Stem Cell Transplantation for Cutaneous Stem Cell Lymphomas
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.
Cutaneous T-cell lymphoma (CTCL) is slowly progressing lymphoma that has unique features. It primarily affects the skin but is also present in the blood and can spread. Although prognosis varies depending on the stage, patients who have skin tumors, lymph node or visceral involvement, or blood involvement (Sézary syndrome) generally have a poorer outcome.
For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin (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 before it is widely accepted.
In 2012, the Cochrane team attempted to review available literature evidence to compose a guideline. They found 2077 citations but none were randomized controlled trials. All 41 studies that were thought to be potentially suitable were excluded after full text screening for being non-randomized, not including the condition CTCL or being review articles and not original research. The Cochrane team says in the conclusion section: “We planned to report evidence from genetically or non-genetically randomized controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, no randomized trials addressing this question were identified. Nevertheless, prospective genetically randomized 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 allogeneic SCT has been reported in case reports and small series in patients with advanced MF and SS. It references 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.
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