Abstract
Background. Allogeneic stem cell transplant is the treatment of choice for systemic cutaneous T-cell lymphoma (CTCL) which provides graft-versus-lymphoma effect. Herein we discuss a case of recurrence of CTCL skin lesions after cord blood transplant in a patient who continued to have 100% donor chimerism in bone marrow. Case Presentation. A 48-year-old female with history of mycosis fungoides (MF) presented with biopsy proven large cell transformation of MF. PET scan revealed multiple adenopathy in abdomen and chest suspicious for lymphoma and skin biopsy showed large cell transformation. She was treated with multiple cycles of chemotherapy. Posttherapy PET scan showed resolution of lymphadenopathy. Later she underwent ablative preparative regimen followed by single cord blood transplant. Bone marrow chimerism studies at day +60 after transplant showed 100% donor cells without presence of lymphoma. However 5 months after transplant she had recurrence of MF with the same genotype as prior skin lesion. Bone marrow chimerism study continued to show 100% donor cells. Conclusion. A differential graft-versus-lymphoma effect in our case prevented lymphoma recurrence systemically but failed to do so in skin. We hypothesize that this response may be due to presence of other factors in the bone marrow and lymph node microenvironments preventing recurrence in these sites.
Highlights
Allogeneic stem cell transplant is the treatment of choice for systemic cutaneous T-cell lymphoma (CTCL) which provides graft-versus-lymphoma effect
The overall prognosis in mycosis fungoides (MF) patients depends on the disease stage and clinical presentation, which are the key determinants of their clinical management
Recent studies show that allogeneic stem cell transplant is a standard treatment modality used for transformed CTCL with a curative intent [2, 3, 5,6,7,8]
Summary
Cutaneous T-cell lymphoma (CTCL) is a group of lymphoproliferative disorders characterized by infiltration of malignant T lymphocytes to the skin [1,2,3]. Based on current evidence allogeneic stem cell transplant is a standard treatment modality used for transformation of CTCL with a curative intent [2, 3, 5,6,7,8] and is associated with durable response [9] likely due to graftversus-lymphoma (GVL) effect [7, 8]. Limited data exists in the form of case reports regarding effectiveness of cord blood transplant in this setting [10,11,12]. To our knowledge no studies have been performed comparing the efficacy of allogeneic stem cell transplantation with umbilical cord blood transplantation in the treatment of advanced CTCL. We report a case of a transformed MF who received myeloablative single unit umbilical cord blood (sUCB) transplantation. Pathobiological aspects of this important but rare differential GVL response of extramedullary compared to intramedullary disease
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