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Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma

  1. Max Schlaak1,†,*,
  2. Juliane Pickenhain1,‡,
  3. Sebastian Theurich2,§,
  4. Nicole Skoetz3,
  5. Michael von Bergwelt-Baildon2,¶,
  6. Peter Kurschat1,‖

Editorial Group: Cochrane Haematological Malignancies Group

Published Online: 29 AUG 2013

Assessed as up-to-date: 11 APR 2013

DOI: 10.1002/14651858.CD008908.pub3


How to Cite

Schlaak M, Pickenhain J, Theurich S, Skoetz N, von Bergwelt-Baildon M, Kurschat P. Allogeneic stem cell transplantation versus conventional therapy for advanced primary cutaneous T-cell lymphoma. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008908. DOI: 10.1002/14651858.CD008908.pub3.

Author Information

  1. 1

    University Hospital of Cologne, Department of Dermatology and Venerology, Cologne, Germany

  2. 2

    University Hospital of Cologne, Department I of Internal Medicine, Stem Cell Transplantation Program, Cologne, Germany

  3. 3

    University Hospital of Cologne, Cochrane Haematological Malignancies Group, Department I of Internal Medicine, Cologne, Germany

  1. authors have contributed equally (first author)

  2. authors have contributed equally (first author)

  3. §

    authors have contributed equally (first author)

  4. authors have contributed equally (last author)

  5. authors have contributed equally (last author)

*Max Schlaak, Department of Dermatology and Venerology, University Hospital of Cologne, Kerpener Str. 62, Cologne, 50924, Germany. max.schlaak@uk-koeln.de.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 29 AUG 2013

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Primary cutaneous T-cell lymphomas (CTCL) belong to the group of non-Hodgkin lymphomas and usually run an indolent course. However, some patients progress to advanced tumour or leukaemic stages. To date, there is no cure for those cases. In the last few years, several publications reported durable responses in some patients following allogeneic stem cell transplantation (alloSCT). This is an update of a Cochrane review first published in 2011 and updated in 2013.

Objectives

To compare the efficacy and safety of conventional therapies with allogeneic stem cell transplantation in patients with advanced primary cutaneous T-cell lymphomas.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1), MEDLINE (1950 to January 2013), Internet-databases of ongoing trials, conference proceedings of the American Society of Clinical Oncology (ASCO, 2009 to July 2013) and the American Society of Hematology (ASH, 2009 to July 2013). We also contacted members of the European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force to check for ongoing study activities. We handsearched citations from identified trials and relevant review articles. In addition, we handsearched randomised controlled trials from the European Group for Blood and Marrow Transplantation (EBMT) and International Conference on Cutaneous T-cell Lymphoma, ASCO and ASH up to July 2013.

Selection criteria

Trials eligible for inclusion were genetically randomised controlled trials (RCTs) comparing alloSCT plus conditioning therapy (regardless of agents) with conventional therapy as treatment for advanced CTCL.

Data collection and analysis

Two review authors would have extracted data from eligible studies and assessed their quality. The primary outcome measure was overall survival; secondary outcomes were time to progression, response rate, treatment-related mortality, adverse events and quality of life.

Main results

We did not identify any randomised controlled trials from the updated search in January 2013. In 2011, we found 2077 citations but none were relevant genetically or non-genetically randomised controlled trials. All 41 studies that were thought to be potentially suitable were excluded after full text screening for being non-randomised, not including CTCL or being review articles.

Authors' conclusions

We planned to report evidence from genetically or non-genetically randomised controlled trials comparing conventional therapy and allogeneic stem cell transplantation. However, we did not identify any randomised controlled trials addressing this question. Nevertheless, prospective genetically randomised controlled trials need to be initiated to evaluate the precise role of alloSCT in advanced CTCL.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

The role of allogeneic stem cell transplantation for patients with advanced stage primary cutaneous T-cell lymphoma

Primary cutaneous T-cell lymphomas (CTCLs) are a subgroup of blood cancers called non-Hodgkin lymphomas. CTCL is usually seen first in the skin. It is characterised by an uncontrolled increase in T-lymphocytes, which are a special kind of white blood cell. Most people who get the disease are older than 60 years of age. Compared to other T-lymphocyte diseases, this type usually progresses slowly. The likely course and outcome of the disease is also better for this type of cancer. However, there is still no cure yet. The most common subtype of CTCL is Mycosis fungoides (MF) which typically grows slowly in the early stages. However, approximately 20% of people in early-stage of the disease will get worse and progress to tumour stage or develop a type of leukaemia called Sézary syndrome. Most of these people are then subjected to chemotherapies to kill off the cancer cells. The chemotherapy may involve one or more drugs (known as monochemotherapy or polychemotherapies). Although some patients respond well at the beginning of treatment, the disease often returns and life expectancy is uncertain. Furthermore, many patients can experience severe side effects from the treatment. In the last few years, several publications have reported durable responses following a procedure called allogeneic stem cell transplantation (alloSCT). This is when the patient receives a transplant of stem cells from another donor. Before the transplant begins, the patient undergoes treatment to reduce the size of the tumour. This is called full-intensity or reduced-intensity conditioning (RIC). Reduced-intensity conditioning allows the patient to avoid the standard regimes of high-dose therapy. It appears to be equally effective but with significantly less toxicity. The use of reduced-intensity conditioning means that older people, who are the majority of patients with this disease, can be treated with stem cells.

We planned to carry out a review of the effect of allogeneic stem cell transplantation compared to standard therapy in patients with cutaneous T-cell lymphomas. However, after thorough searches, we did not find any relevant studies.

Instead we have only been able to give a summary of some case series and clinical evaluations. These do not allow us to clearly assess the possibilities and limitations of this treatment. Nevertheless, they do show that allogeneic stem cell transplantation may be of some benefit, with acceptable side effects. Therefore, it can be considered as a promising treatment option for patients with advanced CTCL but more research is needed.