ASTCT and USCLC clinical practice recommendations for allogeneic stem cell transplant in mycosis fungoides and Sézary syndrome - 13/05/25

Doi : 10.1016/j.jaad.2025.04.005

Amrita Goyal, MD ^a,^⁎ , Daniel O'Leary, MD ^b, Bouthaina Dabaja, MD ^c, Wen-Kai Weng, MD ^d, Jasmine Zain, MD ^e, Corey Cutler, MD, MPH ^f, Joan Guitart, MD ^g, Youn H. Kim, MD ^h, Larisa J. Geskin, MD ⁱ, Richard T. Hoppe, MD ^j, Lynn D. Wilson, MD ^k, Anne W. Beaven, MD ^l, Steve Horwitz, MD ^m, Pamela B. Allen, MD ⁿ, Stefan K. Barta, MD ^o, Kimberly Bohjanen, MD ^a, Jonathan E. Brammer, MD ^p, Joi B. Carter, MD ^q, Nneka Comfere, MD ^r, Jennifer A. DeSimone, MD ^s, Kathryn Dusenbery, MD ^t, Madeleine Duvic, MD ^u, Auris Huen, MD ^u, Deepa Jagadeesh, MD, MPH ^v, Chris R. Kelsey, MD ^w, Michael S. Khodadoust, MD ^x, Mary Jo Lechowicz, MD ^y, Neha Mehta-Shah, MD ^z, Alison J. Moskowitz, MD ^m, Elise A. Olsen, MD ^aa, Christina Poh, MD ^ab, Barbara Pro, MD ^ac, Christiane Querfeld, MD, PhD ^ad, Craig Sauter, MD ^v, Lubomir Sokol, MD, PhD ^ae, Olayemi Sokumbi, MD ^af, Ryan A. Wilcox, MD, PhD ^ag, John A. Zic, MD ^ah, Alejandro Gru, MD ⁱ, Mehdi Hamadani, MD ^ai, Francine Foss, MD ^aj
^a Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
^b Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
^c Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
^d Blood and Marrow Transplantation, and Cellular Therapy, Department of Medicine, Stanford University, Stanford, California
^e Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
^f Division of Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
^g Department of Dermatology, Northwestern Feinberg School of Medicine, Evanston, Illinois
^h Division of Oncology, Departments of Dermatology and Medicine, Stanford University, Stanford, California
ⁱ Department of Dermatology, Columbia University, New York, New York
^j Department of Radiation Oncology, Stanford University, Stanford, California
^k Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
^l Division of Hematology, University of North Carolina, Chapel Hill, North Carolina
^m Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
ⁿ Department of Hematology & Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia
^o Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
^p Division of Hematology, Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
^q Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
^r Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
^s Department of Dermatology, University of Virginia Schar Cancer Institute, Fairfax, Virginia
^t Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
^u Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
^v Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
^w Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
^x Division of Oncology, Department of Medicine, Stanford University, Stanford, California
^y Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
^z Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
^aa Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina
^ab Division of Hematology and Oncology, University of Washington, Seattle, Washington
^ac Department of Hematology and Oncology, New York Presbyterian - Columbia University Irving Medical Center, New York, New York
^ad Division of Dermatology, Department of Pathology, Beckman Research Institute, City of Hope National Medical Center, Duarte, California
^ae Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
^af Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, Florida
^ag Division of Internal Medicine, Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
^ah Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
^ai Division of Hematology & Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
^aj Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut

^∗Correspondence to: Amrita Goyal, MD, Department of Dermatology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55401.Department of DermatologyUniversity of Minnesota420 Delaware St SEMinneapolisMN55401

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 13 May 2025
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Abstract

Introduction

Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma. While MF generally follows an indolent course, a subset of patients will experience progressive and/or treatment-refractory disease. SS is an aggressive cutaneous T-cell lymphoma associated with high morbidity and mortality secondary to immune compromise and opportunistic infection.

Although allogeneic hematopoietic cell transplant (allo-HCT) is currently the only available potentially curative treatment modality for MF/SS and is included in the National Comprehensive Cancer Network and the American Society for Transplantation and Cellular Therapy treatment guidelines, there is no published guidance regarding referral criteria, timing and allo-HCT approach to help guide clinicians caring for these patients.

Methods

Delphi survey of 32 specialists in dermatology (n = 9), transplant hematology/oncology (n = 10), nontransplant hematology/oncology (n = 8), and radiation oncology (n = 5) from across the United States. Consensus required agreement of ≥75% of participants.

Results

Sixteen consensus statements were generated on 4 topics: 1) criteria for referral for consideration for allo-HCT, 2) allo-HCT preparative regimens and procedures, 3) disease status at the time of allo-HCT, and 4) multidisciplinary management in the pre- and post-transplant settings.

Conclusion

These clinical practice guidelines provide a framework for decision-making regarding allo-HCT for MF/SS and highlight areas for future prospective investigation.

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Key words : allogeneic, allogeneic stem cell transplant, conditioning, cutaneous T-cell lymphoma, dermatology, graft-versus-host, hematology/oncology, hematopoietic stem cell transplant, matched related donor, matched unrelated donor, myeloablative, mycosis fungoides, radiation oncology, reduced intensity, Sezary syndrome, stem cell transplant, transplant, total body irradiation, total lymphoid irradiation, total skin electron beam, TSEBT

Abbreviations used : allo-HCT, CTCL, LCT, MF, SS