Haematopoietic stem cell transplant in cutaneous T-cell lymphomas: A multicentre propensity-score matched study.

in Journal of the European Academy of Dermatology and Venereology : JEADV by Lía Bejarano, Mercè Grau-Pérez, Marina Paíno-Román, María Pilar García Muret, Mercedes Morillo, Cristina Muniesa, Juan Torre-Castro, M Teresa Estrach, Elena Amutio Díez, Rosa Mª Lzu Belloso, Yeray Peñate, Constanza Martínez-Mera, Rafael Botella-Estrada, Miren Josune Michelena Eceiza, Pablo L Ortiz Romero, Mar Blanes, Ricardo Fernández-de-Misa, Lucía Prieto-Torres, María Elisabet Parera Amer, Helena Iznardo, Carlos Moreno-Vílchez, Octavio Servitje, Ignacio García-Doval, Javier Cañueto

TLDR

  • The study evaluated the outcome of patients receiving HSCT for advanced primary CTCL in Spain, finding no significant differences in overall survival between HSCT and non-HSCT groups.
  • HSCT achieved a complete response in 70.6% of patients and partial response in 13.7%, with 56.9% experiencing relapse and 39.2% dying.
  • Larger studies may help identify subgroups of patients who could benefit from HSCT.

Abstract

Advanced cutaneous T-cell lymphomas (CTCL) are rare, generally refractory to therapeutic options, and have a poor prognosis. Haematopoietic stem cell transplantation (HSCT), mainly allogeneic HSCT (allo-HSCT), is considered a potentially curative option in CTCL refractory to other therapies. However, around half of patients relapse, and allo-HSCT is associated with significant adverse events. The available evidence on the usefulness of HSCT in CTCL generally comes from isolated cases and case series with a limited number of patients. Our aim was to evaluate the outcome of patients undergoing HSCT for advanced primary CTCL in Spain in a real-world environment and to compare their survival with that of similar patients who did not receive HSCT. We performed a retrospective observational study nested within the Primary Cutaneous Lymphoma Registry (RELCP) of the Spanish Academy of Dermatology and Venereology, collecting data on all patients receiving HSCT. Then, we performed propensity score matching (PSM) to pair HSCT patients with non-HSCT patients, adjusting for diagnosis, highest disease stage and age at diagnosis. We then performed survival analysis by means of Cox regression. Of 2848 patients included in the RELCP, 51 patients underwent HSCT. Thirty-six patients (70.6%) achieved a complete response and seven patients (13.7%) partial response. Relapse was developed by 56.9% of patients, and 39.2% died (19.6% due to disease progression and 15.7% due to HSCT complications, mainly graft-versus-host disease (GVHD) and sepsis). Overall survival (OS) after HSCT at 5 years was 58.9%. No differences in OS were found between HSCT and non-HSCT groups. We did not observe a survival benefit among HSCT patients compared to non-HSCT patients within the RELCP cohort. This could be due to patients having received a mean of 6.3 lines of treatment before HSCT. Larger studies might help identify subgroups of patients who might benefit from HSCT.

Overview

  • The study aimed to evaluate the outcome of patients undergoing haematopoietic stem cell transplantation (HSCT) for advanced primary cutaneous T-cell lymphomas (CTCL) in Spain.
  • A retrospective observational study was performed, collecting data on all patients receiving HSCT from the Primary Cutaneous Lymphoma Registry (RELCP) of the Spanish Academy of Dermatology and Venereology.
  • The primary objective was to compare the survival of patients receiving HSCT with those not receiving HSCT, while adjusting for diagnosis, highest disease stage, and age at diagnosis.

Comparative Analysis & Findings

  • Of 2848 patients included in the RELCP, 51 patients underwent HSCT, with 70.6% achieving a complete response and 13.7% partial response.
  • Relapse was developed by 56.9% of patients, and 39.2% died (19.6% due to disease progression and 15.7% due to HSCT complications, mainly graft-versus-host disease (GVHD) and sepsis).
  • No differences in overall survival (OS) were found between HSCT and non-HSCT groups; 58.9% of patients receiving HSCT survived at 5 years.

Implications and Future Directions

  • Larger studies might help identify subgroups of patients who might benefit from HSCT.
  • The study highlights the importance of considering the effectiveness of HSCT for advanced primary CTCL and its potential complications.
  • Future research could investigate the impact of HSCT on patient quality of life and identify strategies to improve treatment outcomes.
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