701
|
Olek-Hrab K, Silny W. Diagnostics in mycosis fungoides and Sezary syndrome. Rep Pract Oncol Radiother 2013; 19:72-6. [PMID: 24936324 DOI: 10.1016/j.rpor.2013.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/20/2013] [Indexed: 12/17/2022] Open
Abstract
AIM The aim of this paper was to present diagnostic methods helping in the recognition of mycosis fungoides (MF) and Sezary syndrome (SS). BACKGROUND Mycosis fungoides is the most common form of primary cutaneous T-cell lymphomas. It is characterized by a distinctive long-term course and malignant T-cell proliferation. MF diagnosis is not easy, mainly due to the atypical clinical presentation of the disease at an early stage. MATERIALS AND METHODS Low specific changes, which can be observed at the histopathological examination. Initially, the skin lesions may resemble psoriasis, atopic dermatitis or chronic eczema. Patients are qualified according to the available, and generally accepted WHO-EORTC classification, based on a combination of clinical and histopathological markers. From a clinical point of view, it is also important to carry out the qualification according to the TNMB assessment, which allows to specify the stage of the disease, and is helpful in the monitoring of the course of disease and therapeutic effects. RESULTS In this paper we try to present currently available diagnostic methods. CONCLUSION Diagnosis of MF and SS still causes many problems due to less characteristic changes in the early stage of disease and requires wide interdisciplinary knowledge.
Collapse
Affiliation(s)
- Karolina Olek-Hrab
- Department of Dermatology of Karol Marcinkowski University of Medical Sciences in Poznań, Poland
| | - Wojciech Silny
- Department of Dermatology of Karol Marcinkowski University of Medical Sciences in Poznań, Poland
| |
Collapse
|
702
|
Sugaya M, Tokura Y, Hamada T, Tsuboi R, Moroi Y, Nakahara T, Amano M, Ishida S, Watanabe D, Tani M, Ihn H, Aoi J, Iwatsuki K. Phase II study of i.v. interferon-gamma in Japanese patients with mycosis fungoides. J Dermatol 2013; 41:50-6. [DOI: 10.1111/1346-8138.12341] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/13/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Makoto Sugaya
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Shizuoka Japan
| | - Toshihisa Hamada
- Departments of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Ryoji Tsuboi
- Department of Dermatology; Tokyo Medical University; Tokyo Japan
| | - Yoichi Moroi
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Takeshi Nakahara
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Masahiro Amano
- Department of Dermatology; Faculty of Medicine; University of Miyazaki; Miyazaki Japan
| | - Syuichi Ishida
- Department of Dermatology; Yokohama City University School of Medicine; Kanagawa Japan
| | - Daisuke Watanabe
- Department of Dermatology; Aichi Medical University; Nagoya Japan
| | - Mamori Tani
- Department of Dermatology; Osaka University Graduate School of Medicine; Osaka Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery; Kumamoto University; Kumamoto Japan
| | - Jun Aoi
- Department of Dermatology and Plastic Surgery; Kumamoto University; Kumamoto Japan
| | - Keiji Iwatsuki
- Departments of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| |
Collapse
|
703
|
Abstract
PURPOSE The pharmacology, pharmacokinetic and pharmacodynamic properties, and clinical data on a novel therapy for the treatment of cutaneous or peripheral T-cell lymphoma (CTCL, PTCL) are summarized. SUMMARY Romidepsin is the only bicyclic histone deacetylase (HDAC) inhibitor to undergo clinical development. A potent and specific inhibitor of class 1 HDACs, romidepsin has linear pharmacokinetics and is primarily metabolized by cytochrome P-450 isoenzyme 3A4. In two Phase II studies involving patients with relapsed or refractory CTCL, romidepsin therapy produced overall response rates of 34-35% (including patients with advanced and heavily pretreated disease), with a complete response seen in about 6% of patients in both studies; romidepsin responses were seen across all evaluated disease sites (skin, blood, lymph, viscera). In two Phase II studies in patients with relapsed or refractory PTCL, romidepsin produced overall response rates of 25-38%, and 15-18% of patients experienced a complete response; therapeutic responses were seen across major PTCL subtypes regardless of the number or types of previous therapies or refractoriness to the last prior therapy. In clinical trials to date, romidepsin therapy was generally well tolerated, with nausea, fatigue, and vomiting reported as the most common nonhematologic adverse events. However, thrombocytopenia and neutropenia are relatively common events, especially in patients with PTCL. CONCLUSION Romidepsin, a class 1-specific HDAC inhibitor, induces durable responses, with a manageable toxicity profile, in patients with relapsed or refractory CTCL or PTCL who have few therapeutic options.
Collapse
Affiliation(s)
- Angie L McGraw
- Middle Tennessee Medical Center, 1700 Medical Center Parkway, Murfreesboro, TN 37129, USA.
| |
Collapse
|
704
|
Horna P, Deaver DM, Qin D, Moscinski LC, Sotomayor EM, Glass LF, Sokol L. Quantitative flow cytometric identification of aberrant T cell clusters in erythrodermic cutaneous T cell lymphoma. Implications for staging and prognosis. J Clin Pathol 2013; 67:431-6. [PMID: 24319102 DOI: 10.1136/jclinpath-2013-201748] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS Assessment of peripheral blood tumour burden for staging of cutaneous T cells lymphoma is most often accomplished by flow cytometry (FC) using various non-standarised strategies. We report the results of calculating absolute Sezary cell counts (SCCs) by FC, based on the identification of aberrant T cell clusters on a virtual 6-dimensional space and independently of the expected immunophenotype (6D-FC SCC). METHODS 6D-FC SCCs were calculated on 65 peripheral blood specimens from 28 patients with erythrodermic cutaneous T cells lymphoma (stage III or IV). Comparisons were made with recommended FC strategies and correlations with overall mortality were studied. RESULTS At first visit, 17 of 28 patients (61%) had 6D-FC SCCs meeting current criteria for Stage IV disease (≥1000 SC/μL); while only 2 patients (7%) met Stage IV criteria on other tissues. As defined by comprehensive staging using clinicomorphological criteria and 6D-FC SCCs, Stage IV disease identified a subgroup of patients with worse overall survival (p=0.0227). Residual non-aberrant CD4 T cells were markedly decreased in Stage IV disease (p=0.018). Among 65 specimens, discrepancies were observed between 6D-FC SCCs and usual FC thresholds for Stage IV disease, namely a CD4:CD8 ratio ≥10:1 (9 discrepancies, 14%), and ≥40% aberrant CD4 T cells (4 discrepancies, 6%). Surprisingly, 8 cases (12%) from 6 patients exhibited two distinctively separate clusters of aberrant CD4 T cells with different CD7 and/or CD26 expression. CONCLUSIONS Visual 6-dimensional identification of aberrant T cell clusters by FC allows for the calculation of clinically significant SCCs. Simplified gating strategies and relative quantitative values might underestimate the immunophenotypical complexity of Sezary cells.
Collapse
Affiliation(s)
- Pedro Horna
- Department of Hematopathology and Labororatory Medicine, H. Lee Moffitt Cancer Center, , Tampa, Florida, USA
| | | | | | | | | | | | | |
Collapse
|
705
|
Weng WK, Armstrong R, Arai S, Desmarais C, Hoppe R, Kim YH. Minimal Residual Disease Monitoring with High-Throughput Sequencing of T Cell Receptors in Cutaneous T Cell Lymphoma. Sci Transl Med 2013; 5:214ra171. [DOI: 10.1126/scitranslmed.3007420] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
706
|
Thonnart N, Ram-Wolff C, Bagot M, Bensussan A, Marie-Cardine A. Aberrant expression of CD56 by circulating Sézary syndrome malignant T lymphocytes. World J Immunol 2013; 3:68-71. [DOI: 10.5411/wji.v3.i3.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/28/2013] [Accepted: 10/16/2013] [Indexed: 02/05/2023] Open
Abstract
Sézary syndrome (SS) is an aggressive variant of cutaneous T cell lymphoma characterized by the presence of malignant T cells in the skin, peripheral blood and lymph nodes. The tumoral population typically displays a CD3+ CD4+ CD45RO+ memory T cell phenotype. We report a case of SS with an aberrant CD56+ immunophenotype. This patient presented with a generalized erythroderma and palpable small axillary lymph nodes. SS (stage IVA) was diagnosed on histological criteria and by the detection of a major T cell clone in skin and blood, an elevated CD4/CD8 T cell ratio and Sézary cells count > 1000/mm3. Beside the Sézary cell marker KIR3DL2, immunostainings revealed that two third of the malignant cells expressed CD56 but no other natural killer (NK) cell marker such as CD16, CD160 or NKp46. This atypical expression was not linked to an activation-dependent process and remained stable during the time course of the disease. No loss of the pan T-cell markers CD2, CD3 or CD4 was detected while a complete down-modulation of CD26 was observed. Despite several lines of treatment, no durable amelioration was observed and patient died after 10 mo of follow-up. Because this CD4+ CD56+ SS case is the only one reported so far, the functional significance of CD56 expression remained difficult to assess in terms of aggressiveness and prognosis.
Collapse
|
707
|
Silva Dos Santos L, Drummond MR, da Costa França AFE, Cintra ML, Ferreira Velho PEN. Paraffin-embedded tissue: an alternative to Bartonella sp. infection diagnosis. J Dtsch Dermatol Ges 2013; 16:1147-1148. [PMID: 24251729 DOI: 10.1111/ddg.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
708
|
de Masson A, Beylot-Barry M, Bouaziz JD, Peffault de Latour R, Aubin F, Garciaz S, d'Incan M, Dereure O, Dalle S, Dompmartin A, Suarez F, Battistella M, Vignon-Pennamen MD, Rivet J, Adamski H, Brice P, François S, Lissandre S, Turlure P, Wierzbicka-Hainaut E, Brissot E, Dulery R, Servais S, Ravinet A, Tabrizi R, Ingen-Housz-Oro S, Joly P, Socié G, Bagot M. Allogeneic stem cell transplantation for advanced cutaneous T-cell lymphomas: a study from the French Society of Bone Marrow Transplantation and French Study Group on Cutaneous Lymphomas. Haematologica 2013; 99:527-34. [PMID: 24213148 DOI: 10.3324/haematol.2013.098145] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The treatment of advanced stage primary cutaneous T-cell lymphomas remains challenging. In particular, large-cell transformation of mycosis fungoides is associated with a median overall survival of two years for all stages taken together. Little is known regarding allogeneic hematopoietic stem cell transplantation in this context. We performed a multicenter retrospective analysis of 37 cases of advanced stage primary cutaneous T-cell lymphomas treated with allogeneic stem cell transplantation, including 20 (54%) transformed mycosis fungoides. Twenty-four patients (65%) had stage IV disease (for mycosis fungoides and Sézary syndrome) or disseminated nodal or visceral involvement (for non-epidermotropic primary cutaneous T-cell lymphomas). After a median follow up of 29 months, 19 patients experienced a relapse, leading to a 2-year cumulative incidence of relapse of 56% (95%CI: 0.38-0.74). Estimated 2-year overall survival was 57% (95%CI: 0.41-0.77) and progression-free survival 31% (95%CI: 0.19-0.53). Six of 19 patients with a post-transplant relapse achieved a subsequent complete remission after salvage therapy, with a median duration of 41 months. A weak residual tumor burden before transplantation was associated with increased progression-free survival (HR=0.3, 95%CI: 0.1-0.8; P=0.01). The use of antithymocyte globulin significantly reduced progression-free survival (HR=2.9, 95%CI: 1.3-6.2; P=0.01) but also transplant-related mortality (HR=10(-7), 95%CI: 4.10(-8)-2.10(-7); P<0.001) in univariate analysis. In multivariate analysis, the use of antithymocyte globulin was the only factor significantly associated with decreased progression-free survival (P=0.04). Allogeneic stem cell transplantation should be considered in advanced stage primary cutaneous T-cell lymphomas, including transformed mycosis fungoides.
Collapse
|
709
|
Dummer R, Rozati S, Guenova E, Cozzio A. Less can be more: the impact of chemotherapy on cutaneous T-cell lymphomas. Future Oncol 2013; 9:1061-4. [PMID: 23902236 DOI: 10.2217/fon.13.87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
710
|
Brandenburg A, Humme D, Terhorst D, Gellrich S, Sterry W, Beyer M. Long-term outcome of intravenous therapy with rituximab in patients with primary cutaneous B-cell lymphomas. Br J Dermatol 2013; 169:1126-32. [DOI: 10.1111/bjd.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 12/01/2022]
Affiliation(s)
- A. Brandenburg
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
- Dermatologikum Hamburg; Hamburg Germany
| | - D. Humme
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| | - D. Terhorst
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
- Centre d'Immunologie Marseille-Luminy; INSERM - CNRS - Université de la Mediterannée; Marseille France
| | - S. Gellrich
- Medical practice for Dermatology and Allergy Sylke Gellrich; Berlin Germany
| | - W. Sterry
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| | - M. Beyer
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| |
Collapse
|
711
|
Moritz RKC, Ditschkowski M, Klemke CD, Terras S, Schlaak M, Knorr M, Theurich S, Hegenbart U, Kremens B, Beelen DW, Stücker M, Kreuter A. Allogeneic stem cell transplantation in patients with aggressive primary cutaneous T-cell lymphoma - a case series of the ADF working group "cutaneous lymphomas". J Dtsch Dermatol Ges 2013; 12:39-46. [PMID: 24134607 DOI: 10.1111/ddg.12212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 08/07/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Allogeneic stem cell transplantation (alloSCT) is a treatment option for primary cutaneous T-cell lymphomas that may induce long-lasting complete remissions. Little information is available on safety and efficacy. PATIENTS AND METHODS We retrospectively reviewed the data from patients with primary cutaneous T-cell lymphoma treated in the Departments of Dermatology of the Universities of Bochum, Mannheim and Cologne who received subsequent alloSCT between 2005 and 2012. RESULTS Nine patients with aggressive primary cutaneous T-cell-lymphoma received alloSCT. With a follow-up of 14 to 36 months after transplantation, 4 patients are alive and in complete remission. Two patients had recurrent disease post-transplantation, which was successfully treated with donor lymphocyte infusions. Non-relapse mortality was observed in three patients in advanced disease stages within six months after alloSCT. One patient showed only partial remission and died of disease after 32 months and one patient died 26 months after alloSCT with cause of death unknown. CONCLUSIONS This report documents the possible benefit of a graft-versus-lymphoma effect in primary cutaneous T-cell lymphoma, as has been observed for other T-cell malignancies and emphasizes that alloSCT warrants further studies in this setting.
Collapse
|
712
|
Aggressive Behavior and Elevated Lactate Dehydrogenase at Baseline Confer Inferior Prognosis in Patients With Primary Cutaneous Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:534-40. [DOI: 10.1016/j.clml.2013.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 01/22/2023]
|
713
|
Willemze R, Hodak E, Zinzani P, Specht L, Ladetto M. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi149-54. [DOI: 10.1093/annonc/mdt242] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
714
|
Pileri A, Delfino C, Grandi V, Pimpinelli N. Role of bexarotene in the treatment of cutaneous T-cell lymphoma: the clinical and immunological sides. Immunotherapy 2013; 5:427-33. [PMID: 23557425 DOI: 10.2217/imt.13.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of lymphoid neoplasms. The incidence of CTCLs has risen over the last three decades. The most common CTCLs are mycosis fungoides and Sèzary syndrome. Therapies for CTCLs are various and range from skin-directed therapy to chemotherapy. Retinoids have been used in CTCL treatment since the 1980s with good results. Bexarotene is the first retinoid approved by the US FDA for CTCL therapy. Since then, numerous experiences of both its efficacy and mechanism of action have been reported. The aim of this paper is to review bexarotene action on CTCLs, as well as to highlight its immunological targets.
Collapse
Affiliation(s)
- Alessandro Pileri
- Dermatology, Department of Specialised, Experimental & Diagnostic Medicine, University of Bologna, Italy.
| | | | | | | |
Collapse
|
715
|
Moraes FYD, Carvalho HDA, Hanna SA, Silva JLFD, Marta GN. Literature review of clinical results of total skin electron irradiation (TSEBT) of mycosis fungoides in adults. Rep Pract Oncol Radiother 2013; 19:92-8. [PMID: 24936326 DOI: 10.1016/j.rpor.2013.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/11/2013] [Accepted: 08/22/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is an extranodal, indolent non-Hodgkin lymphoma of T cell origin. Even with the establishment of MF staging, the initial treatment strategy often remains unclear. AIM The aim of this study was to review the clinical results of total skin electron beam therapy (TSEBT) for MF in adults published in English language scientific journals searched in Pubmed/Medline database until December 2012. RESULTS MF is very sensitive to radiation therapy (RT) delivered either by photons or by electrons. In limited patches and/or plaques local electron beam irradiation results in good outcomes besides the fact of not being superior to other modalities. For extensive patches and/or plaques data suggest that TSEBT shows superior response rates. The cutaneous disease presentation is favorably managed with radiotherapy due to its ability to treat the full thickness of deeply infiltrated skin. For generalized erythroderma presentation, TSEBT seems to be an appropriate initial therapy. For advanced disease, palliation, or recurrence after the first radiotherapy treatment course, TSEBT may still be beneficial, with acceptable toxicity. Recommended dose is 30-36 Gy delivered in 6-10 weeks. CONCLUSION TSEBT can be used to treat any stage of MF. It also presents good tumor response with symptoms of relief and a palliative effect on MF, either after previous irradiation or failure of other treatment strategies.
Collapse
Affiliation(s)
| | - Heloisa de Andrade Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libânes, São Paulo, SP, Brazil ; Radiotherapy - Department of Radiology and Oncology, Radiology Institute - InRad, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libânes, São Paulo, SP, Brazil ; Department of Radiation Oncology, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, SP, Brazil
| |
Collapse
|
716
|
Kaźmierska J. Clinical results of the total skin electron irradiation of the mycosis fungoides in adults. Conventional fractionation and low dose schemes. Rep Pract Oncol Radiother 2013; 19:99-103. [PMID: 24936327 DOI: 10.1016/j.rpor.2013.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/26/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is a rare skin condition, effectively treated by irradiation. Since 1951, different methods of total skin irradiation have been developed. Although dose-response effect has been demonstrated in many publications, controversies about low dose treatment still exist. AIM The analysis of results of the total skin electron irradiation (TSEI), especially low dose TSEI in comparison with standard dose treatment is the subject of this review. Also, acute and late side effects of radiotherapy in MF are discussed. MATERIALS AND METHODS Medline search and analysis of studies published between 1995 and 2012, containing key words: mycosis fungoides, standard dose TSEI, low dose TSEI, total skin electron beam therapy (TSEBT). RESULTS Detailed analysis of relevant studies demonstrated that standard dose radiotherapy 30-36 Gy is the most effective treatment used in clinical practice. Objective response rate (ORR) is high, especially for less advanced stages of disease. Complete response rate (CR), although slightly lower, is still relatively high. For more advanced MF, TSEI serves as a very good method of palliative treatment and relief of symptoms, like pruritus, pain or desquamation. There is no consensus regarding low dose TSEI; the method is widely accepted as a palliative treatment or in case of reirradiation. CONCLUSIONS Standard dose TSEI is an effective method of MF treatment for radical and palliative treatment, producing high rate of ORR and reasonably long time to progression (TTP). Acute and late side effect of treatment are mostly mild and easy to manage. Low dose TSEI is still in the phase of clinical studies.
Collapse
Affiliation(s)
- Joanna Kaźmierska
- Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland ; Electroradiology Department, University of Medical Sciences, Poznan, Poland
| |
Collapse
|
717
|
Accart N, Urosevic-Maiwald M, Dummer R, Bataille V, Kehrer N, Niculescu C, Limacher JM, Chenard MP, Bonnefoy JY, Rooke R. Lymphocytic infiltration in the cutaneous lymphoma microenvironment after injection of TG1042. J Transl Med 2013; 11:226. [PMID: 24063735 PMCID: PMC4015780 DOI: 10.1186/1479-5876-11-226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/17/2013] [Indexed: 11/16/2022] Open
Abstract
Background Primary cutaneous lymphomas (CLs), characterized by an accumulation of clonal T or B lymphocytes preferentially localized in the skin, have been successfully treated with interferons (IFNs) which counterbalance the Th2-immunosuppressive state associated with this pathology. In a phase I/II clinical trial, we correlated the local immune infiltrate and the anti-tumor effects of repeated intralesional administrations of an adenovirus vector expressing human interferon-gamma (IFN-g) termed TG1042, in patients with advanced primary cutaneous T-cell lymphomas (CTCL) or multilesional cutaneous B-cell lymphomas (CBCL). Methods For each patient, variation in time of specific lymphocyte populations, defined by immunohistochemical stainings, was assessed in biopsies of injected lesions. For each patient, the change in local immune response was associated with the patient’s objective response at the end of the study. Results Immunohistochemical analyses of biopsies indicate that infiltration of CD8+ T lymphocytes and of TIA-1+ cytotoxic T-cells in lesions injected with TG1042 correlates with clinical benefit. Conclusions These data suggest for the first time that a CD8+ cytotoxic infiltrate, induced by local expression of IFN-g correlates with a clinical response. Trial registration The phase I step (TG1042.01) does not have a registration number. The phase II step (TG1042.06) registration number was NCT00394693.
Collapse
Affiliation(s)
- Nathalie Accart
- Transgene S,A,, Boulevard Gonthier d'Andernach, Parc d'Innovation, 67405 Cedex Illkirch Graffenstaden, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
718
|
Abstract
Sézary syndrome (SS) is an incurable leukemic variant of cutaneous T-cell lymphoma characterized by recurrent chromosomal alterations, among which, chromosome 10q deletion is very frequent. In this study, we investigated the PTEN status, on locus 10q23, in 44 SS patients; our findings show that PTEN is deleted in 36% of SS cases, whereas PTEN downregulation is observed in almost all of the samples evaluated by quantitative reverse-transcriptase polymerase chain reaction and Western blotting analysis. Neither DNA sequence mutation nor promoter hypermethylation were found at the PTEN locus, but we demonstrate that PTEN level can be also reduced by a group of miRs previously found upregulated and of prognostic relevance in SS; particularly, miR-21, miR-106b, and miR-486 were able to control PTEN abundance either in vitro or in vivo. Finally, because reduced PTEN activates the PI3/AKT-mediated pathway of cell growth and survival, we demonstrate that PTEN deficiency is associated with activated AKT in skin resident but not circulating SS cells, suggesting that the cutaneous milieu may strongly contribute to the SS cell growth. To our knowledge, this is the first study fully exploring the PTEN status in a large cohort of SS patients, unveiling potential elements of clinical utility in this malignancy.
Collapse
|
719
|
Quéreux G, Brocard A, Saint-Jean M, Peuvrel L, Knol AC, Allix R, Khammari A, Renaut JJ, Dréno B. Photodynamic therapy with methyl-aminolevulinic acid for paucilesional mycosis fungoides: a prospective open study and review of the literature. J Am Acad Dermatol 2013; 69:890-7. [PMID: 24041738 DOI: 10.1016/j.jaad.2013.07.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/05/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Publications reporting photodynamic therapy (PDT) in mycosis fungoides (MF) are rare, involve small samples, and are difficult to compare because of a lack of technical standardization. OBJECTIVE We sought to assess PDT effectiveness and tolerability in early-stage MF using a strict reproducible procedure. METHODS This was a prospective study conducted in Nantes University Hospital, France, including patients older than 18 years with histologically proven MF (stage IA or IB). Methyl-aminolevulinic acid-PDT sessions were repeated monthly for 6 months. Clinical and histologic responses were assessed 1 month after the last session. Patient satisfaction was assessed by telephone survey. RESULTS Twelve patients (with 29 lesions) were treated with PDT. An objective response in target lesions was obtained in 75% of patients. Response rates were similar between plaques and patches but higher in sun-protected compared with sun-exposed areas (trend without reaching significance). During PDT, new lesions appeared in 5 of 12 patients in untreated areas. Most patients were highly satisfied and preferred PDT to the topical chemotherapy previously used. LIMITATIONS PDT procedure criteria selection was partially arbitrary. CONCLUSIONS In early-stage MF, PDT is effective and appreciated (especially when compared with conventional topical chemotherapy). Unilesional and paucilesional forms and lesions in sun-protected areas are to be preferred.
Collapse
Affiliation(s)
- Gaelle Quéreux
- Skin Cancer Unit, Nantes University Hospital, Nantes, France
| | | | | | | | | | | | | | | | | |
Collapse
|
720
|
Kopp KL, Ralfkiaer U, Nielsen BS, Gniadecki R, Woetmann A, Ødum N, Ralfkiaer E. Expression of miR-155 and miR-126 in situ in cutaneous T-cell lymphoma. APMIS 2013; 121:1020-4. [PMID: 24033365 DOI: 10.1111/apm.12162] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 12/29/2022]
Abstract
Recently, miR-155 has been implicated in cutaneous T-cell lymphoma (CTCL). Thus, elevated levels of miR-155 were observed in skin lesions from CTCL patients as judged from qPCR and micro-array analysis and aberrant, high miR-155 expression was associated with severe disease. Moreover, miR-155 promoted proliferation of malignant T cells in vitro. Little is, however, known about which cell types express miR-155 in vivo in CTCL skin lesions. Here, we study miR-155 expression using in situ hybridization (ISH) with a miR-155 probe, a negative control (scrambled), and a miR-126 probe as a positive control in nine patients with mycosis fungoides, the most frequent subtype of CTCL. We provide evidence that both malignant and non-malignant T cells stain weakly to moderately positive with the miR-155 probe, but generally negative with the miR-126 and negative control probes. Reversely, endothelial cells stain positive for miR-126 and negative for miR-155 and the control probe. Solitary T cells with a malignant morphology display brighter staining with the miR-155 probe. Taken together, our findings suggest that both malignant and non-malignant T cells express miR-155 in situ in CTCL. Moreover, they indicate heterogeneity in miR-155 expression among malignant T cells.
Collapse
Affiliation(s)
- Katharina L Kopp
- Department of International Health, Immunology and Microbiology (UoC), Copenhagen, Denmark
| | | | | | | | | | | | | |
Collapse
|
721
|
Li JY, Pulitzer MP, Myskowski PL, Dusza SW, Horwitz S, Moskowitz A, Querfeld C. A case-control study of clinicopathologic features, prognosis, and therapeutic responses in patients with granulomatous mycosis fungoides. J Am Acad Dermatol 2013; 69:366-74. [DOI: 10.1016/j.jaad.2013.03.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 11/30/2022]
|
722
|
Tobisawa SI, Honma M, Ishida-Yamamoto A, Saijo Y, Iizuka H. Prognostic factors in 105 Japanese cases of mycosis fungoides and Sézary syndrome: Clusterin expression as a novel prognostic factor. J Dermatol Sci 2013; 71:160-6. [DOI: 10.1016/j.jdermsci.2013.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 04/10/2013] [Accepted: 04/20/2013] [Indexed: 01/27/2023]
|
723
|
Chaudhary S, Bansal C, Ranga U, Singh K. Erythrodermic mycosis fungoides with hypereosinophilic syndrome: a rare presentation. Ecancermedicalscience 2013; 7:337. [PMID: 23940492 PMCID: PMC3738031 DOI: 10.3332/ecancer.2013.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Indexed: 11/12/2022] Open
Abstract
Mycosis fungoides (MF) is the most common variant of primary cutaneous T-cell lymphoma (CTCL). It is generally associated with an indolent clinical course and characterised by well-defined clinicopathological features. Although rare, CTCLs constitute 65% of all cutaneous lymphoid malignancies, of which 50% are patients with MF. The erythrodermic variants of MF, a malignancy of mature, skin homing and clonal T lymphocytes, usually present in mid to late adulthood. Association with hypereosinophilia is important in prognosis. We report a case of erythrodermic MF with hypereosinophilic syndrome in a 22-year-old female presenting with gradually progressive intractable erythroderma with intensely pruritic multiple papules, plaques, and nodules involving more than 90% of body surface area. Diagnosis was confirmed by histopathological examination and immunophenotyping from multiple skin biopsies.
Collapse
Affiliation(s)
- Savita Chaudhary
- Department of Dermatology, Era's Lucknow Medical College and Hospital, Lucknow 226003, Uttar Pradesh, India
| | | | | | | |
Collapse
|
724
|
Reduced-intensity conditioning followed by cord blood transplantation in a patient with refractory folliculotropic mycosis fungoides. Int J Hematol 2013; 98:491-5. [DOI: 10.1007/s12185-013-1410-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
|
725
|
Carter JB, Barnes JA, Niell BL, Nardi V. Case records of the Massachusetts General Hospital. Case 24-2013. A 53-year-old woman with erythroderma, pruritus, and lymphadenopathy. N Engl J Med 2013; 369:559-69. [PMID: 23924007 DOI: 10.1056/nejmcpc1201415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Joi B Carter
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | |
Collapse
|
726
|
Duvic M, Geskin L, Prince HM. Duration of Response in Cutaneous T-Cell Lymphoma Patients Treated With Denileukin Diftitox: Results From 3 Phase III Studies. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:377-84. [DOI: 10.1016/j.clml.2013.02.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 01/04/2013] [Accepted: 02/01/2013] [Indexed: 11/16/2022]
|
727
|
Quéreux G, Saint-Jean M, Peuvrel L, Brocard A, Knol AC, Dréno B. Bexarotene in cutaneous T-cell lymphoma: third retrospective study of long-term cohort and review of the literature. Expert Opin Pharmacother 2013; 14:1711-21. [PMID: 23837676 DOI: 10.1517/14656566.2013.810718] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Bexarotene was approved for cutaneous T-cell lymphoma (CTCL) in 1999. Apart from the two first clinical trials published ten years ago, very few data were published on the long-term use of bexarotene in CTCL patients. OBJECTIVES We performed a retrospective review of CTCL patients treated with bexarotene at a single skin Cancer department between 2002 and 2012. We aimed to determine retrospectively the long-term tolerability and outcome of bexarotene in a cohort of CTCL patients and to compare these results with data from the literature. RESULTS Thirty-two patients were included (18 men/14 women); 20 patients had a mycosis fungoïdes and 12 a Sézary syndrome. The longest bexarotene treatment duration observed was 65.2 months and 10 patients were treated for more than 24 months. A clinical response was reported in 60% of all patients and in 75% of patients with Sézary syndrome. Most common drug-related adverse events were hypothyroidism (94%), hypertriglyceridemia (78%) and hypercholesterolemia (44%). Most events (84%) were mild to moderate. CONCLUSIONS This study with a very long observation time confirms that bexarotene is well tolerated by CTCL patients during long-term use. It is effective in early and advanced stages of CTCL.
Collapse
Affiliation(s)
- Gaëlle Quéreux
- Nantes University Hospital, Skin Cancer Unit, INSERM 892, 1 Place Alexis Ricordeau 44093, Nantes Cedex, France
| | | | | | | | | | | |
Collapse
|
728
|
Abstract
Inappropriately regulated expression of interleukin (IL)-17A is associated with the development of inflammatory diseases and cancer. However, little is known about the role of other IL-17 family members in carcinogenesis. Here, we show that a set of malignant T-cell lines established from patients with cutaneous T-cell lymphoma (CTCL) spontaneously secrete IL-17F and that inhibitors of Janus kinases and Signal transducer and activator of transcription 3 are able to block that secretion. Other malignant T-cell lines produce IL-17A but not IL-17F. Upon activation, however, some of the malignant T-cell lines are able to coexpress IL-17A and IL-17F, leading to formation of IL-17A/F heterodimers. Clinically, we demonstrate that IL-17F messenger RNA expression is significantly increased in CTCL skin lesions compared with healthy donors and patients with chronic dermatitis. IL-17A expression is also increased and a significant number of patients express high levels of both IL-17A and IL-17F. Concomitantly, we observed that the expression of the IL-17 receptor is significantly increased in CTCL skin lesions compared with control subjects. Importantly, analysis of a historic cohort of 60 CTCL patients indicates that IL-17F expression is associated with progressive disease. These findings implicate IL-17F in the pathogenesis of CTCL and suggest that IL-17 cytokines and their receptors may serve as therapeutic targets.
Collapse
|
729
|
CD164 and FCRL3 are highly expressed on CD4+CD26- T cells in Sézary syndrome patients. J Invest Dermatol 2013; 134:229-236. [PMID: 23792457 PMCID: PMC3869886 DOI: 10.1038/jid.2013.279] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/03/2013] [Accepted: 05/20/2013] [Indexed: 12/22/2022]
Abstract
Sézary syndrome (SS) cells express cell surface molecules also found on normal activated CD4 T cells. In an effort to find a more specific surface marker for malignant SS cells, a microarray analysis of gene expression was performed. Results showed significantly increased levels of mRNA for CD164, a sialomucin found on human CD34+ hematopoietic stem cells, and FCRL3, a molecule present on a subset of human natural T regulatory cells. Both markers were increased in CD4 T cells from SS patients compared to healthy donors. Flow cytometry studies confirmed the increased expression of CD164 and FCRL3 primarily on CD4+CD26− T cells of SS patients. Importantly, a statistically significant correlation was found between an elevated percentage of CD4+CD164+ T cells and an elevated percentage of CD4+CD26− T cells in all tested SS patients but not in patients with Mycosis Fungoides and atopic dermatitis or healthy donors. FCRL3 expression was significantly increased only in high tumor burden patients. CD4+CD164+ cells displayed cerebriform morphology and their loss correlated with clinical improvement in treated patients. Our results suggest that CD164 can serve as a marker for diagnosis and for monitoring progression of CTCL/SS and that FCRL3 expression correlates with a high circulating tumor burden.
Collapse
|
730
|
Quaglino P, Knobler R, Fierro MT, Savoia P, Marra E, Fava P, Bernengo MG. Extracorporeal photopheresis for the treatment of erythrodermic cutaneous T-cell lymphoma: a single center clinical experience with long-term follow-up data and a brief overview of the literature. Int J Dermatol 2013; 52:1308-18. [PMID: 23786842 DOI: 10.1111/ijd.12121] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extracorporeal photopheresis (ECP) is a therapeutic procedure in which leukapheresed peripheral blood mononuclear cells are exposed to ultraviolet A in the presence of the photosensitizer 8-methoxypsoralen and then reinfused. Several guidelines recommend ECP as a treatment of choice in erythrodermic primary cutaneous T-cell lymphomas (E-CTCL). However, the level of evidence is low due to the rarity of this disease and the lack of randomized controlled trials. We performed a review of the English literature, restricting our analysis to studies including erythrodermic patients and more than 10 cases. Based on these criteria, we identified 28 studies, with a total of 407 patients. The median response rate in erythrodermic patients was 63% (range 31-86%), with a complete response rate ranging between 0 and 62% (median 20%). In our experience, we treated 51 patients with E-CTCL since 1992. A clinical response was obtained in 32 of 51 patients (63%), with a 16% complete response rate. The median time for response induction was eight months (range: 1-23). The median response duration was 22.4 months (range six months to 11 years). The treatment was generally well tolerated without systemic toxicities grade III-IV. The pretreatment parameters significantly associated with a higher likelihood to obtain a clinical response were the B-score in the peripheral blood, CD4/CD8 ratio, and amount of circulating CD3+CD8+ cells. Literature data together with our personal experience clearly support the clinical activity and tolerability of ECP in patients with E-CTCL. Prospective controlled clinical trials are strongly recommended to better document the evidence.
Collapse
Affiliation(s)
- Pietro Quaglino
- Department of Medical Sciences and Human Oncology, Section of Dermato-Oncology, University of Turin, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
731
|
Jang MS, Jang JG, Han SH, Park JB, Kang DY, Kim ST, Suh KS. Clinicopathological features of mycosis fungoides in patients exposed to Agent Orange during the Vietnam War. J Dermatol 2013; 40:606-12. [DOI: 10.1111/1346-8138.12202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/22/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Min Soo Jang
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| | - Jun Gyu Jang
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| | - Sang Hwa Han
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| | - Jong Bin Park
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| | - Dong Young Kang
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| | - Sang Tae Kim
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| | - Kee Suck Suh
- Department of Dermatology; Kosin University College of Medicine; Busan; South Korea
| |
Collapse
|
732
|
A cutaneous lymphoma international prognostic index (CLIPi) for mycosis fungoides and Sezary syndrome. Eur J Cancer 2013; 49:2859-68. [PMID: 23735705 DOI: 10.1016/j.ejca.2013.04.018] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no prognostic index for primary cutaneous T-cell lymphomas such as mycosis fungoides (MF) and Sezary syndrome (SS). METHOD Two prognostic indices were developed for early (IA-IIA) and late stage (IIB-IVB) disease based on multivariate data from 1502 patients. End-points included overall survival (OS) and progression free survival (PFS). External validation included 1221 patients. FINDINGS Significant adverse prognostic factors at diagnosis consisted of male gender, age >60, plaques, folliculotropic disease and stage N1/Nx for early stage, and male gender, age >60, stages B1/B2, N2/3 and visceral involvement for late stage disease. Using these variables we constructed two separate models each defined using 3 distinct groups for early and late stage patients: 0-1 (low risk), 2 (intermediate risk), and 3-5 factors (high risk). 10 year OS in the early stage model was 90.3% (low), 76.2% (intermediate) and 48.9% (high) and for the late stage model 53.2% (low), 19.8% (intermediate) and 15.0% (high). For the validation set significant differences in OS and PFS in early stage patients (both p<0.001) were also noted. In late stage patients, only OS differed between the groups (p=0.002). INTERPRETATION This proposed cutaneous lymphoma prognostic index provides a model for prediction of OS in early and late stage MF/SS enabling rational therapeutic choices and patient stratification in clinical trials.
Collapse
|
733
|
Improvement in peripheral blood disease burden in patients with Sézary syndrome and leukemic mycosis fungoides after total skin electron beam therapy. J Am Acad Dermatol 2013; 68:972-7. [DOI: 10.1016/j.jaad.2012.09.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/13/2012] [Accepted: 09/24/2012] [Indexed: 11/21/2022]
|
734
|
Fernández-Guarino M, Jaén-Olasolo P. Terapia fotodinámica en micosis fungoides. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2012.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
735
|
Gu X, Wang Y, Zhang G, Li W, Tu P. Aberrant expression of BCL11B in mycosis fungoides and its potential role in interferon-induced apoptosis. J Dermatol 2013; 40:596-605. [PMID: 23682716 DOI: 10.1111/1346-8138.12160] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 03/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaoguang Gu
- Department of Dermatology and Venerology; Peking University First Hospital; Beijing; China
| | - Yang Wang
- Department of Dermatology and Venerology; Peking University First Hospital; Beijing; China
| | - Gaolei Zhang
- Department of Dermatology and Venerology; Peking University First Hospital; Beijing; China
| | - Weiwei Li
- Department of Dermatology and Venerology; Peking University First Hospital; Beijing; China
| | - Ping Tu
- Department of Dermatology and Venerology; Peking University First Hospital; Beijing; China
| |
Collapse
|
736
|
Levidou G, Siakantaris M, Papadaki T, Papadavid E, Vassilakopoulos TP, Angelopoulou MK, Marinos L, Nikolaou V, Economidi A, Antoniou C, Patsouris E, Korkolopoulou P. A comprehensive immunohistochemical approach of AKT/mTOR pathway and p-STAT3 in mycosis fungoides. J Am Acad Dermatol 2013; 69:375-84. [PMID: 23685026 DOI: 10.1016/j.jaad.2013.04.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/19/2012] [Accepted: 04/08/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although the expression pattern of phosphorylated (p)-mTOR pathway components has attracted scientific interest in several neoplasms, to our knowledge, there is no published information regarding its significance in mycosis fungoides (MF). OBJECTIVE We sought to perform a comprehensive simultaneous assessment of key members of AKT/mTOR pathway along with p-extracellular signal-regulated kinase (ERK), NOTCH1, and p-STAT3 in patients with MF. METHODS In all, 54 skin biopsy specimens (21 tumors, 30 plaques, and 3 folliculotropic MF) from 50 patients with MF were analyzed immunohistochemically for p-mTOR, its upstream p-AKT, its downstream effectors p-p70S6K and p-4E-BP1, and for p-ERK1/2, NOTCH1, and p-STAT3. RESULTS p-mTOR was coexpressed with p-p70S6K in 67.3% of lesions, but coexpression with other molecules was less common. p-p70S6K and marginally NOTCH1 displayed higher H-scores in tumors than in plaques. Significant correlations were recorded between p-ERK and p-4E-BP1, as well as between NOTCH1 and p-p70S6K or p-4E-BP1. NOTCH1, p-4E-BP1, and p-p70S6K expression were associated with advanced stage. In survival analysis simultaneous overexpression of p-AKT and p-p70S6K, along with p-4E-BP1 positivity, adversely affected cancer-specific, disease-free, and progression-free survival in advanced-stage cases. LIMITATIONS A limitation may be the small number of cases included in our investigation, precluding multivariate survival analysis. CONCLUSIONS Activation of AKT/mTOR pathway in MF appears to be correlated with NOTCH1, p-ERK, and p-STAT3 and is implicated in the acquisition of a more aggressive phenotype. The combination of p-AKT, p-p70S6K, and p-4E-BP1 emerges as a significant potential prognostic marker in patients with advanced stage.
Collapse
Affiliation(s)
- Georgia Levidou
- Department of Pathology, University of Athens, Medical School, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
737
|
Photodynamic therapy in mycosis fungoides. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:393-9. [PMID: 23664412 DOI: 10.1016/j.adengl.2012.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 11/07/2012] [Indexed: 11/23/2022] Open
Abstract
Photodynamic therapy involves the topical application of a photosensitizer to a lesion, which is then subsequently exposed to a light source. It is mainly used in the nonsurgical treatment of nonmelanoma skin cancer, in which it achieves good response and an excellent cosmetic result. In the last 10 years, photodynamic therapy has also been used with some success in the treatment of plaque-stage mycosis fungoides and has emerged as an alternative to skin-directed therapies. Its main advantages are the good response to treatment, lack of toxicity, and excellent cosmetic results. This article reviews the literature and the practical application of photodynamic therapy in mycosis fungoides.
Collapse
|
738
|
Stadler R, Assaf C, Klemke CD, Nashan D, Weichenthal M, Dummer R, Sterry W. Brief S2k guidelines - Cutaneous lymphomas. J Dtsch Dermatol Ges 2013; 11 Suppl 3:19-28, 20-30. [DOI: 10.1111/ddg.12015_5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rudolf Stadler
- Department of Dermatology; Johannes Wesling Klinikum; Minden Germany
| | - Chalid Assaf
- Department of Dermatology; HELIOS Klinikum; Krefeld Germany
| | - Claus-Detlev Klemke
- Department of Dermatology, Venereology, and Allergology; Mannheim University Hospital; Germany
| | | | - Michael Weichenthal
- Department of Dermatology, Venereology, and Allergology; University Hospital Schleswig-Holstein (UKSH); Campus Kiel Germany
| | - Reinhard Dummer
- Department of Dermatology; Zürich University Hospital; Switzerland
| | - Wolfram Sterry
- Department of Dermatology; Venereology, and Allergology, Charité - Universitätsmedizin Berlin; Germany
| |
Collapse
|
739
|
Vonderheid EC, Pavlov I, Delgado JC, Martins TB, Telang GH, Hess AD, Kadin ME. Prognostic factors and risk stratification in early mycosis fungoides. Leuk Lymphoma 2013; 55:44-50. [DOI: 10.3109/10428194.2013.790541] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
740
|
Iwakura T, Ohashi N, Tsuji N, Naito Y, Isobe S, Ono M, Fujikura T, Tsuji T, Sakao Y, Yasuda H, Kato A, Fujiyama T, Tokura Y, Fujigaki Y. Calcitriol-induced hypercalcemia in a patient with granulomatous mycosis fungoides and end-stage renal disease. World J Nephrol 2013; 2:44-48. [PMID: 24175265 PMCID: PMC3782225 DOI: 10.5527/wjn.v2.i2.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 03/27/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
An 86-year-old man, diagnosed as having mycosis fungoides in May 2008 and treated with repeated radiation therapy, was admitted to our hospital for initiation of hemodialysis due to end-stage renal disease (ESRD) in April 2012. On admission, his corrected serum calcium level was 9.3 mg/dL, and his intact parathyroid hormone level was 121.9 pg/mL (normal range 13.9-78.5 pg/mL), indicating secondary hyperparathyroidism due to ESRD. After starting hemodialysis, urinary volume diminished rapidly. The serum calcium level increased (12.7 mg/dL), and the intact parathyroid hormone level was suppressed (< 5 pg/mL), while the 1,25-dihydroxyvitamin D3 (calcitriol) level increased (114 pg/mL, normal range: 20.0-60.0 pg/mL) in June 2012. The possibilities of sarcoidosis and tuberculosis were ruled out. Skin biopsies from tumorous lesions revealed a diagnosis of granulomatous mycosis fungoides. The serum soluble interleukin-2 receptor levels and the degrees of skin lesions went in parallel with the increased serum calcium and calcitriol levels. Therefore, the patient was diagnosed as having calcitriol-induced hypercalcemia possibly associated with granulomatous mycosis fungoides. Granulomatous mycosis fungoides is rare, and its association with calcitriol-induced hypercalcemia has not been reported. Careful attention to calcium metabolism is needed in patients with granulomatous mycosis fungoides, especially in patients with ESRD.
Collapse
|
741
|
Song SX, Willemze R, Swerdlow SH, Kinney MC, Said JW. Mycosis fungoides: report of the 2011 Society for Hematopathology/European Association for Haematopathology workshop. Am J Clin Pathol 2013; 139:466-90. [PMID: 23525617 DOI: 10.1309/ajcpobdp2oqaj5br] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Session 1 of the 2011 Workshop of the Society for Hematopathology and European Association for Haematopathology focused on mycosis fungoides (MF), the most common cutaneous lymphoma. The 62 cases in this case group demonstrated a wide spectrum of clinicopathologic features, including those seen in typical cases as well as those, by contrast, with atypical clinical history, morphology, immunophenotype, and/or genotype. Of the 62 cases, 27 (44%) were presented at the workshop and highlighted diagnostic challenges plus related issues. This report summarizes the approach recommended for making a confident diagnosis of MF and its clinically significant variants; emphasizes pitfalls in evaluating early MF, assessing nodal involvement, and diagnosing transformed MF; and discusses the relationship between MF and primary cutaneous CD30+ T-cell lymphoproliferative disorders. Last, Sézary syndrome is discussed, with concentration on those features distinct from MF.
Collapse
Affiliation(s)
- Sophie X. Song
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, CA
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Steven H. Swerdlow
- Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Marsha C. Kinney
- Department of Pathology, University of Texas Health Science Center, San Antonio, TX
| | - Jonathan W. Said
- Department of Pathology and Laboratory Medicine, UCLA Medical Center, Los Angeles, CA
| |
Collapse
|
742
|
|
743
|
Schmitt C, Marie-Cardine A, Bagot M, Bensussan A. Natural killer reprogramming in cutaneous T-cell lymphomas: Facts and hypotheses. World J Immunol 2013; 3:1-6. [DOI: 10.5411/wji.v3.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To better understand the pathogenesis of Sézary cells, distinguish them from reactive skin-infiltrating T-cells and improve disease treatment, efforts have been made to identify molecular targets deregulated by the malignant process. From immunophenotypic analysis and subtractive differential expression experiments to pan-genomic studies, many approaches have been used to identify markers of the disease. During the last decade several natural killer (NK) cell markers have been found aberrantly expressed at the surface of Sézary cells. In particular, KIR3DL2/CD158k, expressed by less than 2% of healthy individuals CD4+ T-cells, is an excellent marker to identify and follow the tumor burden in the blood of Sézary syndrome patients. It may also represent a valuable target for specific immunotherapy. Other products of the NK cluster on chromosome 19q13 have been detected on Sézary cells, raising the hypothesis of an NK reprogramming process associated with the malignant transformation that may induce survival functions.
Collapse
|
744
|
Duvic M, Martin AG, Olsen EA, Fivenson DP, Prince HM. Efficacy and safety of denileukin diftitox retreatment in patients with relapsed cutaneous T-cell lymphoma. Leuk Lymphoma 2013; 54:514-9. [PMID: 22891708 DOI: 10.3109/10428194.2012.720372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This open-label phase III trial, a companion to an earlier placebo-controlled trial, evaluated safety and efficacy of denileukin diftitox (DD) in patients with cutaneous T-cell lymphoma (CTCL) who relapsed after responding to DD primary treatment in the earlier trial. Twenty relapsed patients (stages IA-III) received DD 18 μg/kg/day intravenously on days 1-5 of a 21-day cycle, for ≤ 8 cycles. Efficacy was assessed monthly during the first year then every 3 months. The overall response rate was 40%, mostly partial responses. Nine patients (all baseline stages ≤ IIA) experienced progression. Intent-to-treat median progression-free survival was 205 days, and median duration of response was 274 days. The most common adverse events were nausea, upper respiratory tract infections, fatigue and rigors. Three patients withdrew because of toxicity. This study showed that DD may provide clinically meaningful benefit in patients with CTCL who relapsed after initial response to DD.
Collapse
Affiliation(s)
- Madeleine Duvic
- The University of Texas, MD Anderson Cancer Center, Department of Dermatology, Houston, TX 77030-4095, USA.
| | | | | | | | | |
Collapse
|
745
|
Abstract
Mycosis fungoides is a candidate for skin-directed therapies in its initial stages. In recent years, therapeutic options outside of the normal treatment recommendations such as topical imiquimod, topical tazarotene, topical methotrexate, excimer light sources, and photodynamic therapy have been published with variable results. These alternatives have been useful in cases of localized mycosis fungoides that do not respond to routine treatments; nevertheless, more studies on these methods are still needed. This article summarizes the literature and data that are known so far about these treatments.
Collapse
|
746
|
Cheeley J, Sahn RE, DeLong LK, Parker SR. Acitretin for the treatment of cutaneous T-cell lymphoma. J Am Acad Dermatol 2013; 68:247-54. [DOI: 10.1016/j.jaad.2012.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 06/21/2012] [Accepted: 07/10/2012] [Indexed: 11/28/2022]
|
747
|
Döbbeling U, Waeckerle-Men Y, Zabel F, Graf N, Kündig TM, Johansen P. The antihistamines clemastine and desloratadine inhibit STAT3 and c-Myc activities and induce apoptosis in cutaneous T-cell lymphoma cell lines. Exp Dermatol 2013; 22:119-24. [DOI: 10.1111/exd.12086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Udo Döbbeling
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - Ying Waeckerle-Men
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - Franziska Zabel
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - Nicole Graf
- Center for Clinical Research; University of Zurich; Zurich; Switzerland
| | - Thomas M. Kündig
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| | - Pål Johansen
- Department of Dermatology; University Hospital Zurich; Zurich; Switzerland
| |
Collapse
|
748
|
Ladizinski B, Bazakas A, Olsen EA. Aprepitant: a novel neurokinin-1 receptor/substance P antagonist as antipruritic therapy in cutaneous T-cell lymphoma. J Am Acad Dermatol 2013; 67:e198-9. [PMID: 23062910 DOI: 10.1016/j.jaad.2012.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/20/2012] [Accepted: 02/02/2012] [Indexed: 10/27/2022]
|
749
|
Imam MH, Shenoy PJ, Flowers CR, Phillips A, Lechowicz MJ. Incidence and survival patterns of cutaneous T-cell lymphomas in the United States. Leuk Lymphoma 2013; 54:752-9. [PMID: 23004352 DOI: 10.3109/10428194.2012.729831] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using the United States Surveillance, Epidemiology and End Results (SEER) 17 dataset, we examined incidence and survival patterns for patients with cutaneous T-cell lymphomas (CTCLs) diagnosed following institution of the World Health Organization-European Organisation for Research and Treatment of Cancer (WHO-EORTC) classification. From 2005 to 2008, 2273 cases of CTCL were diagnosed. The age-adjusted incidence rate per 100,000 person-years for mycosis fungoides (MF) was 0.55 and for Sézary syndrome (SS) was 0.01. Incidence was higher among males (MF/SS male-to-female incidence rate ratio [IRR] 1.57) and black patients (MF black-to-white IRR 1.55). Black patients with CTCL were diagnosed at a younger age and black patients with MF/SS presented with advanced stage and had worse survival than white patients. In multiple-variable Cox-regression models, age > 60 (hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.97-7.70), black race (HR 2.09, 95% CI 1.29-3.37) and advanced stage (HR 6.06, 95% CI 3.66-10.05) predicted worse survival for patients with MF/SS. Additional research identifying reasons for these differences are necessary to better understand these diseases and for new strategies in the treatment of CTCL.
Collapse
|
750
|
Damaj G, Gressin R, Bouabdallah K, Cartron G, Choufi B, Gyan E, Banos A, Jaccard A, Park S, Tournilhac O, Schiano-de Collela JM, Voillat L, Joly B, Le Gouill S, Saad A, Cony-Makhoul P, Vilque JP, Sanhes L, Schmidt-Tanguy A, Bubenheim M, Houot R, Diouf M, Marolleau JP, Béné MC, Martin A, Lamy T. Results From a Prospective, Open-Label, Phase II Trial of Bendamustine in Refractory or Relapsed T-Cell Lymphomas: The BENTLY Trial. J Clin Oncol 2013; 31:104-10. [DOI: 10.1200/jco.2012.43.7285] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the efficacy and safety of bendamustine as a single agent in refractory or relapsed T-cell lymphomas. Patients and Methods Patients with histologically confirmed peripheral T-cell lymphoma (PTCL) or cutaneous T-cell lymphoma who progressed after one or more lines of prior chemotherapy received bendamustine at 120 mg/m2 per day on days 1 through 2 every 3 weeks for six cycles. The primary end point was overall response rate (ORR). Secondary end points were duration of response (DOR), progression-free survival (PFS), and overall survival (OS). Results Of the 60 patients included, 27 (45%) were refractory to their last prior chemotherapy, and the median duration of the best previous response was 6.6 months. Histology was predominantly angioimmunoblastic lymphadenopathy and PTCL not otherwise specified. The disease was disseminated in the majority of patients (87%). The median number of previous lines of chemotherapy was one (range, one to three). Twenty patients (33%) received fewer than three cycles of bendamustine, mostly because of disease progression. In the intent-to-treat population, the ORR was 50%, including complete response in 17 patients (28%) and partial response in 13 patients (22%). Bendamustine showed consistent efficacy independent of major disease characteristics. The median values for DoR, PFS, and OS were 3.5, 3.6, and 6.2 months, respectively. The most frequent grade 3 to 4 adverse events were neutropenia (30%), thrombocytopenia (24%), and infections (20%). Conclusion Bendamustine showed an encouraging high response rate across the two major PTCL subtypes, independent of age and prior treatment, with acceptable toxicity in refractory or relapsed T-cell lymphoma.
Collapse
Affiliation(s)
- Gandhi Damaj
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Rémy Gressin
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Krimo Bouabdallah
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Guillaume Cartron
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Bachra Choufi
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Emmanuel Gyan
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Anne Banos
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Arnaud Jaccard
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Sophie Park
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Olivier Tournilhac
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Jean-Marc Schiano-de Collela
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Laurent Voillat
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Bertrand Joly
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Steven Le Gouill
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Alain Saad
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Pascale Cony-Makhoul
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Jean-Pierre Vilque
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Laurence Sanhes
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Aline Schmidt-Tanguy
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Michael Bubenheim
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Roch Houot
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Momar Diouf
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Jean-Pierre Marolleau
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Marie-Christine Béné
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Antoine Martin
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| | - Thierry Lamy
- Gandhi Damaj, Momar Diouf, and Jean-Pierre Marolleau, Centre Hospitalier Universitaire (CHU), Amiens; Rémy Gressin, CHU de Grenoble and L'Institut National de la Santé et de la Recherche Médicale (INSERM) U823, Institut Albert Bonniot, Grenoble; Krimo Bouabdallah, CHU, Bordeaux; Guillaume Cartron, CHU, Montpellier; Bachra Choufi, Hôpital Duchenne, Boulogne sur Mer; Emmanuel Gyan, INSERM and Clinical Investigation Center (CIC) U202, CHU, Tours; Anne Banos, Hôpital de Bayonne, Bayonne; Arnaud Jaccard, CHU,
| |
Collapse
|