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Joan Guitart, MD; Scott C. Wickless, DO; Yu Oyama, MD; Timothy M. Kuzel, MD; Steve T. Rosen, MD; Ann Traynor, MD; Richard Burt, MD

Arch Dermatol. 2002;138:1359-1365.

Background  Allogeneic hematopoietic stem cell transplantation has proved to be an effective therapeutic option in various hematologic neoplastic disorders. Because patients with advanced cutaneous T-cell lymphoma have a poor prognosis, with minimal possibilities of sustained remission, we studied the therapeutic potential of hematopoietic stem cell transplantation.

Observations  Three young patients with refractory tumor stage mycosis fungoides underwent allogeneic HLA-matched sibling transplantation with combined marrow and CD34-enriched peripheral blood stem cell transplantation after cytoreductive chemotherapy and total-body irradiation. Complete and sustained clinical and histologic remission was achieved in 2 patients, and both remain disease free 4 years and 15 months later. One patient was in complete remission for 9 months, followed by limited cutaneous recurrence. Mild graft-vs-host disease and graft-vs-tumor effect have contained the recurring disease as a low-grade process.

Conclusions  Allogeneic hematopoietic stem cell transplantation has the potential for sustained remission and the possibility of cure for young patients with advanced and recalcitrant cutaneous T-cell lymphoma. Even in the absence of complete remission, an allogeneic graft-vs-tumor effect may provide an immune mechanism to control the malignant T-cell process and alter the natural history of disease.

From the Department of Dermatology (Drs Guitart and Wickless) and the Divisions of Hematology/Oncology (Drs Oyama, Kuzel, and Rosen) and Immunotherapy (Drs Traynor and Burt), Department of Internal Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical School, Chicago, Ill.

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