Autologous bone marrow transplantation for advanced stage mycosis fungoides

Patients with advanced stage cutaneous T cell lymphoma (CTCL) have a median survival of 2-5 years with no currently available curative therapy. This limited pilot study was performed to determine if CTCL patients could undergo autologous bone marrow transplantation (ABMT) as a curative treatment without developing life-threatening infections. Since selection of a chemotherapeutic regimen is essentially empirical at this time, several drug combinations were screened. Total skin electron beam radiotherapy was used prior to transplantation to control the skin disease of four patients. Six patients have been transplanted and all have engrafted normally. Infections that developed after transplantation responded to conventional therapy and were typical of those observed in other patients undergoing ABMT. Five of the six patients had a complete clinical response to ABMT but three of these responses lasted less than 100 days. Two recent patients who were treated with carmustine, etoposide, and cisplatin are alive more than 1 year after transplantation without evidence of active disease. Thus, although this study does not prove the efficacy of ABMT, it does demonstrate that patients with CTCL can undergo ABMT without developing life-threatening infections and that carmustine-etoposide-cisplatin plus ABMT should be evaluated in subsequent studies to treat patients with poor prognosis CTCL.