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Durable Clinical, Cytogenetic, and Molecular Remissions After Allogeneic Hematopoietic Cell Transplantation for Refractory Sezary Syndrome and Mycosis Fungoides

From the Divisions of Hematology/Hematopoietic Cell Transplantation and Anatomic Pathology (Hematopathology and Cytogenetics), City of Hope National Medical Center, Duarte, CA

Address reprint requests to Arturo Molina, MD, MS, City of Hope Comprehensive Cancer Center, Division of Hematology and Hematopoietic Cell Transplantation, 1500 E Duarte Rd, Duarte, CA 94305; e-mail: arturo.molina{at}biogenidec.com

PURPOSE: Sezary syndrome (SS) and tumor-stage mycosis fungoides (MF) are generally incurable with currently available treatments. We conducted a retrospective study to evaluate the outcome of allogeneic hematopoietic stem-cell transplantation (HSCT) in this patient population.

PATIENT AND METHODS: From August 1996 through October 2002, eight patients with advanced MF/SS underwent allogeneic HSCT at our institution. All patients were heavily pretreated, having failed a median number of seven prior therapies (range, five to 12). Clonal T-cell populations in peripheral blood or bone marrow were detectable by polymerase chain reaction analyses of T-cell receptor -chain gene rearrangements in six patients and cytogenetics in three patients. The conditioning regimen included total-body irradiation and cyclophosphamide (n = 3), busulfan and cyclophosphamide (n = 1), and the reduced-intensity regimen of fludarabine and melphalan (n = 4). Allogeneic hematopoietic stem cells were obtained from HLA-matched siblings (n = 4) and unrelated donors (n = 4).

RESULTS: All patients achieved complete clinical remission and resolution of molecular and cytogenetic markers of disease within 30 to 60 days after HSCT. Two patients died from transplantation-related complications; graft-versus-host disease (GVHD; n = 1) and respiratory syncytial virus pneumonia (n = 1). With a median follow-up of 56 months, six patients remain alive and without evidence of lymphoma.

CONCLUSION: Our results suggest that allogeneic HSCT from both HLA–matched sibling and unrelated donors can induce durable clinical, molecular, and cytogenetic remissions in patients with advanced cutaneous T-cell lymphoma that is refractory to standard therapies.

Supported in part by United States Public Service Grants 30206 and 33572 from the National Cancer Institute. A.M. was supported in part by an American Cancer Society Clinical Oncology Career Development Award.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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