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Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas

1
Department of Dermatology, APHP, Saint-Louis Hospital, F-75010 Paris, France
2
INSERM U976, Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, F-75010 Paris, France
3
Department of Medicine, Université de Paris, F-75010 Paris, France
4
Hematology-Bone Marrow Transplantation, APHP, Saint-Louis Hospital, F-75010 Paris, France
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(10), 2856; https://doi.org/10.3390/cancers12102856
Received: 31 August 2020 / Revised: 30 September 2020 / Accepted: 1 October 2020 / Published: 3 October 2020
(This article belongs to the Special Issue Stem Cell Transplantation in Cancer Treatment)
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.
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. View Full-Text
Keywords: cutaneous T-cell lymphomas; mycosis fungoides; Sézary syndrome; allogeneic hematopoietic stem cell transplantation; lymphomas; review cutaneous T-cell lymphomas; mycosis fungoides; Sézary syndrome; allogeneic hematopoietic stem cell transplantation; lymphomas; review
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Dumont, M.; Peffault de Latour, R.; Ram-Wolff, C.; Bagot, M.; de Masson, A. Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas. Cancers 2020, 12, 2856.

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