Transplantation in the Treatment of Primary Cutaneous Aggressive Epidermotropic Cytotoxic CD8-Positive T-Cell Lymphoma

Several studies have suggested that hematopoietic stem cell transplantation (HSCT) might provide a cure for primary cutaneous aggressive epidermotropic cytotoxic CD8-positive T-cell lymphoma (CD8(+) PCAETL). We summarize published literature on this disease and present outcomes of 8 patients with CD8(+) PCAETL treated at our institution. In our experience, allogeneic HSCT and the novel agents brentuximab and pralatrexate show substantial activity against this disease. Background: Primary cutaneous aggressive epidermotropic cytotoxic CD8 positive T-cell lymphoma (CD8(+) PCAETL) is a rare subtype of peripheral T-cell lymphoma with poor outcomes and without a standardized treatment strategy. Allogeneic hematopoietic stem cell transplantation (HSCT) has been suggested as a potential curative therapy. Patients and Methods: We conducted a retrospective case series. We identified 8 patients with the diagnosis of CD8(+) PCAETL, 4 of whom also underwent allogeneic HSCT. Results: Eight patients were treated at our center with combination chemotherapy and several novel agents, including histone deacetylase inhibitors, brentuximab, and pralatrexate. Patients underwent a median of 8.5 treatments before HSCT. Six of the 8 patients examined, including all 4 who received an HSCT, were alive at their last follow-up. Conclusion: Allogeneic HSCT is a promising treatment modality for CD8(+) PCAETL. Because of the aggressive nature of this disease and lack of sustained remission with currently available therapies, HSCT should be considered early in the course of treatment. Two novel agents, brentuximab and pralatrexate, showed significant activity against CD8(+) PCAETL, and may be incorporated earlier in the treatment course. (C) 2017 Elsevier Inc. All rights reserved.