Understanding TreatmentOptions in
Cutaneous Lymphoma
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Cutaneous T-Cell Lymphomas
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StemCell Transplantation
If cutaneous lymphoma recurs after treatment andnumerous other treatments
have been tried and are no longer effective, a stem cell transplantmay be
considered.A stem cell is an immature cell in the bonemarrow that candevelop
intomature blood cells. Stem cell transplantations are serious treatments that
shouldnot be taken lightly or considered early in a patient’s disease journey and
may not be suitable for all patients. For a stem cell transplant, patients are given
highdoses of chemotherapy or radiation,which kills stem cells in the bone
marrow that develop into blood cells.The bonemarrow cells are then replaced
with the patient’s ownhealthy stem cells storedprior to treatment (autologous
stem cell transplantation) or those from a geneticallymatcheddonor (allogeneic
stem cell transplantation).Of these 2 types of transplants, allogeneic stem cell
transplantation is the only procedure used for patientswithCTCL.These stems
cellswill formnew, healthywhite blood cells.
The ability to transplant stem cells allows physicians to use higher doses of
chemotherapy to treat the cancer than the patient couldnormally tolerate.
High-dose chemotherapy candestroy not only cancer cells, but alsohealthy
bonemarrowneeded tomaintain a patient’s blood cells.After high-dose
chemotherapy,which is sometimes givenwith radiation, blood cell counts are
low,which increases a patient’s risk of infection, and the ability of the blood to
clot is reduced,whichmay increase the risk of bleeding. In addition, because
the chemotherapy doses are higher, side effects from the chemotherapymay be
more intense, especially immediately following transplantation and for a few
weeks afterward.Patientswith adverse health conditions or thosewho aremore
advanced in agemay be at higher riskwhile undergoing this procedure.
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Because patientswith adverse health conditions and/or thosewithmore
advanced age are put at higher riskwhen their bonemarrow is destroyed,
theymay be candidates for reduced-intensity transplantation (also called
non-myeloablative ormini-allogeneic stem cell transplantation).During this
procedure, reduced-intensity treatment kills some of the cancer cells and some
of the bonemarrow, suppressing the immune system just enough to allow
the donor’s stem cells to be taken up.The cells from both the donor and the
patient exist together in the patient’s body. Slowly, the donor’s cells take over the
patient’s bonemarrow.These newdonor cellsmay be capable of responding to
the cutaneous lymphoma by helping the patient’s immune system kill the cancer
cells.This is a less intense approach than full stem cell transplantation.This
approach is being investigatedmore thoroughly andmay become adopted by
more physicians for the treatment of a broader range of patients if it proves to
be sufficiently effective inhealthier patients.
With allogeneic stem cell transplantation, there is a risk of graft-versus-host
disease (GVHD). Immune cells are able todetect “foreign” tissues.GVHD
occurswhen the new stem cells from the donor see the recipient’s body cells
as foreign and attack them.GVHD is a common condition that can either be
aminor problem or a very serious one. It is usually controlledwithdrugs that
suppress the immune cells to keep them from attacking the recipient’s cells.
Stem cell transplantation is an area of great interest tomany leaders in the
field.There is significant discussion and investigation intodetermining the best
approach for treating patientswithCTCL.
