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Treatment of Advanced Mycosis Fungoides by Allogeneic Stem Cell Transplantation with Reduced Intensity Conditioning Regimen



Treatment of Advanced Mycosis Fungoides by Allogeneic Stem Cell Transplantation with Reduced Intensity Conditioning Regimen



Blood 100(11): Abstract No 5403, November 16



Mycosis fungoides (MF) is the most frequent primary lymphomas involving the skin. Histopathological features are similar in both diseases and are characterized by marked epidermotropism of T lymphocytes with convoluted pleomorphic or cerebriform nuclei. The malignant cells express more commonly a mature and memory T-helper phenotype (CD45RO+CD4+) and their clonality always emerges from T-cell receptor TCR-gamma gene rearrangements by molecular analyses. Although the natural history of MF is usually indolent, many patients eventually progress to more advanced stages with an aggressive clinical course and shortened survival. Conventional allogeneic stem cell transplantation (SCT) has been described thus far in few patients with MF with evidence of a graft-versus-tumor (GVT) effect. Given the poor prognosis of patients with advanced cutaneous T-cell lymphoma and the high transplant related mortality associated with conventional allogeneic bone marrow transplantation we performed from HLA-identical siblings in 3 patients with this disease. Full donor chimerism was obtained already on day +30 and persisted in the two evaluable patients; the monitoring of chimerism by DNA-microsatellites on immuno-selected peripheral blood CD8+ T-lymphocytes was able to predict engraftment and the evolution of the disease. Between day 30 and day 60 after transplantation all 3 patients had completely cleared the clonal T-cells in the skin, in lymphnodes, in bone marrow and in peripheral blood as demonstrated by clinical, histological and molecular analysis. Remission were durable in the two evaluable patients. All patients, between day 30 and 60, developed clinical and histological signs of acute grade II-III cutaneous GVHD, which rapidly improved with corticosteroid therapy. Severe, life-threatening infections during the transplant course were common to all our patients. Two out of three presented SA bacteremia that is reportedly the most common cause of death in MF and which was fatal in one patient. Two patients are alive, well and in CR after 18 and 24 months after the transplant. Although patients selection, preparative regimens as well as identification and treatment of infectious complications should be further optimized, allogeneic stem cell transplantation with reduced intensity conditioning seems to be the only curative option in these patients.

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