Stem Cell Transplantation for Cutaneous Stem Cell Lymphomas – pro
Cutaneous T-cell lymphoma (CTCL) is classified as an indolent hematologic malignancy with distinct clinicopathologic features. Although prognosis varies depending on the stage, patients who have cutaneous tumor, lymph node or visceral involvement, or peripheral blood involvement (Sézary syndrome) generally have a poor outcome. Evidence for stem cell transplantation, both autologous and allogeneic is on the level of case reports. Experts agree that more investigation is needed.
For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin diftitox (Ontak), and single-agent chemotherapy. Combination therapies can be used when single agents fail or when patients have advanced or progressive disease. For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin diftitox (Ontak), and single-agent chemotherapy. Combination therapies can be used when single agents fail or when patients have advanced or progressive disease.
Evidence for stem cell transplantation, both autologous and allogeneic is on the level of case reports. Experts agree that more investigation is needed.
In 2012, the Cochrane team attempted to review available evidence to compose a guideline. They found 2077 citations but none were relevant randomised controlled trials. All 41 studies that were thought to be potentially suitable were excluded after full text screening for being non-randomised, not including CTCL or being review articles.They say in the conclusion section: “We planned to report evidence from genetically or non-genetically randomised controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, no randomised trials addressing this question were identified. Nevertheless, prospective genetically randomised controlled trials need to be initiated to evaluate the precise role of alloSCT in advanced CTCL.”
The NCCN on p. MFSS-7 does say” “Consider non-ablative allogeneic transplant as appropriate”. A note “aa” says: ” The role of allogeneic transplant is controversial. See discussion for further details”. This discussion is found on page MS – 130. It says that allogenic SCT has been reported in case reports and small series in patients with advanced MF and SS. It references a a a meta-analysis that compares allogeneic and autologous transplant and concludes that additional study in high-risk patients with advanced diseases is warranted. The rationale for lukewarmly recommending non-ablative approach is probably to reduce toxicity.
Y. Oyama, J. Guitart, T. Kuzel, R. Burt, S. RosenHigh-dose therapy and bone marrow transplantation in cutaneous T-cell lymphoma. Hematology/Oncology Clinics of North America, Volume 17, Issue 6, Pages 1475-1483, 2003. Whittaker SJ, Marsden JR, Spittle M, Russell Jones R. Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomas. Br J Dermatol 2003 Dec;149(6):1095-107. [67 references
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