Allogeneic Hematopoietic Stem Cell Transplantation in Advanced Stage Mycosis Fungoides and Sézary Syndrome

A Concise Review

William T. Johnson; Reetu Mukherji; Saritha Kartan; Neda Nikbakht; Pierluigi Porcu; Onder Alpdogan


Chin Clin Oncol. 2019;8(1) 

In This Article

Our Recommendations for HSCT for Advanced Stage CTCL

  1. We agree with the recommendations from the NCCN, EORTC and the ASBMT of including HSCT as a treatment option for advanced stage, relapsed or refractory CTCL;

  2. We agree with their recommendations to not offer HSCT in early stage (IA–IIA) CTCL and we also agree the strong recommendation against autologous stem cell transplant for CTCL in any clinical setting;

  3. While the optimal timing of HSCT transplant (1st line, 2nd line or greater) has yet to be determined, we recommend early consultation in transplant eligible patients. This recommendation is based on the data showing increased OS and decreased REL when HSCT is utilized as an earlier treatment option and before progression to LCT;

  4. We have shown convincing data supporting the use of RIC over MAC in improving NRM with equivocal efficacy, and we recommend a RIC conditioning regimen in all eligible patients. Minimal disease burden at time of transplant, while showing better ORR rates in some studies, has not been consistent in the literature. Additionally, the now well recognized graft-versus-lymphoma effect negates the need for strict CR prior to transplant;

  5. The use of TBSEBT has been successful in the MD Anderson cohort, but others have reported severe cutaneous toxicities. In patients with significant skin involvement we do recommend this as an option;

  6. Keeping with the graft-versus-lymphoma effect, we consider that T-cell depletion is not necessary in this patient population. On the other hand, the incidence and severity of GVHD has been decreased with T-cell depletion. GVHD is all but universal; however, with better understanding of the GVHD process and better treatments, this complication has become more manageable.