Total skin electron beam and non-myeloablative allogeneic hematopoietic stem-cell transplantation in advanced mycosis fungoides and Sezary syndrome.

Abstract

PURPOSE:

Transformed mycosis fungoides (MF) and Sézary syndrome (SS) are currently incurable. We studied the safety and efficacy of total skin electron beam with allogeneic hematopoietic stem-cell transplantation (HSCT) in patients with cutaneous T-cell lymphoma (CTCL).

PATIENTS AND METHODS:

Nineteen patients with advanced CTCL (median age, 50 years; four prior therapies) underwent total skin electron beam radiation followed by allogeneic HSCT between July 2001 and July 2008. Sixteen patients were conditioned with fludarabine (125 mg/m(2)) and melphalan (140 mg/m(2)) plus thymoglobulin (for mismatched donors). Graft-versus-host disease (GVHD) prophylaxis was with tacrolimus/mini methotrexate.

RESULTS:

Eighteen patients experienced engraftment, and one died as a result of sepsis on day 16. Median time to recovery of absolute neutrophil count (ANC) was 12 days. Fifteen achieved full donor chimerism, 12 had acute GVHD, and 12 were treated for chronic GVHD. The overall intent-to-treat response was 68%, and the complete response rate was 58%. Four of six patients died in complete remission as a result of bacterial sepsis (n = 2), chronic GVHD and fungal infection (n = 1), or lung cancer (n = 1); only two died as a result of progressive disease. Eight experienced relapse in skin; five regained complete response with reduced immunosuppression or donor lymphocyte infusions. Eleven of 13 are currently in complete remissions, with median follow-up of 19 months (range, 1.3 to 8.3 years). Median overall survival has not been reached.

CONCLUSION:

Total skin electron beam followed by allogeneic stem-cell transplantation merits additional evaluation for a selected group of patients with refractory, advanced, cutaneous T-cell lymphoma with evidence for graft-versus-tumor effect.

• Authors: Madeleine Duvic, Michele Donato, Bouthaina Dabaja, Heather Richmond, Lotika Singh, Wei Wei, Sandra Acholonu, Issa Khouri, Richard Champlin, Chitra Hosing
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 14 Pg. 2365-72 (May 10 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20351328 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal
• Antilymphocyte Serum
• Immunosuppressive Agents
• Myeloablative Agonists
• thymoglobulin
• Vidarabine
• fludarabine
• Melphalan
• Tacrolimus
• Methotrexate

Topics

• Adult
• Antibodies, Monoclonal (therapeutic use)
• Antilymphocyte Serum
• Disease Progression
• Disease-Free Survival
• Female
• Graft vs Host Disease (etiology, prevention & control)
• Graft vs Tumor Effect
• Hematopoietic Stem Cell Transplantation (adverse effects, mortality)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kaplan-Meier Estimate
• Male
• Melphalan (therapeutic use)
• Methotrexate (therapeutic use)
• Middle Aged
• Mycosis Fungoides (immunology, mortality, radiotherapy, surgery)
• Myeloablative Agonists (therapeutic use)
• Recurrence
• Sezary Syndrome (immunology, mortality, radiotherapy, surgery)
• Tacrolimus (therapeutic use)
• Time Factors
• Transplantation Chimera
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Treatment Outcome
• Vidarabine (analogs & derivatives, therapeutic use)
• Whole-Body Irradiation
• Young Adult