Allogeneic hematopoietic stem cell transplantation in cutaneous T-cell lymphoma – A rarely applied but potentially curative therapeutic option

Abstract

The management of advanced-stage cutaneous T-cell lymphomas (CTCL) remains a major clinical challenge due to the pronounced biological and clinical heterogeneity of the disease and its frequent resistance to therapy. Durable remission can be achieved solely through allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this summary, we review the role of allo-HSCT in CTCL, based on a retrospective analysis of patients who underwent stem cell transplantation in Budapest between 1984 and 2024, in comparison with international data. CTCL accounted for only 0.5% of adult allo-HSCTs performed over the past 40 years. The majority of patients underwent transplantation in advanced stage disease, following a median of three prior lines of therapy, either in partial remission or with progressive disease. Conditioning regimens were reduced-intensity (RIC) in 67% and myeloablative (MAC) in 33% of cases. Acute graft-versus-host disease (GVHD) involving the skin occurred in 67% of patients. Overall mortality was 67%, and the relapse rate was 44%. Durable remission was achieved in some cases of late relapse with donor lymphocyte infusion (DLI). Although allo-HSCT offers curative potential in CTCL, its application remains limited. Closer cooperation among disciplines involved in the management of these patients may promote its more widespread use.