TY - JOUR
T1 - Efficacy of Allogeneic Hematopoietic Cell Transplantation in Cutaneous T Cell Lymphoma
T2 - Results of a Systematic Review and Meta-Analysis
AU - Iqbal, Madiha
AU - Reljic, Tea
AU - Ayala, Ernesto
AU - Sher, Taimur
AU - Murthy, Hemant
AU - Roy, Vivek
AU - Foran, James
AU - Tun, Han
AU - Kumar, Ambuj
AU - Kharfan-Dabaja, Mohamed A.
N1 - Funding Information:
Financial disclosure: The authors have nothing to disclose. Conflict of interest statement: T.S.: Research funding from Janssen and Incyte Corp. J.F.: Research funding from Trillium and Merck. H.T.: Consultancy for Celgene, Mundi Pharma, Bristol Myers Squibb, TG, and Seattle Genetics. M.A.K.-D.: Consultancy for Daiichi Sankyo and Pharmacyclics; speaker Bureau for Seattle Genetics, Incyte Corp, and Alexion Pharmaceuticals. All other authors declare no relevant financial conflicts of interest. Authorship statement: M.I. and T.R. contributed equally to this study and share first authorship. Financial disclosure: See Acknowledgments on page 81.
Funding Information:
Conflict of interest statement: T.S.: Research funding from Janssen and Incyte Corp. J.F.: Research funding from Trillium and Merck. H.T.: Consultancy for Celgene, Mundi Pharma, Bristol Myers Squibb, TG, and Seattle Genetics. M.A.K.-D.: Consultancy for Daiichi Sankyo and Pharmacyclics; speaker Bureau for Seattle Genetics, Incyte Corp, and Alexion Pharmaceuticals. All other authors declare no relevant financial conflicts of interest.
Publisher Copyright:
© 2019 American Society for Transplantation and Cellular Therapy
PY - 2020/1
Y1 - 2020/1
N2 - Mycosis fungoides and Sézary syndrome are the most common types of primary cutaneous T cell lymphomas. The clinical presentation of mycosis fungoides is generally indolent, whereas Sézary syndrome represents a more aggressive disease variant. Stage at diagnosis is the most important determinant of long-term survival outcome. Although most patients present with early-stage disease, those who develop progressive disease or have an advanced stage represent a therapeutic challenge because of a lack of effective therapies. Allogeneic hematopoietic cell transplantation (allo-HCT) has been used as a potentially curative treatment modality with encouraging long-term outcomes. However, a lack of randomized controlled data remains, and the published literature is limited to mostly retrospective studies. We performed a comprehensive search of the medical literature using PubMed/Medline, EMBASE, and Cochrane reviews on September 13, 2018. We extracted data on clinical outcomes related to benefits (overall [OS] and progression-free [PFS] survival) and harms (relapse and nonrelapse mortality [NRM]) independently by 2 authors. Our search strategy identified 289 references. Five studies (266 patients) were included in this systematic review and meta-analysis. Reduced-intensity and nonmyeloablative regimens were more commonly prescribed (76%). Mobilized peripheral blood stem cells were the preferred graft source (78%). The pooled OS and PFS rates were 59% (95% confidence interval [CI], 50% to 69%) and 36% (95% CI, 27% to 45%), respectively. Pooled relapse rate was 47% (95% CI, 41% to 53%) and pooled NRM rate 19% (95% CI, 13% to 27%). Results of this systematic review and meta-analysis show that allo-HCT yields encouraging OS and PFS rates; however; relapse remains a significant cause of allo-HCT failure. Novel strategies to further improve outcomes should focus on offering allo-HCT before the development of resistant disease and reducing relapse by incorporating post-transplant maintenance therapies.
AB - Mycosis fungoides and Sézary syndrome are the most common types of primary cutaneous T cell lymphomas. The clinical presentation of mycosis fungoides is generally indolent, whereas Sézary syndrome represents a more aggressive disease variant. Stage at diagnosis is the most important determinant of long-term survival outcome. Although most patients present with early-stage disease, those who develop progressive disease or have an advanced stage represent a therapeutic challenge because of a lack of effective therapies. Allogeneic hematopoietic cell transplantation (allo-HCT) has been used as a potentially curative treatment modality with encouraging long-term outcomes. However, a lack of randomized controlled data remains, and the published literature is limited to mostly retrospective studies. We performed a comprehensive search of the medical literature using PubMed/Medline, EMBASE, and Cochrane reviews on September 13, 2018. We extracted data on clinical outcomes related to benefits (overall [OS] and progression-free [PFS] survival) and harms (relapse and nonrelapse mortality [NRM]) independently by 2 authors. Our search strategy identified 289 references. Five studies (266 patients) were included in this systematic review and meta-analysis. Reduced-intensity and nonmyeloablative regimens were more commonly prescribed (76%). Mobilized peripheral blood stem cells were the preferred graft source (78%). The pooled OS and PFS rates were 59% (95% confidence interval [CI], 50% to 69%) and 36% (95% CI, 27% to 45%), respectively. Pooled relapse rate was 47% (95% CI, 41% to 53%) and pooled NRM rate 19% (95% CI, 13% to 27%). Results of this systematic review and meta-analysis show that allo-HCT yields encouraging OS and PFS rates; however; relapse remains a significant cause of allo-HCT failure. Novel strategies to further improve outcomes should focus on offering allo-HCT before the development of resistant disease and reducing relapse by incorporating post-transplant maintenance therapies.
KW - Allogeneic hematopoietic cell transplantation
KW - Cutaneous T cell lymphoma
KW - Mycosis fungoides
KW - Sézary syndrome
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UR - http://www.scopus.com/inward/citedby.url?scp=85072712772&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2019.08.019
DO - 10.1016/j.bbmt.2019.08.019
M3 - Article
C2 - 31494227
AN - SCOPUS:85072712772
SN - 1083-8791
VL - 26
SP - 76
EP - 82
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 1
ER -