Allogeneic haematopoietic cell transplant in cutaneous T‐cell lymphomas: Recommendations from the <scp>EBMT PH</scp>&amp;G Committee

Journal of the European Academy of Dermatology and Venereology
Open Access

Clinical Summary

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What was studied

Expert consensus guidance from the EBMT PH&G Committee on when and how to use allogeneic haematopoietic cell transplantation for cutaneous T‑cell lymphomas (mycosis fungoides and Sézary syndrome), covering referral criteria, timing/bridging, donor selection, conditioning/GVHD prophylaxis, and post‑transplant care.

Key findings

In the CUTALLO propensity‑matched prospective study (n=99), allo‑HCT prolonged PFS to 9.0 months vs 3.0 months with conventional therapy (HR 0.38, 95% CI 0.21–0.69; p<0.0001). Historical/pooled benchmarks for allo‑HCT show 5‑year OS 38% and PFS 26% (EBMT registry), and OS 51% at 1 year and 40% at 3 years with PFS 42% at 1 year and 33% at 3 years (meta‑analysis).

Study limitations

Recommendations rest largely on retrospective series, registry analyses, and small prospective cohorts, with heterogeneous conditioning, donor sources, and peri‑transplant practices. Evidence for haploidentical donors, modern GVHD prophylaxis (e.g., PTCy), MRD monitoring, and maintenance strategies remains limited or inconclusive.

Clinical implications

Refer high‑risk MF/SS early; aim for CR or deep response (VGPR or mSWAT <10) before RIC allo‑HCT, prefer MRD/MUD donors, and observe a 6‑week washout after pre‑HCT mogamulizumab. Manage relapse with immunosuppression taper and DLI, adding site‑directed therapy or TSEB as indicated; routine post‑HCT MRD monitoring or maintenance is not recommended.