Long Term Outcomes of Nonmyeloablative Allogeneic Stem Cell Transplantation with TSEB TLI and ATG for Mycosis Fungoides and Sezary Syndrome

Overview

Journal Bone Marrow Transplant

Specialty General Surgery

Date 2024 Mar 13

PMID 38472408

Authors

S L Morris

B R Thomas

R Palanicawandar

S Whittaker

F Child

M Wain

V Sim

R Szydlo

S Mangar

E Olavarria

S Lozano Cerrada

A Muzamil

E Kanfer

Affiliations

Soon will be listed here.

Abstract

Advanced stage (IIB-IVB) Mycosis Fungoides (MF) and Sezary Syndrome (SS) have a poor prognosis with median survival <5 years. We report long-term outcomes of a non-myeloablative allogeneic stem cell transplantation regimen consisting of total skin electron beam therapy, total lymphoid irradiation and antithymocyte globulin. Our prospective cohort consisted of 41 patients with a higher proportion of MF (34MF, 7SS). Acute GVHD Grade 2 to 4 was seen in 31.7% and chronic GVHD Grade 2 to 4 in 24%. The cumulative incidence of non-relapse mortality was 9.8% at 1 year and 12.6% at 2 years. At Day +90 post-transplant 66% of patients had a complete response (CR). With a median post-transplant follow up of 5.27 years, the 5-year overall survival rate was 37.7% (MF 36.7%, SS 57.1%). The 5-year cumulative incidence of progressive disease or relapse was 52.7% in all patients but only 20.8% in those with CR at transplant compared to 70.6% in those not in CR at transplant (p = 0.006). Long term survival is possible in advanced MF and SS with non-myeloablative transplantation and outcomes are improved in patients with CR at transplant.

References

Agar N, Wedgeworth E, Crichton S, Mitchell T, Cox M, Ferreira S . Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal. J Clin Oncol. 2010; 28(31):4730-9. DOI: 10.1200/JCO.2009.27.7665. View

Duvic M, Donato M, Dabaja B, Richmond H, Singh L, Wei W . Total skin electron beam and non-myeloablative allogeneic hematopoietic stem-cell transplantation in advanced mycosis fungoides and Sezary syndrome. J Clin Oncol. 2010; 28(14):2365-72. DOI: 10.1200/JCO.2009.25.8301. View

Duarte R, Canals C, Onida F, Gabriel I, Arranz R, Arcese W . 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. J Clin Oncol. 2010; 28(29):4492-9. DOI: 10.1200/JCO.2010.29.3241. View

de Masson A, Beylot-Barry M, Bouaziz J, Peffault de Latour R, Aubin F, Garciaz S . 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. Haematologica. 2013; 99(3):527-34. PMC: 3943317. DOI: 10.3324/haematol.2013.098145. View

Hosing C, Bassett R, Dabaja B, Talpur R, Alousi A, Ciurea S . Allogeneic stem-cell transplantation in patients with cutaneous lymphoma: updated results from a single institution. Ann Oncol. 2015; 26(12):2490-5. PMC: 4855245. DOI: 10.1093/annonc/mdv473. View

Samimi S, Benoit B, Evans K, Wherry E, Showe L, Wysocka M . Increased programmed death-1 expression on CD4+ T cells in cutaneous T-cell lymphoma: implications for immune suppression. Arch Dermatol. 2010; 146(12):1382-8. PMC: 4467572. DOI: 10.1001/archdermatol.2010.200. View

Weng W, Arai S, Rezvani A, Johnston L, Lowsky R, Miklos D . Nonmyeloablative allogeneic transplantation achieves clinical and molecular remission in cutaneous T-cell lymphoma. Blood Adv. 2020; 4(18):4474-4482. PMC: 7509879. DOI: 10.1182/bloodadvances.2020001627. View

Morris S, McGovern M, Bayne S, Wain M, Child F, Whittaker S . Results of a 5-week schedule of modern total skin electron beam radiation therapy. Int J Radiat Oncol Biol Phys. 2013; 86(5):936-41. DOI: 10.1016/j.ijrobp.2013.04.042. View

Morris S, Scarisbrick J, Frew J, Irwin C, Grieve R, Humber C . The Results of Low-Dose Total Skin Electron Beam Radiation Therapy (TSEB) in Patients With Mycosis Fungoides From the UK Cutaneous Lymphoma Group. Int J Radiat Oncol Biol Phys. 2017; 99(3):627-633. DOI: 10.1016/j.ijrobp.2017.05.052. View

10.

Olsen E, Whittaker S, Kim Y, Duvic M, Prince H, Lessin S . Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of.... J Clin Oncol. 2011; 29(18):2598-607. PMC: 3422534. DOI: 10.1200/JCO.2010.32.0630. View

11.

Benton E, Crichton S, Talpur R, Agar N, Fields P, Wedgeworth E . A cutaneous lymphoma international prognostic index (CLIPi) for mycosis fungoides and Sezary syndrome. Eur J Cancer. 2013; 49(13):2859-68. DOI: 10.1016/j.ejca.2013.04.018. View

12.

de Masson A, Beylot-Barry M, Ram-Wolff C, Mear J, Dalle S, DIncan M . Allogeneic transplantation in advanced cutaneous T-cell lymphomas (CUTALLO): a propensity score matched controlled prospective study. Lancet. 2023; 401(10392):1941-1950. DOI: 10.1016/S0140-6736(23)00329-X. View

13.

Gilson D, Whittaker S, Child F, Scarisbrick J, Illidge T, Parry E . British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol. 2018; 180(3):496-526. DOI: 10.1111/bjd.17240. View