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. 2018 Sep 5;10(3):7497.
doi: 10.4081/hr.2018.7497.

Long-term complete remission of early hematological relapse after discontinuation of immunosuppressants following allogeneic transplantation for Sezary syndrome

Hiroki Hosoi  1 , Kazuo Hatanaka  1 , Shogo Murata  1 , Toshiki Mushino  1 , Kodai Kuriyama  1 , Akinori Nishikawa  1 , Nobuyoshi Hanaoka  1 , Shinobu Tamura  1 , Hideki Nakakuma  1 , Takashi Sonoki  1
Affiliations

Long-term complete remission of early hematological relapse after discontinuation of immunosuppressants following allogeneic transplantation for Sezary syndrome

Hiroki Hosoi et al. Hematol Rep. .

Abstract

Sezary syndrome (SS) is a leukemic form of cutaneous T-cell lymphoma and is chemo-resistant. Allogeneic hematopoietic stem cell transplantation is a promising therapy for SS; however, relapse is common. Therapeutic options after relapse have not been established. We managed an SS patient with hematological relapse within one month after transplantation. After discontinuation of immunosuppressants, she achieved complete remission and remained relapse-free. The chimeric analyses of Tcells showed that the full recipient type became complete donor chimera after immunological symptoms. This clinical course suggested that discontinuation of immunosuppressants may result in a graftversus- tumor effect, leading to the eradication of lymphoma cells.

Keywords: Allo-HSCT; Graft versus tumor effect; Sezary syndrome.

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Conflict of interest statement

Conflict of interest: the authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Clinical course. After tapering prednisolone and discontinuing cyclosporine, Sezary cells gradually decreased. Bars indicate the result of chimerism analyses of T-cell fraction. The black bar indicated the percentage of donor type. The white bar indicated the percentage of recipient type. After reducing the dose of immunosuppressants, the percentage of donor chimera in T-cell fraction increased. TBI, total body irradiation; CY, cyclophosphamide; FN, febrile neutropenia; GVHD, graft-versus-host disease; CsA, cyclosporine; PSL, prednisolone; WBC, white blood cell.
Figure 2.
Figure 2.
Skin feature. At relapse, the patient suffered from erythroderma. At complete remission, the erythroderma disappeared. A) The skin of antebrachium at relapse after transplantation. B) The skin of abdomen at relapse after transplantation. C) The skin of antebrachium at complete remission after discontinuation of immunosuppressants. D) The skin of abdomen at complete remission after discontinuation of immunosuppressants.
See this image and copyright information in PMC

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