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Allogeneic stem cell transplant for treatment of mycosis fungoides and Sezary syndrome: a systematic review and meta-analysis

Bone Marrow Transplantation volume 59, pages 41–51 (2024)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplant (allo-HSCT) has been noted to be a potential curative treatment in cases of advanced-stage mycosis fungoides (MF) or Sezary syndrome (SS). To assess outcomes of allo-HSCT for MF/SS we performed a systematic review and meta-analysis including 15 manuscripts and 557 patients, published from 2010–2023. Meta-analysis revealed 1-year and 3+year overall survival (OS) of 51% (95% CI 39–64%) and 40% (32–49%). Progression-free survival at 1 year and 3+years were 42% (31–53%) and 33% (25–42%). Non-relapse mortality was 18% (13–23%). Relapse occurred in of 47% (40–53%) with a median time to relapse of 7.9 months (range 1.6–24 months). Rates of acute and chronic graft-versus-host disease (GVHD) were 45% (35–55%) and 40% (33–48%). Reduced-intensity conditioning (RIC) was associated with superior OS compared to myeloablative conditioning (MAC) (58% vs. 30%, p < 0.001). Of patients with relapse after allo-HSCT, 46% treated with donor lymphocyte infusion (DLI) achieved complete remission. These data support use of allo-HSCT for treatment of advanced-stage MF/SS and suggest superiority of RIC over MAC. Rates of GVHD were comparable to allo-HSCT in general. The improved OS for RIC and high rate of CR with DLI underscore the importance of the graft-versus-lymphoma effect in allo-HSCT for MF/SS.

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Fig. 1: Meta-analysis of overall survival (OS) and progression free survival (PFS) after allogeneic hematopoietic stem cell transplant for mycosis fungoides and Sezary syndrome.
Fig. 2: Meta-analysis of rates of non-relapse mortality and incidence of relapse after allogeneic hematopoietic stem cell transplant for mycosis fungoides and Sezary syndrome, and aggregated causes of death after transplant.
Fig. 3
Fig. 4: Meta-analysis of incidence of acute and chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplant for mycosis fungoides and Sezary syndrome.

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Data are available upon request.

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Authors and Affiliations

  1. Department of Dermatology, University of Minnesota, Minneapolis, MN, USA

    Amrita Goyal

  2. Division of Hematology, Oncology, and Bone Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA

    Daniel O’Leary

  3. Section of Hematology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA

    Francine Foss

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AG: Conceptualization, methodology, investigation, formal analysis, data curation, writing, editing. DO: Conceptualization, investigation, validation, data curation, editing. FF: Conceptualization, writing, supervision, editing.

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Correspondence to Amrita Goyal.

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Goyal, A., O’Leary, D. & Foss, F. Allogeneic stem cell transplant for treatment of mycosis fungoides and Sezary syndrome: a systematic review and meta-analysis. Bone Marrow Transplant 59, 41–51 (2024). https://doi.org/10.1038/s41409-023-02122-0

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