LP-02. Efficacy of allogeneic hematopoietic cell transplantation in cutaneous T-cell lymphomas
Liliya G. Gorenkova, Larisa A. Kuzmina, Yana K. Mangasarova, Evgenii E. Zvonkov, Elena N. Parovichnikova
National Medical Research Center for Hematology, Moscow, Russia
Contact: Dr. Liliya G. Gorenkova, e-mail: l.aitova@mail.ru
Summary
There is a rare group of non-Hodgkin lymphomas characterized by neoplastic skin infiltration. Among them, mycosis fungoides is more common disorder (over 50%), whereas Sezary syndrome is much less common. On average, no more than 10 new cases of cutaneous lymphomas are diagnosed per year. Treatment at the early stages of the disease is limited to usage of local therapies. However, the treatment of advanced stages of mycosis fungoides and Sezary syndrome still presents the main challenge. Systemic approaches, e.g., therapy with recombinant interferons, histone deacetylase inhibitors, monoclonal antibodies, and chemotherapy, do not always provide long-term results. Continuous tumor growth during treatment or large cell transformation often lead to unfavorable outcomes. The median survival term for such patients is 11 months.
Results
According to a systematic meta-analysis based on 5 studies, allogeneic hematopoietic cell transplantation (allo-HCT) has demonstrated potential effectiveness in advanced stages of the disease. Pooled overall survival (OS) and progression-free survival (PFS) rates were 59% and 36%, respectively. The pooled relapse rate was 47%, and the pooled non-relapse mortality rate was 19%. At the National Medical Hematology Research Center, allo-HCT was performed in 7 patients with cutaneous T-cell lymphomas, including mycosis fungoides and Sezary syndrome. Two patients experienced disease relapse, but local therapy successfully reduced the disease stage. The median follow-up after allo-HCT was 74 months, and the 5-year OS and PFS rates were 71% and 57%, respectively.
Conclusion
The results of systematic review and our clinical experience show that allo-HCT may be associated with encouraging OS and PFS rates. However, the disease status and progression at the time of allo-HCT and relapse remain the main causes of treatment failure. For young patients with advanced stages of the disease and ineffectiveness of systemic therapy, one may consider allo-HCT before the development of resistant disease. Moreovery, usage of post-transplant maintenance therapy is suggested in order to reduce the risk of relapse.
Keywords
Skin lymphoma, cutaneous lymphomas, treatment, advanced stages, allogeneic hematopoietic cell transplantation, mycosis fungoides, Sezary syndrome.
