Mycosis Fungoides in Solid Organ Transplant Recipients: A Multicenter Retrospective Cohort Study

Background: Mycosis fungoides (MF) in solid-organ transplant recipients (SOTR) is rare, with limited data on disease characteristics. Objective: To study the characteristics of MF in SOTR with an emphasis on the immunosuppressive therapy. Methods: A retrospective cohort of patients diagnosed with MF, who were also SOTR, followed at 3 cutaneous lymphoma outpatient-clinics, between 1/2010-02/2022. Results: Ten patients were included, (7 male; median ages at transplantation and at-diagnosis of MF were, 33 and 48 years, respectively; 40% were diagnosed before the age of 18 years). Median time from transplantation to diagnosis of MF was 8 years, (range 0.5-22). Transplanted organs and immunosuppressive treatments included: liver, (n=5; 4 treated with tacrolimus, 1 with tacrolimus and prednisone), kidney (n=3), liver and kidney (n=1), and heart (n=1), all treated with mycophenolic acid, tacrolimus, and prednisone. Nine had early-stage MF, [IA-4, IB-5; 40% with early-folliculotropic MF], treated with skin-directed-therapies, in 2 combined with acitretin, achieving partial/complete response. One patient had advanced-stage MF (IIIA) with folliculotropic erythroderma, treated with-ultraviolet A and narrowband-ultraviolet B with acitretin, achieving partial response. Immunosuppression was modified in 3. At last follow-up, (median 4 years, range 1-8), no stage-progression was observed; 5 had no evidence of disease, 5 had active disease-(IA/IB-4, III-1). Conclusions: MF in SOTR is usually diagnosed at an early-stage, with over representation of folliculotropic MF, and of children. Immunosuppressive therapy alterations, not conducted in most patients, should be balanced against the risk of organ compromise/rejection. Disease-course was similar to MF in immunocompetent patients, during the limited time of follow-up.