1
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Atilla PA, Atilla E. Are we there yet? cellular therapies for cutaneous T cell lymphoma. Curr Res Transl Med 2023; 71:103390. [PMID: 37062252 DOI: 10.1016/j.retram.2023.103390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
Cutaneous T cell lymphomas (CTCLs) are a heterogenous group of skin-involved T-cell non-Hodgkin lymphoma which Mycosis Fungoides and Sezary Syndrome are the most common variants. Despite considerable progress in distinguishing the pathophysiology, the treatment options are still limited for advanced-stage disease. Recent approval of novel agents such as vorinostat, brentuximab vedotin and mogamulizumab paved a way. Allogeneic hematopoietic stem cell transplantation has been shown to be a feasible option in selected advanced-stage CTCL patients. Chimeric antigen receptor (CAR) T cells have been promising for the treatment of B-cell tumors and have been approved for second-line treatment in non-Hodgkin's lymphoma. Although several obstacles still need to be addressed, CAR T cell treatment for CTCLs seems not far off. This review discusses new discoveries in pathophysiology, the state of cellular therapies in current practice, challenges for cellular treatment in advanced CTCL, and how to overcome these challenges.
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Affiliation(s)
- Pinar Ataca Atilla
- Ankara University Stem Cell Institute, Ankara, Turkey; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | - Erden Atilla
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA; Genyo Centre for Genomics and Oncological Research, Genomic Medicine Department, Pfizer/University of Gradana/Andalusian Regional Government, Health Sciences Technnology Park, Granada, Spain.
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2
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Singh V, Kim S, Deol A, Uberti JP, Modi D. Allogeneic hematopoietic stem cell transplantation in T-cell lymphoma: a Meta-Analysis. Leuk Lymphoma 2021; 63:855-864. [PMID: 34866528 DOI: 10.1080/10428194.2021.1999438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
T-cell lymphoma (TCL) poses a therapeutic challenge. Allogeneic stem cell transplant (alloSCT) is frequently offered in primary refractory disease or failed autologous transplant. We systematically searched published articles on outcomes of alloSCT in TCL through PubMed and EMBASE database between January 2000 and October 2019. Among 651 identified studies, 22 (888 patients) were included. Forty percent patients had peripheral T-cell lymphoma not otherwise specified, 15% had angioimmunoblastic T-cell lymphoma, 21% had anaplastic large cell lymphoma, 5% had cutaneous T-cell lymphoma, and 19% had other histologic subtypes. Thirty-six percent patients had relapsed/refractory disease. Myeloablative conditioning regimens were used in 55% patients. At two-, three- and five-year post-transplant, overall survival was 57, 54 and 51%, respectively; progression-free survival was 45, 50 and 45%, respectively; non-relapse mortality was 9, 29 and 29%, respectively; relapse rate was 30, 28 and 29%, respectively. Our study shows that alloSCT provides durable remission in T cell lymphoma.
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Affiliation(s)
- Vijendra Singh
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | - Seongho Kim
- Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Abhinav Deol
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | - Joseph P Uberti
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | - Dipenkumar Modi
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
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3
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Domingo-Domenech E, Duarte RF, Boumedil A, Onida F, Gabriel I, Finel H, Arcese W, Browne P, Beelen D, Kobbe G, Veelken H, Arranz R, Greinix H, Lenhoff S, Poiré X, Ribera JM, Thompson J, Zuckerman T, Mufti GJ, Cortelezzi A, Olavarria E, Dreger P, Sureda A, Montoto S. Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides and Sézary syndrome. An updated experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation. Bone Marrow Transplant 2021; 56:1391-1401. [PMID: 33420392 DOI: 10.1038/s41409-020-01197-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative treatment option in advanced-stage mycosis fungoides (MF) and Sézary syndrome (SS). This study presents an updated analysis of the initial experience of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation (EBMT) describing the outcomes after allo-HSCT for MF and SS, with special emphasis on the impact of the use of unrelated donors (URD). METHODS AND PATIENTS Eligible for this study were patients with advanced-stage MF or SS who underwent a first allo-HSCT from matched HLA-identical related or URD between January/1997 and December/2011. Sixty patients have been previously reported. RESULTS 113 patients were included [77 MF (68%)]; 61 (54%) were in complete or partial remission, 86 (76%) received reduced-intensity protocols and 44 (39%) an URD allo-HSCT. With a median follow up for surviving patients of 73 months, allo-HSCT resulted in an estimated overall survival (OS) of 38% at 5 years, and a progression-free survival (PFS) of 26% at 5 years. Multivariate analysis demonstrated that advanced-phase disease (complete remission/partial remission >3, primary refractory or relapse/progression in patients that had received 3 or more lines of systemic treatment prior to transplant or the number of treatment lines was not known), a short interval between diagnosis and transplant (<18 months) were independent adverse prognostic factors for PFS; advanced-phase disease and the use of URDs were independent adverse prognostic factors for OS. CONCLUSIONS This extended series supports that allo-HSCT is able to effectively rescue over one third of the population of patients with advanced-stage MF/SS. High relapse rate is still the major cause of failure and needs to be improved with better strategies before and after transplant. The negative impact of URD is a matter of concern and needs to be further elucidated in future studies.
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Affiliation(s)
- E Domingo-Domenech
- Hematology Department, Institut Català d'Oncologia. Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
| | - R F Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - A Boumedil
- EBMT Central Registry Office, Paris, France
| | - F Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS, Milano, Italy
| | - I Gabriel
- Department of Hematology, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - H Finel
- EBMT Central Registry Office, Paris, France
| | - W Arcese
- Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy
| | - P Browne
- St's James Hospital, Dublin, Ireland
| | - D Beelen
- University Hospital, Department of Bone Marrow Transplantation, Essen, Germany
| | - G Kobbe
- Heinrich Heine University, Medical F, Department of Hematology, Düsseldorf, Germany
| | - H Veelken
- Leiden University Medical Center, Leiden, The Netherlands
| | - R Arranz
- Hematology Department, Hospital La Princesa, Madrid, Spain
| | - H Greinix
- Division of Hematology, Medical University Graz, Graz, Austria
| | - S Lenhoff
- Skanes University Hospital, Department of Hematology, Lund, Sweden
| | - X Poiré
- Cliniques Universitaires St. Luc, Department of Hematology, Brussels, Belgium
| | - J M Ribera
- Hematology Department, Institut Català d'Oncologia, Josep Carreras Leukemia Research Institute, Badalona, Spain
| | - J Thompson
- Albert's Stem Cell Transplantation Center, Pretoria, South Africa
| | - T Zuckerman
- Ramban Medical Center, Department of Hematology and Bone Marrow Transplantation, Haifa, Israel
| | - G J Mufti
- GKT School of Medicine, Dept. of Haematological Medicine, King's Denmark Hill Campus, London, United Kingdom
| | - A Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS, Milano, Italy
| | - E Olavarria
- Department of Hematology, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - P Dreger
- Universitaetsklinkum Heidelberg, Heidelberg, Germany
| | - A Sureda
- Hematology Department, Institut Català d'Oncologia. Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - S Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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4
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Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas. Cancers (Basel) 2020; 12:cancers12102856. [PMID: 33023002 PMCID: PMC7601655 DOI: 10.3390/cancers12102856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Advanced-stage cutaneous T-cell lymphomas are aggressive diseases with frequent disease relapses and a reduced overall survival. Most treatment regimens fail to induce long-term remissions. Allogeneic hematopoietic stem cell transplantation has been associated with treatment-free long-term remissions and holds a potential for cure in this disease but is associated with frequent complications, mostly linked to the development of graft-versus-host disease and infections. Herein, we review the current evidence supporting the use of allogeneic stem cell transplantation in advanced-stage cutaneous T-cell lymphomas. Abstract Cutaneous T-cell lymphomas (CTCLs) are non-Hodgkin lymphomas that develop primarily in the skin. They account for almost 80% of primary cutaneous lymphomas. Epidermotropic CTCLs (mycosis fungoides (MF) and Sézary syndrome (SS)) are the most common form of CTCL. The course of the disease ranges from an indolent clinical behavior in early-stage disease to an aggressive evolution in the advanced stages. Advanced-stage disease is defined by the presence of tumors, erythroderma, or significant blood, nodal or visceral involvement. Advanced-stage disease is characterized by frequent disease relapses, refractory disease, a severely impaired quality of life and reduced overall survival. In the last twenty-five years, allogeneic hematopoietic stem cell transplantation (HSCT) has led to prolonged remissions in advanced CTCL, presumably linked to a graft-versus-lymphoma effect and is thus emerging as a potential cure of the disease. However, the high post-transplant relapse rate and severe morbidity and mortality associated with graft-versus-host disease and infections are important issues. Allogeneic HSCT is thus mostly considered in young patients with no comorbidities and an aggressive, advanced-stage CTCL. Allogeneic HSCT gives the best results in patients with a pre-transplant complete remission of the lymphoma. For this reason, one of the challenges is to define the best time to consider allogeneic HSCT in the disease course. Early identification of patients at high risk for progression is important to identify candidates who may benefit from allogeneic HSCT before their disease becomes treatment-refractory. This review describes the role of allogeneic HSCT in CTCL, summarizes the published data and future perspectives in this area.
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Dimitriou F, Schanz U, Nair G, Kimeswenger S, Brüggen MC, Hoetzenecker W, French LE, Dummer R, Cozzio A, Guenova E. Long-Term Disease Control After Allogeneic Hematopoietic Stem Cell Transplantation in Primary Cutaneous T-Cell Lymphoma; Results From a Single Institution Analysis. Front Med (Lausanne) 2020; 7:290. [PMID: 32714935 PMCID: PMC7344271 DOI: 10.3389/fmed.2020.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Allogeneic hematopoietic stem cell transplantation (alloHSCT) has been proposed as curative approach for advanced cutaneous T–cell lymphomas (CTCL). Currently, there is no established consensus for the management of disease relapse after alloHSCT. Results: Ten patients, previously treated with multiple lines of systemic treatment, received alloHSCT. Six patients had achieved partial response (PR, N = 5) and complete response (CR, N = 1) prior to HSCT. Post—HSCT, seven patients (N = 7) relapsed after a median time of 3.3 months (0.5–7.4 months) and were subsequently treated with radiotherapy (RT, N = 1), RT and adoptive T-cell transfer with EBV specific cells (N = 1), R-CHOP (N = 1) and interferon alpha−2a combined either with donor lymphocyte infusion (N = 1) or with brentuximab—vedotin (N = 1). One patient (N = 1) achieved PR only after reducing the immunosuppression. Two patients relapsed again and received interferon alpha−2a and brentuximab—vedotin, respectively. After a median follow-up time of 12.6 months (3.5–73.7 months) six patients were alive (60%) and four had deceased, three (N = 3) due to CTCL and one (N = 1) due to GVHD. Conclusion: Disease relapse after alloHSCT can be controlled with available treatments. For most patients who ultimately relapsed, reduction of immunosuppression and interferon alpha−2a either administered alone or in combination with another systemic agent were preferred. Although interferon alpha−2a, similarly to immunosuppression reduction, may be beneficial for the achievement of graft–vs.–lymphoma effect, the risk of simultaneous worsening of GVHD must be carefully evaluated and taken into consideration.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Urs Schanz
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Gayathri Nair
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital Linz, Linz, Austria.,Department of Soft Matter Physics, Institute for Experimental Physics, Johannes Kepler University, Linz, Austria
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Lars E French
- Department of Dermatology, University Hospital Munich (LMU), Munich, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Antonio Cozzio
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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6
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Iqbal M, Reljic T, Ayala E, Sher T, Murthy H, Roy V, Foran J, Tun H, Kumar A, Kharfan-Dabaja MA. Efficacy of Allogeneic Hematopoietic Cell Transplantation in Cutaneous T Cell Lymphoma: Results of a Systematic Review and Meta-Analysis. Biol Blood Marrow Transplant 2020; 26:76-82. [DOI: 10.1016/j.bbmt.2019.08.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/23/2019] [Accepted: 08/25/2019] [Indexed: 11/25/2022]
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7
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Hosoi H, Hatanaka K, Murata S, Mushino T, Kuriyama K, Nishikawa A, Hanaoka N, Tamura S, Nakakuma H, Sonoki T. Long-term complete remission of early hematological relapse after discontinuation of immunosuppressants following allogeneic transplantation for Sezary syndrome. Hematol Rep 2018; 10:7497. [PMID: 30283619 PMCID: PMC6151344 DOI: 10.4081/hr.2018.7497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/16/2018] [Accepted: 04/27/2018] [Indexed: 12/16/2022] Open
Abstract
Sezary syndrome (SS) is a leukemic form of cutaneous T-cell lymphoma and is chemo-resistant. Allogeneic hematopoietic stem cell transplantation is a promising therapy for SS; however, relapse is common. Therapeutic options after relapse have not been established. We managed an SS patient with hematological relapse within one month after transplantation. After discontinuation of immunosuppressants, she achieved complete remission and remained relapse-free. The chimeric analyses of Tcells showed that the full recipient type became complete donor chimera after immunological symptoms. This clinical course suggested that discontinuation of immunosuppressants may result in a graftversus- tumor effect, leading to the eradication of lymphoma cells.
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Affiliation(s)
- Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Kazuo Hatanaka
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Kodai Kuriyama
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Akinori Nishikawa
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Nobuyoshi Hanaoka
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Hideki Nakakuma
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
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8
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Virmani P, Zain J, Rosen ST, Myskowski PL, Querfeld C. Hematopoietic Stem Cell Transplant for Mycosis Fungoides and Sézary Syndrome. Dermatol Clin 2015; 33:807-18. [DOI: 10.1016/j.det.2015.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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9
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Skin Recurrence of Transformed Mycosis Fungoides Postumbilical Cord Blood Transplant despite Complete Donor Chimerism. Case Rep Hematol 2015; 2014:743856. [PMID: 25580315 PMCID: PMC4279116 DOI: 10.1155/2014/743856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/20/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Allogeneic stem cell transplant is the treatment of choice for systemic cutaneous T-cell lymphoma (CTCL) which provides graft-versus-lymphoma effect. Herein we discuss a case of recurrence of CTCL skin lesions after cord blood transplant in a patient who continued to have 100% donor chimerism in bone marrow. Case Presentation. A 48-year-old female with history of mycosis fungoides (MF) presented with biopsy proven large cell transformation of MF. PET scan revealed multiple adenopathy in abdomen and chest suspicious for lymphoma and skin biopsy showed large cell transformation. She was treated with multiple cycles of chemotherapy. Posttherapy PET scan showed resolution of lymphadenopathy. Later she underwent ablative preparative regimen followed by single cord blood transplant. Bone marrow chimerism studies at day +60 after transplant showed 100% donor cells without presence of lymphoma. However 5 months after transplant she had recurrence of MF with the same genotype as prior skin lesion. Bone marrow chimerism study continued to show 100% donor cells. Conclusion. A differential graft-versus-lymphoma effect in our case prevented lymphoma recurrence systemically but failed to do so in skin. We hypothesize that this response may be due to presence of other factors in the bone marrow and lymph node microenvironments preventing recurrence in these sites.
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Shiratori S, Fujimoto K, Nishimura M, Hatanaka KC, Kosugi-Kanaya M, Okada K, Sugita J, Shigematsu A, Hashimoto D, Endo T, Kondo T, Abe R, Hashino S, Matsuno Y, Shimizu H, Teshima T. Allogeneic hematopoietic stem cell transplantation following reduced-intensity conditioning for mycosis fungoides and Sezary syndrome. Hematol Oncol 2014; 34:9-16. [DOI: 10.1002/hon.2162] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/01/2014] [Accepted: 07/16/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Souichi Shiratori
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Katsuya Fujimoto
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Machiko Nishimura
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Kanako C. Hatanaka
- Department of Surgical Pathology; Hokkaido University Hospital; Sapporo Hokkaido Japan
| | - Mizuha Kosugi-Kanaya
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Kohei Okada
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Junichi Sugita
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Akio Shigematsu
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Daigo Hashimoto
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Tomoyuki Endo
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Takeshi Kondo
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Riichiro Abe
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Satoshi Hashino
- Health Care Center; Hokkaido University; Sapporo Hokkaido Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology; Hokkaido University Hospital; Sapporo Hokkaido Japan
| | - Hiroshi Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
| | - Takanori Teshima
- Department of Hematology; Hokkaido University Graduate School of Medicine; Sapporo Hokkaido Japan
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11
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Schlaak M, Pickenhain J, Theurich S, Skoetz N, von Bergwelt‐Baildon M, Kurschat P. Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma. Cochrane Database Syst Rev 2013; 2013:CD008908. [PMID: 23986525 PMCID: PMC7156921 DOI: 10.1002/14651858.cd008908.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Primary cutaneous T-cell lymphomas (CTCL) belong to the group of non-Hodgkin lymphomas and usually run an indolent course. However, some patients progress to advanced tumour or leukaemic stages. To date, there is no cure for those cases. In the last few years, several publications reported durable responses in some patients following allogeneic stem cell transplantation (alloSCT). This is an update of a Cochrane review first published in 2011 and updated in 2013. OBJECTIVES To compare the efficacy and safety of conventional therapies with allogeneic stem cell transplantation in patients with advanced primary cutaneous T-cell lymphomas. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1), MEDLINE (1950 to January 2013), Internet-databases of ongoing trials, conference proceedings of the American Society of Clinical Oncology (ASCO, 2009 to July 2013) and the American Society of Hematology (ASH, 2009 to July 2013). We also contacted members of the European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force to check for ongoing study activities. We handsearched citations from identified trials and relevant review articles. In addition, we handsearched randomised controlled trials from the European Group for Blood and Marrow Transplantation (EBMT) and International Conference on Cutaneous T-cell Lymphoma, ASCO and ASH up to July 2013. SELECTION CRITERIA Trials eligible for inclusion were genetically randomised controlled trials (RCTs) comparing alloSCT plus conditioning therapy (regardless of agents) with conventional therapy as treatment for advanced CTCL. DATA COLLECTION AND ANALYSIS Two review authors would have extracted data from eligible studies and assessed their quality. The primary outcome measure was overall survival; secondary outcomes were time to progression, response rate, treatment-related mortality, adverse events and quality of life. MAIN RESULTS We did not identify any randomised controlled trials from the updated search in January 2013. In 2011, we found 2077 citations but none were relevant genetically or non-genetically 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. AUTHORS' CONCLUSIONS We planned to report evidence from genetically or non-genetically randomised controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, we did not identify any randomised controlled trials addressing this question. Nevertheless, prospective genetically randomised controlled trials need to be initiated to evaluate the precise role of alloSCT in advanced CTCL.
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Affiliation(s)
- Max Schlaak
- University Hospital of CologneDepartment of Dermatology and VenerologyKerpener Str. 62CologneGermany50924
| | - Juliane Pickenhain
- University Hospital of CologneDepartment of Dermatology and VenerologyKerpener Str. 62CologneGermany50924
| | - Sebastian Theurich
- University Hospital of CologneDepartment I of Internal Medicine, Stem Cell Transplantation ProgramKerpener Str. 62CologneGermany50924
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Michael von Bergwelt‐Baildon
- University Hospital of CologneDepartment I of Internal Medicine, Stem Cell Transplantation ProgramKerpener Str. 62CologneGermany50924
| | - Peter Kurschat
- University Hospital of CologneDepartment of Dermatology and VenerologyKerpener Str. 62CologneGermany50924
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12
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Broccoli A, Stanzani M, Bandini G, Bonifazi F, Stefoni V, Pellegrini C, Derenzini E, Gandolfi L, Quirini F, Argnani L, Tschon M, Casadei B, Baccarani M, Zinzani PL. Allotransplant in relapsed or refractory aggressive T-cell lymphomas: retrospective monocentric analysis of 14 patients. Leuk Lymphoma 2012; 54:1791-3. [PMID: 23153229 DOI: 10.3109/10428194.2012.749470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Treatment of relapsed adult T-cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation: the Nagasaki Transplant Group experience. Blood 2012; 121:219-25. [PMID: 23100309 DOI: 10.1182/blood-2012-07-444372] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adult T-cell leukemia/lymphoma (ATL) relapse is a serious therapeutic challenge after allogeneic hematopoietic stem cell transplantation (allo-SCT). In the present study, we retrospectively analyzed 35 patients who experienced progression of or relapsed persistent ATL after a first allo-SCT at 3 institutions in Nagasaki prefecture (Japan) between 1997 and 2010. Twenty-nine patients were treated by the withdrawal of immune suppressants as the initial intervention, which resulted in complete remission (CR) in 2 patients. As the second intervention, 9 patients went on to receive a combination of donor lymphocyte infusion and cytoreductive therapy and CR was achieved in 4 patients. Of 6 patients who had already had their immune suppressants discontinued before the relapse, 3 patients with local recurrence received local cytoreductive therapy as the initial treatment, which resulted in CR for more than 19 months. Donor lymphocyte infusion-induced remissions of ATL were durable, with 3 cases of long-term remission of more than 3 years and, interestingly, the emergence or progression of chronic GVHD was observed in all of these cases. For all 35 patients, overall survival after relapse was 19.3% at 3 years. The results of the present study suggest that induction of a graft-versus-ATL effect may be crucial to obtaining durable remission for ATL patients with relapse or progression after allo-SCT.
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Abstract
Treatment regimens of patients with CTCL vary widely based on clinician preference and patient tolerance. Skin directed therapies are recommended for patients with early stage IA and IB MF, with combinations used in refractory cases. While no regimen has been proven to prolong survival in advanced stages, immunomodulatory regimens should be used initially to reduce the need for cytotoxic therapies. In more advanced stages of disease, treatment efforts should strive for palliation and improvement of quality of life. With many new therapies and strategies on the horizon, the future looks promising for CTCL patients. Unfortunately, other than allogeneic HCT, there are no potential curative therapies for CTCL. Clinical trials are currently underway to identify new therapies to improve quality of life for patients, and researchers are hard at work to identify novel pathways and genes for prognostication and as targets for therapies. Importantly, collaborative clinical trials to enhance rates of accrual need to be conducted, and improved interpretation of data via standardizing end points and response criteria should be an emphasis. Recently, the International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous Lymphoma Consortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) met to develop consensus guidelines to facilitate collaboration on clinical trials. These proposed guidelines consist of: recommendations for standardizing general protocol design; a scoring system for assessing tumor burden in skin, lymph nodes, blood, and viscera; definition of response in skin, nodes, blood, and viscera; a composite global response score; and a definition of end points. Although these guidelines were generated by consensus panels, they have not been prospectively or retrospectively validated through analysis of large patient cohorts.
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Schlaak M, Pickenhain J, Theurich S, Skoetz N, von Bergwelt-Baildon M, Kurschat P. Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma. Cochrane Database Syst Rev 2012; 1:CD008908. [PMID: 22258991 DOI: 10.1002/14651858.cd008908.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary cutaneous T-cell lymphomas (CTCL) belong to the group of non-Hodgkin lymphomas and usually run an indolent course. However, some patients progress to advanced tumour or leukaemic stages. Up to now, no curative treatment has been established for those cases. In the last few years, several publications have reported durable responses in some patients following allogeneic stem cell transplantation (alloSCT). OBJECTIVES To compare the efficacy and safety of conventional therapies with allogeneic stem cell transplantation in patients with advanced primary cutaneous T-cell lymphomas. SEARCH METHODS The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1950 to May 2011), Internet-databases of ongoing trials (www.controlled-trials.com; www.clinicaltrials.gov), conference proceedings of the American Society of Clinical Oncology (ASCO, 2009 to present) and the American Society of Hematology (ASH, 2009 to present). We also contacted members of the European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force to check for ongoing study activities. We handsearched citations from identified trials and relevant review articles. In addition, randomised controlled trials from the European Group for Blood and Marrow Transplantation (EBMT) and International Conference on Cutaneous T-cell Lymphoma, ASCO and ASH up to 2010 were handsearched. SELECTION CRITERIA Genetically randomised controlled trials (RCT) comparing alloSCT plus conditioning therapy regardless of agents with conventional therapy as treatment for advanced CTCL were eligible to be included. DATA COLLECTION AND ANALYSIS From eligible studies data would have been extracted by two review authors and assessed for quality. Primary outcome measures were overall survival, secondary criteria were time to progression, response rate, treatment-related mortality, adverse events and quality of life. MAIN RESULTS We found 2077 citations but none were relevant genetically or non-genetically 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. AUTHORS' CONCLUSIONS 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.
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Affiliation(s)
- Max Schlaak
- Department ofDermatology andVenerology,UniversityHospital ofCologne,Cologne,Germany.
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Mateen FJ, Muralidharan R, Carone M, van de Beek D, Harrison DM, Aksamit AJ, Gould MS, Clifford DB, Nath A. Progressive multifocal leukoencephalopathy in transplant recipients. Ann Neurol 2011; 70:305-22. [PMID: 21823157 DOI: 10.1002/ana.22408] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), a rare demyelinating disorder caused by oligodendrocyte destruction by JC virus. METHODS Reports of PML following transplantation were found using PubMed Entrez (1958-July 2010). A multicenter, retrospective cohort study also identified all cases of PML among transplant recipients diagnosed at Mayo Clinic, Johns Hopkins University, Washington University, and Amsterdam Academic Medical Center. At 1 institution, the incidence of posttransplantation PML was calculated. RESULTS A total of 69 cases (44 solid organ, 25 bone marrow) of posttransplantation PML were found including 15 from the 4 medical centers and another 54 from the literature. The median time to development of first symptoms of PML following transplantation was longer in solid organ vs bone marrow recipients (27 vs 11 months, p = 0.0005, range of <1 to >240). Median survival following symptom onset was 6.4 months in solid organ vs 19.5 months in bone marrow recipients (p = 0.068). Case fatality was 84% (95% confidence interval [CI], 70.3-92.4%) and survival beyond 1 year was 55.7% (95% CI, 41.2-67.2%). The incidence of PML among heart and/or lung transplant recipients at 1 institution was 1.24 per 1,000 posttransplantation person-years (95% CI, 0.25-3.61). No clear association was found with any 1 immunosuppressant agent. No treatment provided demonstrable therapeutic benefit. INTERPRETATION The risk of PML exists throughout the posttransplantation period. Bone marrow recipients survive longer than solid organ recipients but may have a lower median time to first symptoms of PML. Posttransplantation PML has a higher case fatality and may have a higher incidence than reported in human immunodeficiency virus (HIV) patients on highly-active antiretroviral therapy (HAART) or multiple sclerosis patients treated with natalizumab.
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Affiliation(s)
- Farrah J Mateen
- Department of Neurology, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA.
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Devine SM. Hematopoietic stem cell transplantation for cutaneous T-cell lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2010; 10 Suppl 2:S96-8. [PMID: 20826408 DOI: 10.3816/clml.2010.s.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Duarte RF, Canals C, Onida F, Gabriel IH, Arranz R, Arcese W, Ferrant A, Kobbe G, Narni F, Deliliers GL, Olavarría E, Schmitz N, Sureda A. Allogeneic hematopoietic cell transplantation for patients with mycosis fungoides and Sézary syndrome: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2010; 28:4492-9. [PMID: 20697072 DOI: 10.1200/jco.2010.29.3241] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To analyze the outcome of allogeneic transplantation for mycosis fungoides and Sézary syndrome (MF/SS) in terms of nonrelapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) and to identify factors associated with the outcome. PATIENT AND METHODS Sixty patients with MF (n = 36) and SS (n = 24) who received a first allogeneic hematopoietic cell transplantation (HCT) from a matched related (mRD; n = 45) or unrelated donor (mUD; n = 15) between 1997 and 2007 and who were registered in the European Group for Blood and Marrow Transplantation database were analyzed: 37 men and 23 women, median age 46.5 years (range, 22 to 66 years). Forty-four patients had TNM stage IV, and 40 patients were at advanced phase at transplantation. Forty-four patients received reduced-intensity conditioning (RIC) regimens, and 25 underwent T-cell depletion (TCD). RESULTS Allogeneic transplantation in MF/SS offers an estimated OS of 66% at 1 year and 54% at 3 years, primarily driven by donor type, disease phase, and type of conditioning. RIC decreased NRM (relative risk [RR] = 4.7; P = .008) without increasing REL, leading to a higher OS (RR = 2.8; P = .03). Advanced-phase disease increases REL (RR = 3.0; P = .03) and reduces PFS (RR = 4.4; P = .002) and OS (RR = 3.5; P = .023). Recipients of mRD allogeneic HCT had better PFS (RR = 2.7; P = .006) and OS (RR = 4.0; P = .001) than their mUD counterparts. The risk of REL increases with TCD (RR = 3.2; P = .005). Some patients who experience relapse can successfully undergo rescue treatment with donor lymphocyte infusions. CONCLUSION Allogeneic transplantation is a valid therapeutic alternative for high-risk patients with advanced-stage MF/SS. Our data also suggest the existence of a clinically relevant graft-versus-lymphoma effect in MF/SS.
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Affiliation(s)
- Rafael F Duarte
- Department of Hematology, ICO-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.
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Efficacité à long terme d’une autogreffe de cellules souches au cours d’un mycosis fongoïde de stade IV. Ann Dermatol Venereol 2009; 136:800-5. [DOI: 10.1016/j.annder.2009.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 04/14/2009] [Indexed: 11/24/2022]
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Haematopoietic stem cell transplantation for patients with primary cutaneous T-cell lymphoma. Bone Marrow Transplant 2008; 41:597-604. [PMID: 18176611 DOI: 10.1038/sj.bmt.1705968] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is no standard of care for patients with advanced forms of mycosis fungoides, Sézary syndrome and other less common subtypes of primary cutaneous T-cell lymphoma. Expected median survival for such patients with conventional therapy is only 1-4 years. As a result of such dismal prognosis, alternative strategies based on autologous and allogeneic transplantation have been explored, and a relatively small number of case reports and small series communicated to date have provided evidence for the potential role of haematopoietic transplantation in these patients. High-dose radio-chemotherapy and autologous rescue has been shown to induce complete responses in the majority of patients. Disappointingly though, these responses were very short-lived in nearly all cases. On the contrary, the use of allogeneic transplantation has provided solid evidence for an allogeneic GVL effect in these malignancies. In fact, more than two-thirds of the allogeneic transplant recipients reported in the literature experienced long-term durable remissions of more than 3 years, which would appear superior to the expected median survival for such patients. This review summarizes the experience published to date in this setting and highlights main areas that would merit further investigation.
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