title: Skin Recurrence of Transformed Mycosis Fungoides Postumbilical Cord Blood Transplant despite Complete Donor Chimerism.
abstract: Background. Allogeneic stem cell transplant is the treatment of choice for systemic cutaneous T-cell lymphoma (CTCL) which provides graft-versus-lymphoma effect. Herein we discuss a case of recurrence of CTCL skin lesions after cord blood transplant in a patient who continued to have 100% donor chimerism in bone marrow. Case Presentation. A 48-year-old female with history of mycosis fungoides (MF) presented with biopsy proven large cell transformation of MF. PET scan revealed multiple adenopathy in abdomen and chest suspicious for lymphoma and skin biopsy showed large cell transformation. She was treated with multiple cycles of chemotherapy. Posttherapy PET scan showed resolution of lymphadenopathy. Later she underwent ablative preparative regimen followed by single cord blood transplant. Bone marrow chimerism studies at day +60 after transplant showed 100% donor cells without presence of lymphoma. However 5 months after transplant she had recurrence of MF with the same genotype as prior skin lesion. Bone marrow chimerism study continued to show 100% donor cells. Conclusion. A differential graft-versus-lymphoma effect in our case prevented lymphoma recurrence systemically but failed to do so in skin. We hypothesize that this response may be due to presence of other factors in the bone marrow and lymph node microenvironments preventing recurrence in these sites.
authors.affiliation: Department of Internal Medicine, University of Kansas Medical Center, Mailstop 2027, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
authors.forename: Rahul
authors.identifier: 0000-0002-9347-0129
authors.initials: R
authors.lastname: Pawar
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Anup
authors.initials: A
authors.lastname: Kasi Loknath Kumar
authors.affiliation: Division of Pathology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
authors.forename: Janet
authors.identifier: 0000-0002-0949-2836
authors.initials: J
authors.lastname: Woodroof
authors.affiliation: Division of Pathology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Joseph
authors.identifier: 0000-0002-0539-4796
authors.initials: J
authors.lastname: McGuirk
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Abhyankar
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Sid
authors.initials: S
authors.lastname: Ganguly
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Anurag
authors.identifier: 0000-0003-1114-9508
authors.initials: A
authors.lastname: Singh
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Tara
authors.identifier: 0000-0002-0242-6449
authors.initials: T
authors.lastname: Lin
authors.affiliation: Division of Hematology and Oncology, University of Kansas Medical Center, 2330 Shawnee Mission Parkway, Westwood, KS 66205, USA.
authors.forename: Omar
authors.identifier: 0000-0001-8106-1152
authors.initials: O
authors.lastname: Aljitawi