Allogeneic hematopoietic cell transplant in cutaneous T-cell lymphomas: recommendations from the EBMT PH&G Committee

Abstract

This manuscript provides expert recommendations on the role of allogeneic hematopoietic cell transplantation (allo-HCT) for cutaneous T-cell lymphoma (CTCL), specifically Mycosis Fungoides (MF) and Sezary Syndrome (SS). Critical aspects such as patient selection, timing, and bridging therapy are addressed, as well as donor source, conditioning regimens and post-transplant management. These consensus guidelines are based on a thorough literature review and discussions among leading dermatologists and hematologists. These recommendations aim to harmonise clinical practice towards improving patient outcomes in these rare but aggressive lymphomas. It is of critical importance to consider allo-HCT early in the management of eligible patients with high-risk disease. Advanced stage, large-cell transformation, relapsed or refractory disease following systemic treatment, and N3-stage lymph node involvement are indicators that should trigger consultation with a transplant hematologist in parallel with a donor search. Early interaction between dermatologists and transplant hematologists is vital to avoiding delays, which can significantly impact post-transplant outcomes and survival. This EBMT Practice Harmonisation & Guidelines Committee consensus provides practical recommendations for the selection, timing, and conduct of allogeneic transplantation in advanced-stage mycosis fungoides and Sézary syndrome, aiming to optimize outcomes through early multidisciplinary collaboration and evidence-based decision making.