Allogeneic stem cell transplantation improves progression-free survival in advanced cutaneous T-cell lymphomas

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1. Median progression-free survival in the HSCT group was significantly longer than in the non-HSCT group.

2. HSCT was associated with a slightly increased risk of serious adverse events, including graft-versus-host disease (59% vs. 44%, respectively).

Evidence Rating Level: 2 (Good)

Study Rundown: Advanced cutaneous T-cell lymphoma (CTCL) is a rare and aggressive form of cancer with a very poor prognosis. Allogeneic hematopoietic stem cell transplantation (HSCT) may be used to improve prognosis in patients with advanced CTCLs, although current evidence is limited. This randomized controlled trial aimed to assess the safety and efficacy of allogeneic HSCT vs non-HSCT therapy in patients with advanced-CTCLs. The primary outcome of this study was progression-free survival. According to study results, allogeneic HSCT was associated with longer progression-free survival compared to non-HSCT therapy. However, patients receiving allogeneic HSCT were found to have higher rates of serious adverse events, including graft-versus-host disease. Although this study was well done, it was limited by a relatively small sample size with the inclusion of patients from a single country.

Click to read the study in The Lancet

Relevant Reading: Second-Line Tisagenlecleucel or Standard Care in Aggressive B-Cell Lymphoma

In-depth [randomized-controlled trial]: Between Jun 1, 2016, and Mar 3, 2022, 99 patients were screened for eligibility across 17 centers in France. Included were patients ≥ 18 years with mycosis fungoides or Sézary syndrome and ≥ 1 poor prognostic criteria. Altogether, 55 patients in the HSCT group and 44 in the non-HSCT group were included in the final analysis. The primary outcome of progression-free survival was significantly longer in the HSCT group (9.0 months, 95% confidence interval [CI] 6.6-30.5) than in the non-HSCT group (3.0 months, 95% CI 2.0-6.3, hazard ratio [HR] 0.38, p<0.0001). Slightly more patients in the HSCT group (78%) had serious adverse events than the non-HSCT group (67%). These included graft vs. host disease (59% vs. 44% for HSCT vs. non-HSCT therapy) and infections. Overall, findings from this study suggest that allogenic HSCT had significantly longer survival vs. non-allogenic HSCT.

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