Allogeneic Hematopoietic Cell Transplantation for Patients With Mycosis Fungoides and Sezary Syndrome: A Retrospective Analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation

Purpose To analyze the outcome of allogeneic transplantation for mycosis fungoides and Sezary 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. J Clin Oncol 28:4492-4499. (C) 2010 by American Society of Clinical Oncology