas.
abstract: The treatment of advanced stage primary cutaneous T-cell lymphomas remains challenging. In particular, large-cell transformation of mycosis fungoides is associated with a median overall survival of two years for all stages taken together. Little is known regarding allogeneic hematopoietic stem cell transplantation in this context. We performed a multicenter retrospective analysis of 37 cases of advanced stage primary cutaneous T-cell lymphomas treated with allogeneic stem cell transplantation, including 20 (54%) transformed mycosis fungoides. Twenty-four patients (65%) had stage IV disease (for mycosis fungoides and Sézary syndrome) or disseminated nodal or visceral involvement (for non-epidermotropic primary cutaneous T-cell lymphomas). After a median follow up of 29 months, 19 patients experienced a relapse, leading to a 2-year cumulative incidence of relapse of 56% (95%CI: 0.38-0.74). Estimated 2-year overall survival was 57% (95%CI: 0.41-0.77) and progression-free survival 31% (95%CI: 0.19-0.53). Six of 19 patients with a post-transplant relapse achieved a subsequent complete remission after salvage therapy, with a median duration of 41 months. A weak residual tumor burden before transplantation was associated with increased progression-free survival (HR=0.3, 95%CI: 0.1-0.8; P=0.01). The use of antithymocyte globulin significantly reduced progression-free survival (HR=2.9, 95%CI: 1.3-6.2; P=0.01) but also transplant-related mortality (HR=10(-7), 95%CI: 4.10(-8)-2.10(-7); P<0.001) in univariate analysis. In multivariate analysis, the use of antithymocyte globulin was the only factor significantly associated with decreased progression-free survival (P=0.04). Allogeneic stem cell transplantation should be considered in advanced stage primary cutaneous T-cell lymphomas, including transformed mycosis fungoides.
authors.affiliation: martine.bagot@sls.aphp.fr.
authors.forename: Adèle
authors.initials: A
authors.lastname: de Masson
authors.forename: Marie
authors.initials: M
authors.lastname: Beylot-Barry
authors.forename: Jean-David
authors.initials: JD
authors.lastname: Bouaziz
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: François
authors.initials: F
authors.lastname: Aubin
authors.forename: Sylvain
authors.initials: S
authors.lastname: Garciaz
authors.forename: Michel
authors.initials: M
authors.lastname: d'Incan
authors.forename: Olivier
authors.initials: O
authors.lastname: Dereure
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dalle
authors.forename: Anne
authors.initials: A
authors.lastname: Dompmartin
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.forename: Maxime
authors.initials: M
authors.lastname: Battistella
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Vignon-Pennamen
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Rivet
authors.forename: Henri
authors.initials: H
authors.lastname: Adamski
authors.forename: Pauline
authors.initials: P
authors.lastname: Brice
authors.forename: Sylvie
authors.initials: S
authors.lastname: François
authors.forename: Séverine
authors.initials: S
authors.lastname: Lissandre
authors.forename: Pascal
authors.initials: P
authors.lastname: Turlure
authors.forename: Ewa
authors.initials: E
authors.lastname: Wierzbicka-Hainaut
authors.forename: Eolia
authors.initials: E
authors.lastname: Brissot
authors.forename: Rémy
authors.initials: R
authors.lastname: Dulery
authors.forename: Sophie
authors.initials: S
authors.lastname: Servais
authors.forename: Aurélie
authors.initials: A
authors.lastname: Ravinet
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.forename: Saskia
authors.initials: S
authors.lastname: Ingen-Housz-Oro
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Martine
authors.initials: M
authors.lastname: Bagot
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult