Peripheral Stem Cell Transplant

Autologous and allogeneic stem cell transplantation (SCT) is a well-established treatment option for various hematologic diseases, though there is limited experience in CTCL. A few retrospective studies have reported on autologous SCT leading to complete remissions in the majority of patients treated; however, most patients relapse rapidly.8081 The duration of remission does not seem to be related to stage of the disease or absence of a detectable T-cell clone in the harvest.82 However, it is now suggested that a greater T-cell depletion of the harvest may be associated with a greater risk of rapid relapse, perhaps by compromising the immune antitumor response.8283

Allogeneic transplants are known to achieve more durable complete remissions, most likely due to an immunologic graft-versus-lymphoma effect. Response durations as long as 6 years posttransplant have been reported, suggesting that it may be a curative option.84 It does, however, carry a higher risk of treatment-related mortality, including life-threatening infections and graft-versus-host disease (GVHD). Molina et al. followed six patients with advanced and refractory MF/SS who received donor-related allogeneic SCT (four patients) and donor-unrelated SCT (two patients).85 All patients achieved a CR, with mild GVHD. Five patients remained disease free from 3 to 65 months posttransplant, and one patient died of GVHD 16 months posttransplant. Guitart et al. reported on allogeneic SCT therapy in patients with advanced stages of MF/SS who had not responded to standard treatment options.86 A sustained CR was achieved in two patients with disease-free duration time of 15 months and 41i2 years, respectively, post-transplant. There was no evidence of GVHD. One patient with advanced and refractory stage IVA and large cell transformation on histology relapsed after 9 months with limited cutaneous recurrence and remained alive more than 6 years posttransplant.

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