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SnapshotDx Quiz: May 2021. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sumarni U, Reidel U, Eberle J. Targeting Cutaneous T-Cell Lymphoma Cells by Ingenol Mebutate (PEP005) Correlates with PKCδ Activation, ROS Induction as Well as Downregulation of XIAP and c-FLIP. Cells 2021; 10:cells10050987. [PMID: 33922439 PMCID: PMC8146015 DOI: 10.3390/cells10050987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 01/25/2023] Open
Abstract
New therapeutic strategies are needed for cutaneous T-cell lymphoma (CTCL), and the plant extract ingenol mebutate (PEP005) may be considered. PEP005 has been approved for actinic keratosis, and proapoptotic activities were described in different cancer cells. Here, we aimed to investigate its efficacy in four CTCL cell lines and its mode of action. While HuT-78 and HH responded with induced apoptosis as well as with loss of cell viability and cell proliferation, MyLa and SeAx remained resistant. Interestingly, both sensitive and resistant cells showed caspase-8 activation and enhanced levels of reactive oxygen species (ROS), while final caspase-3 activation was restricted to sensitive cells. Apoptosis induction was prevented by the caspase inhibitor QVD-Oph as well as by the antioxidant vitamin E. Caspase activation by PEP005 may be explained to some extent by the downregulation of the caspase antagonistic proteins c-FLIP and XIAP in sensitive cells, whereas both proteins were strongly expressed in resistant cells. Finally, PEP005 resulted in the activation of proapoptotic PKCδ, and the PKC inhibitor bisindolylmaleimide I reduced apoptosis, caspase-3 processing and ROS production, as well as restored cell viability. In conclusion, PKCδ appeared as a central player in apoptosis regulation in CTCL cells, also suggesting its therapeutic targeting.
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MESH Headings
- Apoptosis
- CASP8 and FADD-Like Apoptosis Regulating Protein/antagonists & inhibitors
- Cell Cycle
- Cell Movement
- Cell Proliferation
- Diterpenes/pharmacology
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/metabolism
- Lymphoma, T-Cell, Cutaneous/pathology
- Protein Kinase C-delta/genetics
- Protein Kinase C-delta/metabolism
- Reactive Oxygen Species/metabolism
- Skin Neoplasms/drug therapy
- Skin Neoplasms/genetics
- Skin Neoplasms/metabolism
- Skin Neoplasms/pathology
- Tumor Cells, Cultured
- X-Linked Inhibitor of Apoptosis Protein/antagonists & inhibitors
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Keto J, Hahtola S, Linna M, Väkevä L. Mycosis fungoides and Sézary syndrome: a population-wide study on prevalence and health care use in Finland in 1998-2016. BMC Health Serv Res 2021; 21:166. [PMID: 33618714 PMCID: PMC7898452 DOI: 10.1186/s12913-021-06109-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Information about health care use and costs of cutaneous T-cell lymphoma (CTCL) patients is limited, particularly in a European setting. METHODS In this population-wide study we set out to investigate prevalence, and trends in health care use in two CTCL subtypes, mycosis fungoides (MF) and Sézary syndrome (SS) over a time period of 19 years in 1998-2016 by using a nation-wide patient register containing data on all diagnosed MF and SS cases in Finland. RESULTS The prevalence of diagnosed MF and SS rose from 2.04 to 5.38/100000, and from 0.16 to 0.36/100000 for MF and SS respectively during 1998-2016. We found a substantial decrease in inpatient treatment of MF/SS in the past two decades with a mean of 2 inpatient days/patient/year due to MF/SS in 2016, while the mean numbers of MF/SS related outpatient visits remained stable at 8 visits/year/patient. Most MF/SS-related outpatient visits occurred in the medical specialty of dermatology. In a ten-year follow-up after MF/SS diagnosis, the main causes for outpatient visits and inpatient stays were MF/SS itself, other cancers, and other skin conditions. Also cardiovascular disease and infections contributed to the number of inpatient days. Mean total hospital costs decreased from 11,600 eur/patient/year to 3600 eur/patient/year by year 4 of the follow-up, and remained at that level for the remainder of the 10-year follow-up. MF/SS accounted for approximately half of the hospital costs of these patients throughout the follow-up. CONCLUSIONS The nearly 3-fold increase in prevalence of diagnosed MF/SS during 1998-2016 puts pressure on the health care system, as this is a high-cost patient group with a heavy burden of comorbidities. The challenge can be in part answered by shifting the treatment of MF/SS to a more outpatient-based practice, and by adapting new pharmacotherapy, as has been done in Finland.
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Affiliation(s)
- Jaana Keto
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Sonja Hahtola
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Miika Linna
- Institute of Healthcare Engineering, Management and Architecture, Aalto University, Espoo, Finland
| | - Liisa Väkevä
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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McColl M, Boozalis E, Aguh C, Eseonu AC, Okoye GA, Kwatra SG. Pruritus in Black Skin: Unique Molecular Characteristics and Clinical Features. J Natl Med Assoc 2021; 113:30-38. [DOI: 10.1016/j.jnma.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/01/2020] [Accepted: 07/04/2020] [Indexed: 01/08/2023]
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Malachowski SJ, Moy A, Messina J, Chen YA, Sun J, Sokol L, Seminario-Vidal L. Mapping cutaneous T-cell lymphoma in the state of Florida: A retrospective exploratory spatial analysis of incidence patterns. J Am Acad Dermatol 2021; 86:186-188. [PMID: 33476732 DOI: 10.1016/j.jaad.2021.01.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Stephen J Malachowski
- Department of Dermatology and Cutaneous Surgery, University of South Florida (USF), Tampa, Florida; Department of Internal Medicine, St. Joseph's Hospital, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin
| | - Adrian Moy
- Department of Dermatology and Cutaneous Surgery, University of South Florida (USF), Tampa, Florida
| | - Jane Messina
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida; Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Y Ann Chen
- Departments of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer and Research Institute, Tampa, Florida
| | - James Sun
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida; Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, Ohio
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, University of South Florida (USF), Tampa, Florida; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida.
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Cutaneous Lymphomas — Part I: Mycosis Fungoides, Sézary Syndrome, and CD30+ Cutaneous Lymphoproliferative Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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57
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Pujol R, Gallardo F. Linfomas cutáneos. Parte I: micosis fungoide, síndrome de Sézary y proliferaciones linfoides cutáneas CD30 positivas. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:14-23. [DOI: 10.1016/j.ad.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022] Open
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Wohlmuth-Wieser I, Ramjist JM, Shear N, Alhusayen R. Morphologic Features of Cutaneous T-Cell Lymphomas Using Dermoscopy and High Frequency Ultrasound. J Clin Med 2020; 10:jcm10010017. [PMID: 33374774 PMCID: PMC7795589 DOI: 10.3390/jcm10010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023] Open
Abstract
The diagnosis of cutaneous T-cell lymphomas (CTCL) is frequently delayed by a median of three years and requires the clinical evaluation of an experienced dermatologist and a confirmatory skin biopsy. Dermoscopy and high-frequency ultrasound (HFUS) represent two non-invasive diagnostic tools. While dermoscopy is inexpensive and widely used for the diagnosis of melanoma and non-melanoma skin cancers, HFUS of skin lymphomas represents a novel diagnostic approach that is not yet implemented in the routine dermatologic practice. The aim of our study was to prospectively assess skin lesions of patients with either CTCL patches or plaques with dermoscopy and HFUS and to compare the findings with atopic dermatitis (AD) and psoriasis. Thirteen patients with an established diagnosis of CTCL, psoriasis, or AD were studied: Dermoscopy features including spermatozoa-like structures and the presence of white scales could assist in differentiating between early-stage CTCL and AD. HFUS measurements of the skin thickness indicated increased epidermal-, thickness in CTCL, and psoriasis compared with AD. Our results support the use of dermoscopy as a useful tool to diagnose CTCL. HFUS could augment the dermatologic assessment, but further studies will be needed to define standardized parameters.
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Affiliation(s)
- Iris Wohlmuth-Wieser
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada; (N.S.); (R.A.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
- Correspondence:
| | - Joel M. Ramjist
- Department of Electrical, Computer, and Biomedical Engineering, Ryerson University, Toronto, ON M5B 2K3, Canada;
| | - Neil Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada; (N.S.); (R.A.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Center, Toronto, ON M4N 3M5, Canada; (N.S.); (R.A.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Stainthorpe A, Fleeman N, Houten R, Chaplin M, Boland A, Beale S, Dundar Y, McEntee J, Syndikus I. Brentuximab Vedotin for Treating Relapsed or Refractory CD30-Positive Cutaneous T-Cell Lymphoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. PHARMACOECONOMICS - OPEN 2020; 4:563-574. [PMID: 32207075 PMCID: PMC7688836 DOI: 10.1007/s41669-020-00203-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
As part of the single technology appraisal process, the National Institute for Health and Care Excellence invited Takeda UK Ltd to submit clinical- and cost-effectiveness evidence for brentuximab vedotin (BV) for treating relapsed or refractory CD30-positive (CD30+) cutaneous T-cell lymphoma (CTCL). The Liverpool Reviews and Implementation Group at the University of Liverpool was commissioned to act as the evidence review group (ERG). This article summarises the ERG's review of the company's submission for BV and the appraisal committee (AC) decision. The principal clinical evidence was derived from a subgroup of patients with advanced-stage CD30+ mycosis fungoides (MF) or primary cutaneous anaplastic large-cell lymphoma (pcALCL) in the phase III ALCANZA randomised controlled trial (RCT). This trial compared BV versus physician's choice (PC) of methotrexate or bexarotene. Evidence from three observational studies was also presented, which included patients with other CTCL subtypes. The ERG's main concerns with the clinical evidence were the lack of RCT evidence for CTCL subtypes other than MF or pcALCL, lack of robust overall survival data (data were immature and confounded by subsequent treatment and treatment crossover on disease progression) and lack of conclusive results from analyses of health-related quality-of-life data. The ERG noted that many areas of uncertainty in the cost-effectiveness analysis were related to the clinical data, arising from the rarity of the condition and its subtypes and the complexity of the treatment pathway. The ERG highlighted that the inclusion of allogeneic stem-cell transplant (alloSCT) as an option in the treatment pathway was based on weak evidence and generated more uncertainty in a disease area that, because of its rarity and diversity, was already highly uncertain. The ERG also lacked confidence in the company's modelling of the post-progression pathway and was concerned that it may not produce reliable results. Results from the company's base-case comparison (including a simple discount patient access scheme [PAS] for BV) showed that treatment with BV dominated PC. The ERG's revisions and scenario analyses highlighted the high level of uncertainty around the company base-case cost-effectiveness results, ranging from BV dominating PC to an incremental cost-effectiveness ratio per quality-adjusted life-year gained of £494,981. The AC concluded that it was appropriate to include alloSCT in the treatment pathway even though data were limited. The AC recommended BV as an option for treating CD30+ CTCL after at least one systemic therapy in adults if they have MF, stage IIB or higher pcALCL or Sézary syndrome and if the company provides BV according to the commercial arrangement (i.e. simple discount PAS).
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Affiliation(s)
- Angela Stainthorpe
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Nigel Fleeman
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Rachel Houten
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Marty Chaplin
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Sophie Beale
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Joanne McEntee
- North West Medicines Information Centre, Liverpool, L69 3GF, UK
| | - Isabel Syndikus
- Faculty of Health and Life Sciences, University of Liverpool, Thompson Yates Building, Liverpool, L69 3GB, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, CH63 4JY, UK
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Mascolo M, Travaglino A, Varricchio S, Russo D, Sabattini E, Agostinelli C, Bertuzzi C, Baldo A, Pileri A, Picardi M, Pane F, Staibano S. Role of chromatin assembly factor-1/p60 and poly [ADP-ribose] polymerase 1 in mycosis fungoides. Virchows Arch 2020; 478:961-968. [PMID: 33098490 PMCID: PMC8099834 DOI: 10.1007/s00428-020-02952-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
Mycosis fungoides (MF) represents the most common type of cutaneous lymphoma. In the majority of patients, the disease has a slow evolution and a protracted course; however, a subset of patients shows poor oncologic outcomes. Unfortunately, there are no reliable prognostic markers for MF, and the currently available treatments are only effective in a minority of patients. This study aimed to evaluate the expression and clinical significance of PARP-1 and CAF-1/p60 in MF. Sixty-four MF representatives of the different stages of disease were assessed by immunohistochemistry for PARP-1 and CAF-1/p60. The association of PARP-1 and CAF-1/p60 with the MF stage and outcome was assessed by using Fisher’s exact test and Kaplan-Meier survival analysis with the Log-rank test; a p value < 0.05 was considered significant. PARP-1 was overexpressed in 57.9% of MF and was significantly associated with a MF stage > II (p = 0.034) but not with the risk of death (p = 0.237). CAF-1/p60 was overexpressed in 26.8% of MF and was significantly associated with decreased overall survival (p < 0.001) but not with the MF stage (p = 1). A significant association was found between PARP-1 overexpression and CAF-1/p60 overexpression (p = 0.0025). Simultaneous overexpression of PARP-1 and CAF-1/p60 was significantly associated with decreased overall survival (p < 0.001), although less strongly than CAF-1/p60 alone (χ2 = 14.916 vs 21.729, respectively). In MF, PARP-1 is overexpressed in advanced stages, while CAF-1/p60 is overexpressed in the cases with shorter overall survival, appearing as a significant prognostic marker. A role for PARP-1 inhibitors and anti-CAF-1/p60 targeted therapy may be reasonably hypothesized in MF.
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Affiliation(s)
- Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Clara Bertuzzi
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonello Baldo
- Department of Clinical Medicine and Surgery, Dermatology Section, University of Naples "Federico II", Naples, Italy
| | - Alessandro Pileri
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
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Ding X, Chen J, Kuai L, Xing M, Ru Y, Luo Y, Luo Y, Zhou M, Li B, Li X. CD4/CD8 dual-positive mycosis fungoides: A case report and literature review. Medicine (Baltimore) 2020; 99:e22786. [PMID: 33080750 PMCID: PMC7571916 DOI: 10.1097/md.0000000000022786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. It appears as patches, plaques, and tumors depending on the stage of the disease, which presents a chronic progressive course. Compared to CD4/CD8 MF, CD4/CD8 dual-positive MF is an uncommon immune phenotype. PATIENT CONCERNS A 36-year-old male patient presented with dryness and scales on his whole body. DIAGNOSIS The patient was diagnosed with MF based on results of pathological examination, immunohistochemical staining, and T-cell receptor gene rearrangement test. INTERVENTIONS The patient was advised to take an herbal medicine orally twice daily and apply a topical moisturizer after showering. OUTCOMES After treatment and follow-up, the patient's symptoms of dryness and scales improved and his condition stabilized. CONCLUSIONS While reviewing the literature, we found no previous reports on the treatment of dual-positive MF with Chinese medicine. In this report, we presented the first case of dual-positive MF successfully treated with Chinese medicine. The results suggest that oral ingestion of herbal medicine may be a feasible method for alleviating clinical symptoms of early stage MF. Therefore, the therapy should be explored for clinical use in the future.
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Affiliation(s)
- Xiaojie Ding
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Jia Chen
- Department of Dermatopathology, Shanghai Dermatology Hospital, Tongji University
| | - Le Kuai
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Meng Xing
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Yi Ru
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Ying Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Yue Luo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Mi Zhou
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Bin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Dobos G, Pohrt A, Ram-Wolff C, Lebbé C, Bouaziz JD, Battistella M, Bagot M, de Masson A. Epidemiology of Cutaneous T-Cell Lymphomas: A Systematic Review and Meta-Analysis of 16,953 Patients. Cancers (Basel) 2020; 12:cancers12102921. [PMID: 33050643 PMCID: PMC7600606 DOI: 10.3390/cancers12102921] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Cutaneous T-cell lymphomas (CTCL) are rare malignant diseases. In this study we have compared the cutaneous lymphoma registries of different countries, which included information on at least 100 patients. The frequencies of each CTCL subtype were compared within and between continents. We found that the registries differed importantly in terms of size and quality. Some rare CTCL subtypes, such as NK/T-cell lymphoma or subcutaneous panniculitis-like lymphomas, were more frequent in Asian countries, while others were evenly distributed. We discuss possible reasons for this and provide suggestions on how to build future CTCL registries. Abstract Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of rare diseases. Many studies have reported on local epidemiology or geographic clustering, however we lack information from a global perspective. A systematic review and meta-analysis was conducted in Medline and the Cochrane Library based on a previously registered protocol and according to the preferred reporting of items for systematic reviews and meta-analyses (PRISMA). We selected publications that enrolled at least 100 patients with primary cutaneous lymphomas according to the current classifications. The relative frequencies (proportions) of subtypes were compared between studies and geographic regions in a meta-analysis. In total, 26 studies met our inclusion criteria, reporting on altogether 16,953 patients. Within primary cutaneous lymphomas, CTCL appeared to be 15% more frequent in Asian populations. Mycosis fungoides (MF) accounted for 62% of CTCL, with an important heterogeneity in frequencies between studies and continents. The proportion of Sézary syndrome (SS) was 3%, stable worldwide. Rare CTCL, such as NK/T-cell lymphoma or subcutaneous panniculitis-like lymphoma, were more frequent in Asian studies. This global meta-analysis of CTCL confirmed the predominance of CTCL among primary cutaneous lymphomas (83% on average) in the three analyzed continents, most of which were MF cases. It revealed the same proportions of SS across continents, and the heterogeneity of MF frequencies, suggesting the possible role of environmental factors in the pathophysiology of the latter. Registration number: CRD42020148295 (PROSPERO).
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Affiliation(s)
- Gabor Dobos
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité-Universitättsmedizin, 10117 Berlin, Germany;
| | - Caroline Ram-Wolff
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
| | - Céleste Lebbé
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
| | - Jean-David Bouaziz
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
| | - Maxime Battistella
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
- Pathology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France
| | - Martine Bagot
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
- Correspondence: ; Tel.: +33-1-5372-2093
| | - Adèle de Masson
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
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Porcu P, Hudgens S, Horwitz S, Quaglino P, Cowan R, Geskin L, Beylot-Barry M, Floden L, Bagot M, Tsianakas A, Moskowitz A, Huen A, Dreno B, Dalle S, Caballero D, Leoni M, Dale S, Herr F, Duvic M. Quality of Life Effect of the Anti-CCR4 Monoclonal Antibody Mogamulizumab Versus Vorinostat in Patients With Cutaneous T-cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:97-105. [PMID: 33158772 DOI: 10.1016/j.clml.2020.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sézary syndrome (SS) and mycosis fungoides (MF), 2 types of cutaneous T-cell lymphoma, cause significant morbidity and adversely affect patients' quality of life (QoL). The present study assessed the QoL measurement changes in patients receiving mogamulizumab versus vorinostat. PATIENTS AND METHODS A multicenter phase III trial was conducted of patients with stage IB-IV MF/SS with ≥ 1 failed systemic therapy. The QoL measures included Skindex-29 and the Functional Assessment of Cancer Therapy-General. The symptoms, function, and QoL subdomains were longitudinally modeled using mixed models with prespecified covariates. Meaningful change thresholds (MCTs) were defined using distribution-based methods. The categorical changes by group over time and the time to clinically meaningful worsening were analyzed. RESULTS Of the 372 randomized patients, mogamulizumab demonstrated improvement in Skindex-29 symptoms (cycles 3, 5, and 7; P < .05) and functional (cycles 3 and 5; P < .05) scales. A significantly greater proportion of mogamulizumab-treated patients improved by MCTs or more from baseline in the Skindex-29 symptoms domain (cycles 3, 5, 7, and 11) and functioning domain (cycle 5). Significant differences in the Functional Assessment of Cancer Therapy-General physical well-being (cycles 1, 3, and 5; P < .05) were observed in favor of mogamulizumab and a greater proportion of patients had declined by MCTs or more at cycles 1, 3, 5, and 7 with vorinostat treatment. The median time to symptom worsening using Skindex-29 was 27.4 months for mogamulizumab versus 6.6 months for vorinostat. In the patients with SS, the time to worsening favored mogamulizumab (P < .005) for all Skindex-29 domains. The time to worsening was similar for the 2 MF treatment arms. CONCLUSION The symptoms, function, and overall QoL of patients with MF/SS favored mogamulizumab over vorinostat across all time points. Patients with the greatest symptom burden and functional impairment derived the most QoL benefit from mogamulizumab.
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Affiliation(s)
- Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Center, Thomas Jefferson University, Philadelphia, PA.
| | | | - Steven Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Richard Cowan
- Cancer Research UK - Christie Hospital Foundation NHS Trust, Manchester, UK
| | - Larisa Geskin
- Department of Dermatology, New York Presbyterian Hospital, New York, NY
| | | | | | - Martine Bagot
- Service de Dermatologie, Hôpital Saint Louis, Paris, France
| | - Athanasios Tsianakas
- Department of Dermatology, Specialist Clinic Bad Bentheim, Bad Bentheim, Germany
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Auris Huen
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brigitte Dreno
- Onco-Dermatology Department, CHU de Nantes - Nantes Hospital, Nantes, France
| | - Stéphane Dalle
- Immucare, Hospices Civils de Lyon, Cancer Research Center of Lyon, Lyon University, Pierre-Bénite, France
| | - Dolores Caballero
- Servicio de Hematología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - Mollie Leoni
- Kyowa Kirin Pharmaceutical Development, Inc, Princeton, NJ
| | - Stephen Dale
- Kyowa Kirin Pharmaceutical Development, Inc, Princeton, NJ
| | | | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX
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64
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Tawa M, Kopp E, McCann S, Cantrell W. Cutaneous T-Cell Lymphoma: Optimizing Care in Patients Receiving Anti-CCR4 Monoclonal Antibody Mogamulizumab. Clin J Oncol Nurs 2020; 23:E73-E80. [PMID: 31322628 DOI: 10.1188/19.cjon.e73-e80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL), including subtypes mycosis fungoides (MF) and Sézary syndrome (SS), represents a rare group of non-Hodgkin lymphomas. Mogamulizumab is a first-in-class monoclonal antibody that selectively binds to C-C chemokine receptor 4, which is overexpressed on the surface of tumor cells in T-cell malignancies, including MF/SS-type CTCL. OBJECTIVES This review identifies common diagnostic features of MF/SS, the efficacy and side effect profile of mogamulizumab, and practical management strategies for optimizing the nursing care of patients with MF/SS-type CTCL. METHODS Case studies are used to describe the role of mogamulizumab in CTCL and to review practical considerations when administering mogamulizumab to patients. FINDINGS Mogamulizumab is an effective treatment for adult patients with relapsed or refractory MF/SS-type CTCL who have received at least one prior systemic therapy. Infusion reactions and drug eruptions require prompt diagnosis and treatment.
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Affiliation(s)
| | - Erin Kopp
- City of Hope Comprehensive Cancer Center
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Bhat TS, Herbosa CM, Rosenberg AR, Sogade O, Jeffe DB, Mehta-Shah N, Semenov YR, Musiek AC. Current measures are not sufficient: an interview-based qualitative assessment of quality of life in cutaneous T-cell lymphoma. Br J Dermatol 2020; 184:310-318. [PMID: 32510571 DOI: 10.1111/bjd.19298] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL) negatively impacts quality of life (QoL), but existing QoL questionnaires may not comprehensively reflect patients' experience. OBJECTIVES To identify the aspects of QoL that are most meaningful to patients with CTCL and to evaluate existing QoL instruments in this context. METHODS Semistructured interviews were conducted between May and June 2019 using purposive sampling of patients with CTCL. Data were analysed by an inductive thematic approach using Dedoose Version 8.0.35. RESULTS One-on-one interviews lasting a median of 43 min were completed by 18 patients [median age 62 years (interquartile range 52-70); 39% advanced-stage (IIB-IV)]. Itch was the most common clinical symptom reported (16 of 18 patients), followed by pain (12 of 18), skin breaks (11 of 18) and skin flaking (10 of 18). Eleven patients reported that their symptoms interfered with sleep, which impacted daily functioning. Patients also noted a lack of understanding of the disease in the community and felt uncertain (12 of 18), depressed (11 of 18), suicidal (four of 18) and hopeless (nine of 18). Nearly all patients (17 of 18) reported a sense of 'otherness' (not feeling 'normal' or 'like themselves'), and most patients (16 of 18) specifically mentioned concern about their physical appearance. Patients also noted substantial treatment burden. Salient patient concerns, including individual clinical symptoms, concern about appearance and problems with sleep, were not adequately or consistently represented in generic, skin-specific or CTCL-specific QoL measures. CONCLUSIONS Incorporating the concerns and priorities that distinguish patients with CTCL from other patient populations will be of paramount importance in developing a comprehensive CTCL-specific measure of QoL that adequately captures patients' experience.
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Affiliation(s)
- T S Bhat
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
| | - C M Herbosa
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
| | - A R Rosenberg
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
| | - O Sogade
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
| | - D B Jeffe
- Department of Medicine, Washington Unive, St Louis, MO, USA
| | - N Mehta-Shah
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Y R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - A C Musiek
- Division of Dermatology, Washington University School of Medicine, St Louis, MO, USA
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66
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Mirza FN, Yumeen S, Girardi M. Disparities in outcomes of CD8 + cutaneous T-cell lymphoma by race and presenting lesion location. Br J Dermatol 2020; 184:170-171. [PMID: 32730673 DOI: 10.1111/bjd.19426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- F N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - S Yumeen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - M Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
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67
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Abstract
BACKGROUND Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, a malignant, chronic disease initially affecting the skin. Several therapies are available, which may induce clinical remission for a time. This is an update of a Cochrane Review first published in 2012: we wanted to assess new trials, some of which investigated new interventions. OBJECTIVES To assess the effects of interventions for MF in all stages of the disease. SEARCH METHODS We updated our searches of the following databases to May 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched 2 trials registries for additional references. For adverse event outcomes, we undertook separate searches in MEDLINE in April, July and November 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) of local or systemic interventions for MF in adults with any stage of the disease compared with either another local or systemic intervention or with placebo. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcomes were improvement in health-related quality of life as defined by participants, and common adverse effects of the treatments. Key secondary outcomes were complete response (CR), defined as complete disappearance of all clinical evidence of disease, and objective response rate (ORR), defined as proportion of patients with a partial or complete response. We used GRADE to assess the certainty of evidence and considered comparisons of psoralen plus ultraviolet A (PUVA) light treatment as most important because this is first-line treatment for MF in most guidelines. MAIN RESULTS This review includes 20 RCTs (1369 participants) covering a wide range of interventions. The following were assessed as either treatments or comparators: imiquimod, peldesine, hypericin, mechlorethamine, nitrogen mustard and intralesional injections of interferon-α (IFN-α) (topical applications); PUVA, extracorporeal photopheresis (ECP: photochemotherapy), and visible light (light applications); acitretin, bexarotene, lenalidomide, methotrexate and vorinostat (oral agents); brentuximab vedotin; denileukin diftitox; mogamulizumab; chemotherapy with cyclophosphamide, doxorubicin, etoposide, and vincristine; a combination of chemotherapy with electron beam radiation; subcutaneous injection of IFN-α; and intramuscular injections of active transfer factor (parenteral systemics). Thirteen trials used an active comparator, five were placebo-controlled, and two compared an active operator to observation only. In 14 trials, participants had MF in clinical stages IA to IIB. All participants were treated in secondary and tertiary care settings, mainly in Europe, North America or Australia. Trials recruited both men and women, with more male participants overall. Trial duration varied from four weeks to 12 months, with one longer-term study lasting more than six years. We judged 16 trials as at high risk of bias in at least one domain, most commonly performance bias (blinding of participants and investigators), attrition bias and reporting bias. None of our key comparisons measured quality of life, and the two studies that did presented no usable data. Eighteen studies reported common adverse effects of the treatments. Adverse effects ranged from mild symptoms to lethal complications depending upon the treatment type. More aggressive treatments like systemic chemotherapy generally resulted in more severe adverse effects. In the included studies, CR rates ranged from 0% to 83% (median 31%), and ORR ranged from 0% to 88% (median 47%). Five trials assessed PUVA treatment, alone or combined, summarised below. There may be little to no difference between intralesional IFN-α and PUVA compared with PUVA alone for 24 to 52 weeks in CR (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.87 to 1.31; 2 trials; 122 participants; low-certainty evidence). Common adverse events and ORR were not measured. One small cross-over trial found once-monthly ECP for six months may be less effective than twice-weekly PUVA for three months, reporting CR in two of eight participants and ORR in six of eight participants after PUVA, compared with no CR or ORR after ECP (very low-certainty evidence). Some participants reported mild nausea after PUVA but no numerical data were given. One participant in the ECP group withdrew due to hypotension. However, we are unsure of the results due to very low-certainty evidence. One trial comparing bexarotene plus PUVA versus PUVA alone for up to 16 weeks reported one case of photosensitivity in the bexarotene plus PUVA group compared to none in the PUVA-alone group (87 participants; low-certainty evidence). There may be little to no difference between bexarotene plus PUVA and PUVA alone in CR (RR 1.41, 95% CI 0.71 to 2.80) and ORR (RR 0.94, 95% CI 0.61 to 1.44) (93 participants; low-certainty evidence). One trial comparing subcutaneous IFN-α injections combined with either acitretin or PUVA for up to 48 weeks or until CR indicated there may be little to no difference in the common IFN-α adverse effect of flu-like symptoms (RR 1.32, 95% CI 0.92 to 1.88; 82 participants). There may be lower CR with IFN-α and acitretin compared with IFN-α and PUVA (RR 0.54, 95% CI 0.35 to 0.84; 82 participants) (both outcomes: low-certainty evidence). This trial did not measure ORR. One trial comparing PUVA maintenance treatment to no maintenance treatment, in participants who had already had CR, did report common adverse effects. However, the distribution was not evaluable. CR and OR were not assessable. The range of treatment options meant that rare adverse effects consequently occurred in a variety of organs. AUTHORS' CONCLUSIONS There is a lack of high-certainty evidence to support decision making in the treatment of MF. Because of substantial heterogeneity in design, missing data, small sample sizes, and low methodological quality, the comparative safety and efficacy of these interventions cannot be reliably established on the basis of the included RCTs. PUVA is commonly recommended as first-line treatment for MF, and we did not find evidence to challenge this recommendation. There was an absence of evidence to support the use of intralesional IFN-α or bexarotene in people receiving PUVA and an absence of evidence to support the use of acitretin or ECP for treating MF. Future trials should compare the safety and efficacy of treatments to PUVA, as the current standard of care, and should measure quality of life and common adverse effects.
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Affiliation(s)
- Arash Valipour
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
- Evidence-Based Medicine Frankfurt, Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Manuel Jäger
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
- Hautklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Peggy Wu
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) Dresden, Dresden, Germany
| | - Charles Bunch
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Tobias Weberschock
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
- Evidence-Based Medicine Frankfurt, Institute of General Practice, Goethe University, Frankfurt, Germany
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68
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Rittig AH, Johansen C, Celis P, Odum N, Litman T, Woetmann A, Lindahl LM, Iversen L. Suppressed microRNA-195-5p expression in mycosis fungoides promotes tumor cell proliferation. Exp Dermatol 2020; 30:1141-1149. [PMID: 32492224 DOI: 10.1111/exd.14124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Several cancers, including mycosis fungoides (MF), have reported dysregulation of miR-195-5p. miR-195-5p plays a role in cell cycle regulation in several malignant diseases. OBJECTIVES This study aimed to investigate: (a) the expression level of miR-195-5p in lesional MF skin biopsies and (b) the potential regulatory roles of miR-195-5p in MF. METHODS Quantitative real-time polymerase chain reaction (RT-qPCR) was used to determine miR-195-5p expression in MF skin biopsies and cell lines. The effect of miR-195-5p and ADP-ribosylation factor-like protein 2 (ARL2) on cell cycle and apoptosis was measured by flow cytometry assays. Changes in ARL2 expression were determined by RT-qPCR and Western blotting (WB). RESULTS We found lower expression levels of miR-195-5p in lesional skin from MF patients compared with non-lesional MF skin and skin from healthy volunteers. Additionally, miR-195-5p showed lower expression levels in the skin from patients with disease progression compared with patients with stable disease. In vitro studies showed that overexpression of miR-195-5p induced a cell cycle arrest in G0G1. Using microarray analysis, we identified several genes that were regulated after miR-195-5p overexpression. The most downregulated gene after miR-195-5p mimic transfection was ARL2. RT-qPCR and WB analyses confirmed downregulation of ARL2 following transfection with miR-195-5p mimic. Lastly, transfection with siRNA against ARL2 also induced a G0G1 arrest. CONCLUSION Upregulation of miR-195-5p in MF inhibits cycle arrest by downregulation of ARL2. miR-195-5p may thus function as a tumor suppressor in MF and low miR-195-5p expression in lesional MF skin may promote disease progression.
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Affiliation(s)
- Anne H Rittig
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Johansen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Pamela Celis
- Department of Molecular Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Odum
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Litman
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Anders Woetmann
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Lise M Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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Dotimas J, Das M, Martin D. Cutaneous T-cell lymphoma in the setting of anti-tumor necrosis factor and immunomodulator therapy: A case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20937223. [PMID: 32655868 PMCID: PMC7328350 DOI: 10.1177/2050313x20937223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/31/2020] [Indexed: 01/23/2023] Open
Abstract
Immunosuppressive therapy is well recognized as increasing the risk of lymphoma. Mycosis fungoides is a rare cutaneous form of T-cell lymphoma with a largely unknown etiology and not typically associated with immunosuppression. In this article, we describe our encounter with a 24-year-old male with Crohn’s disease in remission on immunotherapy, specifically dual therapy with azathioprine and infliximab, presenting with a facial rash found to be consistent with mycosis fungoides on biopsy. The patient’s rash resolved with treatment of topical steroids. In addition, the decision was made to discontinue his azathioprine to minimize his risks of developing future malignancies.
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Affiliation(s)
- James Dotimas
- The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Manjusha Das
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Daniel Martin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Total skin electron beam therapy for primary cutaneous T-cell lymphomas: clinical characteristics and outcomes in a Mexican reference center. Rep Pract Oncol Radiother 2020; 25:562-567. [PMID: 32494229 DOI: 10.1016/j.rpor.2020.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
Aim The aim of this study was to assess treatment modalities, treatment response, toxicity profile, disease progression and outcomes in 14 patients with a confirmed diagnosis of primary cutaneous T-cell lymphoma (PCTCL) treated with total skin electron beam therapy (TSEBT). Background Primary cutaneous lymphomas (PCLs) are extranodal non-Hodgkin lymphomas originating in the skin without evidence of extracutaneous disease at diagnosis. Despite advances in systemic and local therapy options, the management of advanced stages remains mostly palliative. Materials and Methods This is a retrospective study of patients with PCTCL, diagnosed and treated in a reference center in Mexico City, analyzing treatment modalities, response to treatment, long-term outcome, and mortality. Results Eight males (57%) and 6 (43%) females were identified. Most patients were stage IVA (n = 5, 36%) followed by stage IB and IIB (28.5% and 21.4%, respectively). Eleven patients received the low-dose RT scheme (12 Gy), 1 patient, the intermediate-dose RT scheme (24 Gy), and 2 patients, the conventional-dose RT scheme (36 Gy). Mean follow-up time was 4.6 years. At first follow-up examination, 6-8 weeks after radiotherapy, the overall response rate (ORR) for the cohort was 85%. The median PFS for the whole cohort was 6 months. Conclusion This study reinforces the role of TSEBT when compared with other treatment modalities and novel agents. Low-dose TSEBT is now widely used because of the opportunity for retreatment.
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Key Words
- CI, Confidence interval
- CR, Complete response
- Cutaneous lymphoma
- EORTC, European Organisation for Research and Treatment of Cancer
- LCT, Large cell transformation
- LPD, Lymphoproliferative disorder
- MF, Mycosis fungoides
- Mycosis fungoides
- NHL, Non-Hodgkin lymphomas
- ORR, Overall response rate
- OS, Overall survival
- PCL, Primary cutaneous lymphoma
- PCTCL, Primary cutaneous T-cell lymphomas
- PFS, Progression-free survival
- RT, Radiotherapy
- SD, Standard deviation
- SS, Sézary syndrome
- Sézary syndrome
- TSEBT, Total skin electron beam therapy
- Total skin electron beam therapy.
- UV, Ultraviolet
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71
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Abstract
Cutaneous T-cell lymphomas are a heterogeneous collection of non-Hodgkin lymphomas that arise from skin-tropic memory T lymphocytes. Among them, mycosis fungoides (MF) and Sézary syndrome (SS) are the most common malignancies. Diagnosis requires the combination of clinical, pathologic, and molecular features. Significant advances have been made in understanding the genetic and epigenetic aberrations in SS and to some extent in MF. Several prognostic factors have been identified. The goal of treatment is to minimize morbidity and limit disease progression. However, hematopoietic stem cell transplantation, considered for patients with advanced stages, is the only therapy with curative intent.
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Affiliation(s)
- Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Thomas Kupper
- Department of Dermatology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02115, USA
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72
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Peterson E, Weed J, Lo Sicco K, Latkowski JA. Cutaneous T Cell Lymphoma: A Difficult Diagnosis Demystified. Dermatol Clin 2020; 37:455-469. [PMID: 31466586 DOI: 10.1016/j.det.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cutaneous T cell lymphoma (CTCL) represents a heterogeneous group of extranodal non-Hodgkin lymphomas in which monoclonal T lymphocytes infiltrate the skin. The mechanism of CTCL development is not fully understood, but likely involves dysregulation of various genes and signaling pathways. A variety of treatment modalities are available, and although they can induce remission in most patients, the disease may recur after treatment cessation. Owing to relatively low incidence and significant chronicity of disease, and the high morbidity of some therapeutic regimens, further clinical trials are warranted to better define the ideal treatment option for each subtype of CTCL.
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Affiliation(s)
- Erik Peterson
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Jason Weed
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA; New York Harbor VA Healthcare System, Dermatology Residency Training Program.
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73
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Dalal M, Mitchell S, McCloskey C, Zagadailov E, Gautam A. The clinical and humanistic burden of cutaneous T-cell lymphomas and response to conventional and novel therapies: results of a systematic review. Expert Rev Hematol 2020; 13:405-419. [DOI: 10.1080/17474086.2020.1717945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mehul Dalal
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | - Erin Zagadailov
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Ashish Gautam
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
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Clough L, Bayakly AR, Ward KC, Khan MK, Chen SC, Lechowicz MJ, Flowers CR, Allen PB, Switchenko JM. Clustering of cutaneous T-cell lymphoma is associated with increased levels of the environmental toxins benzene and trichloroethylene in the state of Georgia. Cancer 2020; 126:1700-1707. [PMID: 31943154 DOI: 10.1002/cncr.32665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma arising in the skin. Geographic clustering of CTCL has recently been reported, but its association with environmental factors is unknown. Benzene and trichloroethylene (TCE) are environmental toxins with carcinogenic properties. The authors investigated associations between geographic clustering of CTCL incidence in the state of Georgia with benzene and TCE exposure. METHODS The statewide county-level incidence of CTCL within Georgia was obtained from the Georgia Cancer Registry for the years 1999 to 2015. Standardized incidence ratios (SIRs) were calculated by dividing observed cases by expected cases using national incidence rates by age, sex, and race. Clustering of CTCL was analyzed using spatial analyses. County-level concentrations of benzene and TCE between 1996 and 2014 were collected from the Environmental Protection Agency's National Air Toxics Assessment database. Linear regression analyses on CTCL incidence were performed comparing SIRs with levels of benzene and TCE by county. RESULTS There was significant geographic clustering of CTCL in Georgia, particularly around Atlanta, which was correlated with an increased concentration of benzene and TCE exposure. Among the 4 most populous counties in Georgia, CTCL incidence was between 1.2 and 1.9 times higher than the state average, and benzene and TCE levels were between 2.9 and 8.8 times higher. CONCLUSIONS The current results demonstrate nonrandom geographic clustering of CTCL incidence in Georgia. To the authors' knowledge, this is the first analysis to identify a correlation between geographic clustering of CTCL and environmental toxic exposures.
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Affiliation(s)
| | | | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Pamela B Allen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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75
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Griffin DB, Hajar T, Simpson E, White KP, Shinohara MM. Management of Cutaneous T-Cell Lymphoma/Mycosis Fungoides Occurring in the Setting of Solid Organ Transplantation: Report of 2 Cases. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e39-e42. [PMID: 31924574 DOI: 10.1016/j.clml.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/07/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Tamar Hajar
- Department of Dermatology, Oregon Health Science University, Portland, OR
| | - Eric Simpson
- Department of Dermatology, Oregon Health Science University, Portland, OR
| | - Kevin P White
- Department of Dermatology, Oregon Health Science University, Portland, OR
| | - Michi M Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA.
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Kaul S, Belzberg M, Hughes JDM, Mahadevan V, Khanna R, Bakhshi PR, Hong MS, Williams KA, Grossberg AL, Kwatra SG, Sweren RJ. Comorbidities in Mycosis Fungoides and Racial Differences in Co-Existent Lymphomatoid Papulosis: A Cross-Sectional Study of 580 Patients in an Urban Tertiary Care Center. MEDICINES 2019; 7:medicines7010001. [PMID: 31888015 PMCID: PMC7168128 DOI: 10.3390/medicines7010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/22/2022]
Abstract
Background: Mycosis fungoides (MF) is a cutaneous T-cell lymphoma. Previous reports have suggested MF is associated with inflammatory conditions such as psoriasis, increased cardiovascular risk factors as well as secondary neoplasms. Methods: A cross-sectional study of MF patients seen from 2013 to 2019 was performed. Comorbidities were selected based on the 2015 Medicare report highlighting the most common chronic medical illnesses in the United States. Lifetime comorbidity occurrence in patients with MF were compared with that in patients with atopic dermatitis, psoriasis and patients without MF. Additional analyses were performed with patients sub-stratified by race. Results: Compared to control groups, MF was strongly associated with lymphomatoid papulosis and Hodgkin's disease, but not significantly associated with lung, breast or colon cancer. Interestingly, the association with lymphomatoid papulosis was observed in Caucasians (CI 1062-4338; p < 0.001) and not African Americans (p = 0.9). Patients with MF had a greater association with congestive heart failure, hypertension (HT) and hyperlipidemia (HLD) compared with the general population. However, they were significantly less likely to have HT and HLD when compared with psoriasis patients (HT CI: 0.6-0.9; p < 0.001, and HLD CI: 0.05-0.07; p < 0.001). MF patients were also significantly less likely to have concomitant vitamin D deficiency compared with atopic dermatitis (AD) and psoriasis (p < 0.001). Conclusions: Our results suggest that the association of MF with lymphomatoid papulosis varies by race. Compared to the general population, hypertension and hyperlipidemia were positively associated with MF, however, these were significantly less likely on comparison to psoriasis. Unlike previously described, vitamin D deficiency was found to be significantly less in patients with MF.
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Affiliation(s)
- Subuhi Kaul
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-312-864-7000
| | - Micah Belzberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | | | - Varun Mahadevan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Pegah R. Bakhshi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Michael S. Hong
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Kyle A. Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Annie L. Grossberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Ronald J. Sweren
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
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Silva-Hirschberg C, Hartman H, Stack S, Swenson S, Minea RO, Davitz MA, Chen TC, Schönthal AH. Cytotoxic impact of a perillyl alcohol-temozolomide conjugate, NEO212, on cutaneous T-cell lymphoma in vitro. Ther Adv Med Oncol 2019; 11:1758835919891567. [PMID: 31839810 PMCID: PMC6900611 DOI: 10.1177/1758835919891567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Mycosis fungoides (MF) and Sézary syndrome (SS) are subtypes of primary
cutaneous lymphomas and represent complex diseases regarding their
physiopathology and management. Depending on the stage of the disease,
different treatment regimens are applied, but there is no consensus on an
optimal approach. Prognosis for patients with early stage MF is favorable,
but significantly worsens in advanced disease and in SS, where patients
frequently relapse and require multiple therapies. Methods: We investigated the potential anticancer effects of NEO212, a novel compound
generated by covalently conjugating perillyl alcohol (a natural monoterpene)
to temozolomide (an alkylating agent), on MF and SS cell lines in
vitro. HUT-78, HUT-102, and MyLa cells were treated with NEO212
under different conditions, and drug effects on proliferation, viability,
and apoptosis were characterized. Results: NEO212 inhibited proliferation, diminished viability, and stimulated
apoptosis in all cell lines, although with varying degrees of potency in the
different cell lines. It down-regulated c-myc and cyclin D1 proteins, which
are required for cell proliferation, but triggered endoplasmic reticulum
stress and activation of caspases. Pretreatment of cells with antioxidants
ascorbic acid and beta-mercaptoethanol prevented these NEO212-induced
effects. Conclusions: NEO212 exerted promising anticancer effects on SS and MF cell lines. The
generation of reactive oxygen species (ROS) appears to play a key role in
the NEO212-induced cell death process, because the blockage of ROS with
antioxidants prevented caspase activation. We propose that NEO212 should be
investigated further toward clinical testing in these tumor types.
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Affiliation(s)
- Catalina Silva-Hirschberg
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hannah Hartman
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samantha Stack
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Steve Swenson
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Radu O Minea
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael A Davitz
- Leason Ellis, One Barker Avenue, Fifth Floor, White Plains, New York, NY, USA
| | - Thomas C Chen
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, 2011 Zonal Avenue, Los Angeles, CA 90089, USA
| | - Axel H Schönthal
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, 2011 Zonal Avenue, HMR-405, Los Angeles, CA 90089, USA
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78
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Armenta AM, Jones KM, Reichenberg JS. Successful Use of the 308-nm Excimer Laser in Early Patch Stage Mycosis Fungoides. J Lasers Med Sci 2019; 10:251-253. [PMID: 31749954 DOI: 10.15171/jlms.2019.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Mycosis fungoides (MF), a type of cutaneous T-cell lymphoma, is a rare condition with a variety of treatment options. A frequently utilized method in the treatment of early-stage MF is phototherapy. Full body phototherapy can be associated with photoaging of the skin and an increased risk of developing skin cancer. Targeted phototherapy, with a 308-nm excimer laser, may be just as effective and of a lower risk. This makes it especially useful in the treatment of patients with dysplastic nevi (DN) or other conditions which can put them at a higher risk of developing skin cancer. There are currently limited data on the treatment of early-stage MF with an excimer laser. Case Report: This study reports on a 43-year-old female patient presented to the clinic with early-stage (Ia) MF. Given her history of DN, she wished to pursue targeted phototherapy with an excimer laser. Localized light treatment was performed via a 308-nm excimer laser, 3 times weekly, for a total of 17 treatments to affected lesions. Following excimer laser treatment, she had a clinical resolution of her patches. On the follow-up clinic visits, she maintained her excellent response 12 months out. Conclusion: Targeted phototherapy with a 308-nm excimer laser may be a safer and equally effective alternative to generalized phototherapy in the treatment of early-stage MF. This case report demonstrates its efficacy and advantages over traditional generalized phototherapy.
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Affiliation(s)
- Andrew M Armenta
- University of Texas Medical Branch, School of Medicine, Galveston, Texas, USA
| | - Krystal M Jones
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Jason S Reichenberg
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
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79
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Watson S, Marx JB. Mogamulizumab-kpkc: A Novel Therapy for the Treatment of Cutaneous T-Cell Lymphoma. J Adv Pract Oncol 2019; 10:883-888. [PMID: 33425472 PMCID: PMC7517756 DOI: 10.6004/jadpro.2019.10.8.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mogamulizumab-kpkc provides a novel mechanism of action for the treatment of mycosis fungoides and Sézary syndrome. The efficacy and safety of mogamulizumab-kpkc for the treatment of relapsed or refractory mycosis fungoides and Sézary syndrome were demonstrated in a multicenter, open-label, randomized phase III trial comparing mogamulizumab-kpkc with vorinostat. Patients treated with mogamulizumab-kpkc showed a statistically significant increased progression-free survival (PFS; 7.7 months) compared with vorinostat (3.1 months). Overall response rates were higher with mogamulizumab-kpkc compared with vorinostat (28% vs. 5%; p < .0001). The most common adverse events (> 20%) associated with mogamulizumab-kpkc include rash, infusion-related reaction, fatigue, diarrhea, musculoskeletal pain, and upper respiratory tract infection. The use of mogamulizumab-kpkc up to 50 days prior to allogeneic hematopoietic stem cell transplantation has been associated with an increased risk of severe acute graft-vs.-host disease, steroid-refractory graft-vs.-host disease, and mortality. Additional labeled warnings include dermatologic toxicity, infection, and autoimmune complications. The overall benefit to risk assessment of mogamulizumab-kpkc is acceptable, but its use is constrained by the high cost of treatment and the short-term benefit.
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Affiliation(s)
- Sutton Watson
- University of Tennessee Medical Center, Knoxville, Tennessee
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80
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Talaat IM, Abdelmaksoud RE, Guimei M, Agamia NF, Nugud A, El-Serafi AT. Potential role for microRNA-16 (miR-16) and microRNA-93 (miR-93) in diagnosis and prediction of disease progression in mycosis fungoides in Egyptian patients. PLoS One 2019; 14:e0224305. [PMID: 31648231 PMCID: PMC6812867 DOI: 10.1371/journal.pone.0224305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/10/2019] [Indexed: 12/12/2022] Open
Abstract
Mycosis Fungoides (MF) is the most common type of cutaneous T-cell lymphomas. Early stage patients are treated with topical therapies and have normal life expectancy whereas patients with advanced disease encounter frequent relapses and have a five-year survival rate that does not exceed 15%. The aim of the present study was to characterize the expression of microRNA-16 (miR-16) and microRNA-93 (miR-93) in early and advanced cases of MF in relation to the clinicopathological parameters. Ten skin biopsies of early and advanced MF were investigated for the expression of miR-16 and miR-93 using RT-PCR. Immunohistochemical expression of apoptosis markers (BCL-2 and Survivin) were also investigated in the studied cases compared to normal skin and eczema biopsies. In the present study, BCL-2 and Survivin showed strong positive expression on neoplastic lymphocytes in all cases of MF regardless of their stage. We have also shown that miR-16 was significantly upregulated in advanced cases of MF compared to cases with early disease (p-value was less than 0.05). However, expression of miR-16 did not show any statistically significant correlation with age, gender, or expression of apoptotic markers. On the other hand, the expression of miR-93 showed significant downregulation in all lymphoma cases irrespective of their stage, compared to normal and eczema cases. Our results suggest that upregulation of miR-16 could be used to predict an aggressive course of the disease. We also suggest that miR-93 downregulation could serve as possible tool for establishing early diagnosis in early challenging cases. Our findings also provide consistent evidence that the anti-apoptotic molecules may play an important role in the pathogenesis of this type of cutaneous lymphomas and promote the idea that their inhibition could be an interesting novel therapeutic strategy in the treatment of MF.
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Affiliation(s)
- Iman Mamdouh Talaat
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
- Research Institute for Medical & Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Rania ElSaied Abdelmaksoud
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Maha Guimei
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE
- Research Institute for Medical & Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- * E-mail:
| | - Naglaa Fathi Agamia
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Nugud
- Pediatric Resident, Aljalila Children Hospital, Dubai, UAE
| | - Ahmed Taher El-Serafi
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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81
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Geller S, Lebowitz E, Pulitzer MP, Horwitz SM, Moskowitz AJ, Dusza S, Myskowski PL. Outcomes and prognostic factors in African American and black patients with mycosis fungoides/Sézary syndrome: Retrospective analysis of 157 patients from a referral cancer center. J Am Acad Dermatol 2019; 83:430-439. [PMID: 31499157 DOI: 10.1016/j.jaad.2019.08.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/30/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of mycosis fungoides/Sézary syndrome (MF/SS) is higher in the black population than in the white population in the United States and worse outcomes have been observed in black patients. OBJECTIVE To describe the outcomes and to identify prognostic factors in African American and black patients with MF/SS. METHODS Clinical features and follow-up data were analyzed in 157 self-identified African American or black patients seen during 1994-2018. RESULTS We included 122 patients with early stage MF and 35 patients with advanced-stage disease (median follow-up of 25 months). Overall, >80% of the patients who died from disease or progressed had erythema or hyperpigmentation without hypopigmentation. Patients with hypopigmentation, either as the sole manifestation or in combination with other lesions, had better overall survival (P = .002) and progression-free survival (P = .014). Clinical stage, TNMB classification, plaque disease, and elevated serum lactate dehydrogenase were also significantly associated with outcomes. Demographic and socioeconomic parameters were not associated with prognosis. LIMITATIONS A retrospective study at a single cancer center. CONCLUSION MF/SS manifestations and outcomes in African American and black patients are heterogeneous. Demographic and socioeconomic factors do not seem to have a prognostic role, while clinical characteristics might help in the stratification of risk of progression and shorter survival, allowing for individually tailored therapeutic interventions.
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Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | | | - Melissa P Pulitzer
- Weill Cornell Medical College, New York, New York; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steve Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
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82
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Martinez XU, Di Raimondo C, Abdulla FR, Zain J, Rosen ST, Querfeld C. Leukaemic variants of cutaneous T-cell lymphoma: Erythrodermic mycosis fungoides and Sézary syndrome. Best Pract Res Clin Haematol 2019; 32:239-252. [PMID: 31585624 PMCID: PMC9056079 DOI: 10.1016/j.beha.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 01/22/2023]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common types of cutaneous lymphoma, accounting for approximately 60% of cutaneous T-cell lymphomas. Diagnosis requires correlation of clinical, histologic, and molecular features. A multitude of factors have been linked to the aetiopathogenesis, however, none have been definitively proven. Erythrodermic MF (E-MF) and SS share overlapping clinical features, such as erythroderma, but are differentiated on the degree of malignant blood involvement. While related, they are considered to be two distinct entities originating from different memory T cell subsets. Differential expression of PD-1 and KIR3DL2 may represent a tool for distinguishing MF and SS, as well as a means of monitoring treatment response. Treatment of E-MF/SS is guided by disease burden, patients' ages and comorbidities, and effect on quality of life. Current treatment options include biologic, targeted, immunologic, and investigational therapies that can provide long term response with minimal side effects. Currently, allogeneic stem cell transplantation is the only potential curative treatment.
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Affiliation(s)
| | - Cosimo Di Raimondo
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Farah R Abdulla
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Jasmine Zain
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Steven T Rosen
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, United States.
| | - Christiane Querfeld
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, United States.
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83
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84
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Afifi S, Mohamed S, Zhao J, Foss F. A drug safety evaluation of mogamulizumab for the treatment of cutaneous T-Cell lymphoma. Expert Opin Drug Saf 2019; 18:769-776. [DOI: 10.1080/14740338.2019.1643837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Salma Afifi
- Hematology Section, Smilow Cancer Center, New Haven, CT, USA
| | - Sara Mohamed
- Hematology Section, Smilow Cancer Center, New Haven, CT, USA
| | - Jennifer Zhao
- Hematology Section, Smilow Cancer Center, New Haven, CT, USA
| | - Francine Foss
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, New Haven, CT, USA
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85
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Abstract
Non-Hodgkin's lymphoma (NHL) encompasses a diverse collection of systemic and primary cutaneous lymphomas. Cutaneous T-cell lymphomas (CTCLs) represent about 13% of all NHLs, which are further subdivided into a heterogeneous group with vastly different presentations and histologic features. Diagnosis requires integration of clinical, pathologic, and molecular features. Among CTCLs, mycosis fungoides and Sézary syndrome are the most prevalent. Treatment is aimed at limiting morbidity and halting disease progression. Hematopoietic stem cell transplantation is the only therapy with curative intent.
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Affiliation(s)
- Cecilia A Larocca
- Department of Dermatology, Center for Cutaneous Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Center for Cutaneous Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA.
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86
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Ghazawi FM, Alghazawi N, Le M, Netchiporouk E, Glassman SJ, Sasseville D, Litvinov IV. Environmental and Other Extrinsic Risk Factors Contributing to the Pathogenesis of Cutaneous T Cell Lymphoma (CTCL). Front Oncol 2019; 9:300. [PMID: 31106143 PMCID: PMC6499168 DOI: 10.3389/fonc.2019.00300] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 01/17/2023] Open
Abstract
The applications of disease cluster investigations in medicine have developed rather rapidly in recent decades. Analyzing the epidemiology of non-random aggregation of patients with a particular disease fostered identification of environmental and external exposures as disease triggers and promoters. Observation of patient clusters and their association with nearby exposures, such as Dr. John Snow's astute mapping analysis in the mid-1800's, which revealed proximity of cholera patients in London to a contaminated water pump infected with Vibrio cholerae, have paved the way for the field of epidemiology. This approach enabled the identification of triggers for many human diseases including infections and cancers. Cutaneous T-cell lymphomas (CTCL) represent a group of non-Hodgkin lymphomas that primarily affect the skin. The detailed pathogenesis by which CTCL develops remains largely unknown. Notably, non-random clustering of CTCL patients was reported in several areas worldwide and this rare malignancy was also described to affect multiple members of the same family. These observations indicate that external factors are possibly implicated in promoting CTCL lymphomagenesis. Here, we review the epidemiology of CTCL worldwide and the clinical characteristics of CTCL patients, as revealed by global epidemiological data. Further, we review the known risk factors including sex, age, race as well as environmental, infectious, iatrogenic and other exposures, that are implicated in CTCL lymphomagenesis and discuss conceivable mechanisms by which these factors may trigger this malignancy.
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Affiliation(s)
- Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Nebras Alghazawi
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | | | | | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, QC, Canada
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87
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Van-de-Velde V, Zhou Y. Existing and Emerging Therapies for Cutaneous T-Cell Lymphoma. J Cutan Med Surg 2019; 23:319-327. [DOI: 10.1177/1203475419840629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of non-Hodgkin lymphomas characterized by an infiltration of malignant monoclonal T lymphocytes into the skin. Mycosis fungoides (MF), the most common subtype, and the rarer Sézary syndrome (SS), are considered the classical forms of CTCL, which, because of a varying presentation and lack of genetic and immunophenotypical markers, can often have a delayed diagnosis. With skin-directed topical treatment being the mainstay of therapy in the early stages, there is an absence of long-term curative therapies for advanced disease. Recent insight into the pathogenesis of CTCL has identified new potential therapeutic targets including the monoclonal antibody therapies, brentuximab vedotin and mogamulizumab. Brentuximab vedotin, an anti-CD30 antibody-drug conjugate, received extended approval by the US FDA in 2017 to include primary cutaneous anaplastic large-cell lymphoma and CD30-expressing MF. Mogamulizumab, an anti-CCR4 antibody, received FDA approval in 2018 for relapsed or refractory MF and SS. Further targets and therapies continue to be investigated, including the monoclonal antibody therapy alemtuzumab, an anti-CD52 antibody, and the immune checkpoint blockade therapies, pembrolizumab and nivolumab. These new and emerging targets and therapies may lead to a promising broadening of CTCL treatment options in the future.
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Affiliation(s)
- Vanessa Van-de-Velde
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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88
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Ling YL, Huang X, Mitri G, Lovelace B, Pham A, Knobler R, Li X, Gao X. Real-world use of extracorporeal photopheresis for patients with cutaneous T-cell lymphoma in the United States: 2010-2015. J DERMATOL TREAT 2019; 31:91-98. [PMID: 30892982 DOI: 10.1080/09546634.2019.1587144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The National Comprehensive Cancer Network and the European Organization for Research and Treatment of Cancer recommend extracorporeal photopheresis (ECP) as systemic therapy for cutaneous T-cell lymphoma (CTCL).Objective: To investigate real-world use of ECP in CTCL patients in the US.Methods: Data from the Truven MarketScan® database (2010-2015) were used to create a cohort of CTCL patients receiving systemic treatment. Multivariable regressions were performed to compare health care resource utilization between ECP and propensity score-matched non-ECP patients.Results: Of the 1106 eligible patients, 117 (10.6%) received ECP, with an average treatment duration of 13.6 months. Psoriasis, organ transplant, graft versus host disease, and scleroderma were the most common comorbidities. ECP was used as monotherapy in 76 patients (65.0%) and combination in 41 patients (35.0%), mostly with interferon and/or a retinoid. Higher Charlson Comorbidity Index (2.6 vs 2.2, p < .05), rates of organ transplant (49.6% vs 7.8%, p < .001), and graft vs host disease (41.9% vs 3.4%, p < .001) were observed in ECP versus non-ECP patients. Post-matching analyses showed that ECP patients had shorter all-cause inpatient stay (6.67 vs 11.80 days, p = .001).Conclusions: Approximately 1 out of 10 CTCL patients receiving systemic treatment were on ECP treatment in the US. Post-matching analysis showed ECP was associated with a shorter hospital stay.
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Affiliation(s)
- You-Li Ling
- Pharmerit International LP, Bethesda, MA, USA
| | | | - Ghaith Mitri
- Formerly of Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | | | - An Pham
- Formerly of Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA.,School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Xiaocong Li
- Pharmerit International LP, Bethesda, MA, USA
| | - Xin Gao
- Pharmerit International LP, Bethesda, MA, USA
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89
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Ollila TA, Sahin I, Olszewski AJ. Mogamulizumab: a new tool for management of cutaneous T-cell lymphoma. Onco Targets Ther 2019; 12:1085-1094. [PMID: 30799938 PMCID: PMC6369856 DOI: 10.2147/ott.s165615] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) poses unique treatment challenges, given its range of presentations and numerous systemic therapy options. These options often lack comparative evidence or are characterized by low response rates and short remission duration in relapsed/refractory disease. The approval of mogamulizumab, a humanized, glycoengineered IgG1κ monoclonal antibody targeting the chemokine receptor type 4 (CCR4) chemokine receptor, brings a novel tool into the spectrum of treatment options for advanced CTCL and adult T-cell leukemia/lymphoma (ATLL). CCR4 is expressed in almost all cases of ATLL, and in a majority of CTCLs, particularly when blood involvement is present. In a Phase III randomized trial, mogamulizumab was associated with 28% overall response rate among patients with relapsed CTCL, median progression-free survival of 7.7 months, and median duration of remission of 14.1 months. Responses are more frequent among patients with Sézary syndrome and within the blood compartment. Common adverse effects include rash and infusion reactions, which are usually low grade. Sentinel reports indicate that exposure to mogamulizumab may result in severe or refractory graft vs host disease after allogeneic bone marrow transplantation, highlighting the need for vigilance and expert management. Further research may establish incremental efficacy of combining mogamulizumab with cytotoxic or immunomodulatory agents in CTCL, ATLL, and possibly other lymphomas and even solid tumors.
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Affiliation(s)
- Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA, .,Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA,
| | - Ilyas Sahin
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA, .,Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA,
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA, .,Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA,
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90
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Kutane Lymphome. MEDIKAMENTÖSE TUMORTHERAPIE IN DER DERMATO-ONKOLOGIE 2019. [PMCID: PMC7121154 DOI: 10.1007/978-3-662-58012-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kutane Lymphome (cutaneous lymphomas: CL) umfassen die Gruppe der kutanen T-Zell-Lymphome (cutaneous T-cell lymphomas: CTCL), kutanen B-Zell-Lymphome (cutaneous B-cell lymphomas: CBCL) und die sog. hämatodermischen Neoplasien (HN). CL gehören zur Gruppe der Non-Hodgkin-Lymphome (NHL) und stellen in der Subgruppe der extranodalen NHL die zweithäufigste Gruppe hinter den gastrointestinalen Lymphomen dar (Jaffe et al. 2009). Man unterscheidet zwischen primären und sekundären CL. Primäre CL haben ihren Ursprung in der Haut und bleiben in der Regel darauf auch längere Zeit beschränkt, während sekundäre CL kutane Manifestationen von primär nodalen oder extranodalen Lymphomen darstellen (Willemze 2005). Die primären CL unterscheiden sich hinsichtlich klinischem Verlauf, Therapieoptionen und Prognose erheblich von nodalen und extrakutanen Lymphomen. So zeigen z. B. die primär kutanen CD30+-T-Zell-Lymphome einen gutartigen Verlauf, wogegen die nodalen Varianten als aggressiv eingestuft werden. Da die CL zumeist weniger aggressiv sind, werden sie auch weniger aggressiv behandelt.
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91
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Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of non-Hodgkin lymphomas arising in the skin. Mycosis fungoides (MF), the most common variant, is characterised by clonal proliferation of skin residing malignant T-cells. Initially appearing with erythematous patches and plaques it follows a chronic course with progression to cutaneous tumours and extracutaneous involvement in some patients. Phototherapy with ultraviolet A radiation combined with 8-methoxypsoralen (PUVA) and with narrow-band ultraviolet B radiation (NB-UVB) are among the first line options for the treatment of MF and can induce remission in most patients. Sézary syndrome (SS) is a rare and more aggressive CTCL variant with generalized skin involvement. Patients with SS and with erythroderma from MF can benefit from treatment with extracorporeal photochemotherapy (ECP) where peripheral blood is exposed to PUVA. Phototherapy can be safely combined with systemic agents, most notably interferon-alpha and retinoids. Another photoresponsive CTCL variant is lymphomatoid papulosis (LP), a CD30+ lymphoproliferative disease characterised by chronically recurring papules. The disease responds favourably to PUVA but low dose methotrexate might be preferred for long term disease control. Recently updated treatment guidelines have been published to provide evidence-based algorithms for the stage-oriented treatment of MF, SS and LP. Areas of uncertainty are treatment schedules that are currently not optimised for CTCL, the use of phototherapy for maintenance, and the value of ultraviolet A1 radiation, excimer lasers, and photodynamic therapy.
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Affiliation(s)
- Franz Trautinger
- Department of Dermatology and Venereology, Karl Landsteiner University of Health Sciences, University Hospital of St. Pölten, Austria.
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92
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Kron T, Donahoo G, Lonski P, Wheeler G. A technique for total skin electron therapy (TSET) of an anesthetized pediatric patient. J Appl Clin Med Phys 2018; 19:109-116. [PMID: 30267453 PMCID: PMC6236825 DOI: 10.1002/acm2.12457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/22/2018] [Accepted: 08/16/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose Total skin electron therapy (TSET) is a technique to treat cutaneous lymphomas. While TSET is rarely required in pediatric patients, it poses particular problems for the delivery. It was the aim of the present work to develop a method to deliver TSET to young children requiring anesthetics during treatment. Methods A customized cradle with a thin window base and Poly(methyl‐methacrylate) (PMMA) frame was built and the patient was treated in supine position. Two times six fields of 6 MeV electrons spaced by 60° gantry angles were used without electron applicator and a field size of 36 × 36 cm2. The two sets of six fields were matched at approximately 65% surface dose by rotating the patient around an axis 30 cm distance from beam central axis, effectively displacing the two sets of fields in sup/inf direction by 60 cm. Electron energy was degraded using a 12 mm PMMA block on the gantry. Focus to skin distance was maximized by displacing the patient in opposite direction of the beam resulting in a different couch position for each field. Results A 2‐yr‐old patient was treated in 12 fractions of 1.5 Gy over 2.4 weeks. Dose to skin was verified daily using thermoluminescence dosimetry and/or radiochromic film. The treatment parameters were adjusted slightly based on in vivo dosimetry resulting in a dose distribution for most of the treatment volume within ±20% of the prescribed dose. Six areas were boosted using conventional electron therapy. Conclusion TSET can be delivered to pediatric patients using a customized couch top on a conventional linear accelerator.
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Affiliation(s)
- Tomas Kron
- Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Cancer Department; Melbourne University; Melbourne Australia
| | | | - Peta Lonski
- Peter MacCallum Cancer Centre; Melbourne Australia
| | - Greg Wheeler
- Peter MacCallum Cancer Centre; Melbourne Australia
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93
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Tang R, Su C, Bai HX, Zeng Z, Karakousis G, Zhang PJ, Zhang G, Xiao R. Association of insurance status with survival in patients with cutaneous T-cell lymphoma. Leuk Lymphoma 2018; 60:1253-1260. [PMID: 30326769 DOI: 10.1080/10428194.2018.1520987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The effect of insurance status on overall survival (OS) of patients with cutaneous T-cell lymphoma (CTCL) is unclear. We identified 11,861 patients from the US National Cancer Data Base diagnosed with CTCL from 2004-2014, of which 6088 had private insurance, 756 had Medicaid, 4536 had Medicare, and 481 are uninsured. Privately insured patients were more likely to present at an early stage (p < .001). On multivariate Cox regression analysis, privately insured patients had significantly longer OS than patients with Medicaid (HR: 1.936, 95% CI: 1.680-2.230, p < .001), Medicare (HR: 1.342, 95% CI: 1.222-1.474, p < .001), or no insurance (HR 1.849, 95% CI: 1.539-2.222, p < .001). The survival advantage of privately insured patients persisted on relative survival and propensity score-matched analyses. In conclusion, privately insured patients were more likely to present at an early stage, and had longer OS than patients who were Medicaid-, Medicare-, or not insured.
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Affiliation(s)
- Rui Tang
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
| | - Chang Su
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China.,b Department of Dermatology , Yale School of Medicine , New Haven , CT , USA
| | - Harrison X Bai
- c Department of Radiology , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Zhuotong Zeng
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
| | - Giorgos Karakousis
- d Department of Surgery , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Paul J Zhang
- e Department of Pathology and Laboratory Medicine , Hospital of the University of Pennsylvania , Philadelphia , PA , USA
| | - Guiying Zhang
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
| | - Rong Xiao
- a Department of Dermatology , The Second Xiangya Hospital, Central South University , Changsha , China
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94
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Lebowitz E, Geller S, Flores E, Pulitzer M, Horwitz S, Moskowitz A, Kheterpal M, Myskowski PL. Survival, disease progression and prognostic factors in elderly patients with mycosis fungoides and Sézary syndrome: a retrospective analysis of 174 patients. J Eur Acad Dermatol Venereol 2018; 33:108-114. [PMID: 30176169 DOI: 10.1111/jdv.15236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Advanced age at diagnosis is considered a poor prognostic factor in mycosis fungoides (MF) and Sézary syndrome (SS). OBJECTIVE To evaluate the outcomes and prognostic factors in patients diagnosed at an advanced age (≥65 years) with MF/SS. METHODS Survival, progression rates and various clinical and histopathological variables were studied in a group of 174 elderly patients diagnosed with MF/SS between 1992 and 2015 at a single referral cancer center in the United States. Kaplan-Meier estimates were used to determine survival and progression and Cox proportional hazards regression univariate and multivariate models were used to identify prognostic factors. RESULTS Of 174 elderly patients, 76.4% were diagnosed with early-stage (clinical stages IA-IIA) and 23.6% with late-stage MF/SS (IIB-IV). Advanced age was associated with poor overall survival, but not with disease-specific survival (DSS) or progression-free survival (PFS). Gender, increasing clinical stage, T and B classifications, elevated lactate dehydrogenase (LDH) levels and development of large cell transformation (LCT) were significant predictors of poor survival or disease progression. Patients with early-stage MF and <10% total skin involvement (T1 classification) or patch-only disease (T1a/T2a) showed better PFS with no observed disease-specific mortality. Folliculotropic MF was associated with poor DSS in patients with early-stage disease. CONCLUSIONS Older age at diagnosis of MF/SS does not predict worse disease-specific outcomes. Elderly patients with early-stage disease, specifically involving less than 10% of the skin surface with patches but without plaques or folliculotropism, have an excellent prognosis. However, the development of LCT is a strong prognostic indicator of poor survival in elderly patients with MF/SS.
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Affiliation(s)
- E Lebowitz
- Weill Cornell Medical College, New York, NY, USA
| | - S Geller
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Flores
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Pulitzer
- Weill Cornell Medical College, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Horwitz
- Weill Cornell Medical College, New York, NY, USA.,Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - A Moskowitz
- Weill Cornell Medical College, New York, NY, USA.,Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - M Kheterpal
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Duke University, Durham, NC, USA
| | - P L Myskowski
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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95
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Mogamulizumab versus vorinostat in previously treated cutaneous T-cell lymphoma (MAVORIC): an international, open-label, randomised, controlled phase 3 trial. Lancet Oncol 2018; 19:1192-1204. [PMID: 30100375 DOI: 10.1016/s1470-2045(18)30379-6] [Citation(s) in RCA: 345] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphomas are rare non-Hodgkin lymphomas with substantial morbidity and mortality in advanced disease stages. We compared the efficacy of mogamulizumab, a novel monoclonal antibody directed against C-C chemokine receptor 4, with vorinostat in patients with previously treated cutaneous T-cell lymphoma. METHODS In this open-label, international, phase 3, randomised controlled trial, we recruited patients with relapsed or refractory mycosis fungoides or Sézary syndrome at 61 medical centres in the USA, Denmark, France, Italy, Germany, the Netherlands, Spain, Switzerland, the UK, Japan, and Australia. Eligible patients were aged at least 18 years (in Japan, ≥20 years), had failed (for progression or toxicity as assessed by the principal investigator) at least one previous systemic therapy, and had an Eastern Cooperative Oncology Group performance score of 1 or less and adequate haematological, hepatic, and renal function. Patients were randomly assigned (1:1) using an interactive voice web response system to mogamulizumab (1·0 mg/kg intravenously on a weekly basis for the first 28-day cycle, then on days 1 and 15 of subsequent cycles) or vorinostat (400 mg daily). Stratification was by cutaneous T-cell lymphoma subtype (mycosis fungoides vs Sézary syndrome) and disease stage (IB-II vs III-IV). Since this study was open label, patients and investigators were not masked to treatment assignment. The primary endpoint was progression-free survival by investigator assessment in the intention-to-treat population. Patients who received one or more doses of study drug were included in the safety analyses. This study is ongoing, and enrolment is complete. This trial was registered with ClinicalTrials.gov, number NCT01728805. FINDINGS Between Dec 12, 2012, and Jan 29, 2016, 372 eligible patients were randomly assigned to receive mogamulizumab (n=186) or vorinostat (n=186), comprising the intention-to-treat population. Two patients randomly assigned to mogamulizumab withdrew consent before receiving study treatment; thus, 370 patients were included in the safety population. Mogamulizumab therapy resulted in superior investigator-assessed progression-free survival compared with vorinostat therapy (median 7·7 months [95% CI 5·7-10·3] in the mogamulizumab group vs 3·1 months [2·9-4·1] in the vorinostat group; hazard ratio 0·53, 95% CI 0·41-0·69; stratified log-rank p<0·0001). Grade 3-4 adverse events of any cause were reported in 75 (41%) of 184 patients in the mogamulizumab group and 76 (41%) of 186 patients in the vorinostat group. The most common serious adverse events of any cause were pyrexia in eight (4%) patients and cellulitis in five (3%) patients in the mogamulizumab group; and cellulitis in six (3%) patients, pulmonary embolism in six (3%) patients, and sepsis in five (3%) patients in the vorinostat group. Two (67%) of three on-treatment deaths with mogamulizumab (due to sepsis and polymyositis) and three (33%) of nine on-treatment deaths with vorinostat (two due to pulmonary embolism and one due to bronchopneumonia) were considered treatment-related. INTERPRETATION Mogamulizumab significantly prolonged progression-free survival compared with vorinostat, and could provide a new, effective treatment for patients with mycosis fungoides and, importantly, for Sézary syndrome, a subtype that represents a major therapeutic challenge in cutaneous T-cell lymphoma. FUNDING Kyowa Kirin.
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96
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Chang LW, Patrone CC, Yang W, Rabionet R, Gallardo F, Espinet B, Sharma MK, Girardi M, Tensen CP, Vermeer M, Geskin LJ. An Integrated Data Resource for Genomic Analysis of Cutaneous T-Cell Lymphoma. J Invest Dermatol 2018; 138:2681-2683. [PMID: 29981755 DOI: 10.1016/j.jid.2018.06.176] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Li-Wei Chang
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA
| | | | - Wei Yang
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Raquel Rabionet
- Institut de Recerca Sant Joan de Déu; Institut de Biomedicina de la Universitat de Barcelona; and Dept. Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, Spain
| | - Fernando Gallardo
- Hospital del Mar Medical Research Institute; Dermatology Service, Hospital del Mar, Barcelona, Spain
| | - Blanca Espinet
- Hospital del Mar Medical Research Institute; Laboratory of Molecular Cytogenetics, Pathology Service, Hospital del Mar, Barcelona, Spain
| | | | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Cornelis P Tensen
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maarten Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Medical Center, New York, New York, USA.
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97
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Estrach T, Servitje O, Ortiz-Romero PL. AEDV Primary Cutaneous Lymphoma Registry. ACTAS DERMO-SIFILIOGRAFICAS 2018; 108:181-183. [PMID: 28347423 DOI: 10.1016/j.ad.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Indexed: 01/30/2023] Open
Affiliation(s)
- T Estrach
- Servicio de Dermatologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - O Servitje
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat España
| | - P L Ortiz-Romero
- Servicio de Dermatologia, Hospital 12 de Octubre, Instituto i+12, Facultad de Medicina, Universidad Complutense, Madrid, España
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98
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Weyand AC, Hristov A, Tejasvi T, Walkovich K. A diagnosis of mycosis fungoides in a pediatric patient with recurrent Langerhans cell histiocytosis. Pediatr Blood Cancer 2018; 65. [PMID: 29080377 DOI: 10.1002/pbc.26835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Angela C Weyand
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Alexandra Hristov
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Kelly Walkovich
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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99
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Jiang G, Shen X, Kang H, Li K, Zheng J, Yu Y. Serum metabolite profiling of cutaneous T-cell lymphoma based on a multiplatform approach. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1077-1078:71-76. [PMID: 29413580 DOI: 10.1016/j.jchromb.2018.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/07/2017] [Accepted: 01/26/2018] [Indexed: 12/29/2022]
Abstract
Cutaneous T-cell lymphoma (CTCL) is a class of non-Hodgkin lymphoma with a difficult early diagnosis. The overall annual age-adjusted incidence of CTCL had consistently increased to around 10.2 cases per million persons. However, our knowledge regarding its mechanism of disease origin and progression remains unclear. In this study, serum samples from 31 CTCL patients and 31 matched healthy volunteers were analyzed in depth to screen metabolites capable of differentiating CTCL from controls. To obtain a higher coverage of metabolome with various hydrophilicity, a multiplatform approach with GC-MS and UHPLC-QTOF-MS has been employed. Data were analyzed by multivariate statistical analysis and CTCL group was separated from control group successfully using supervised OPLS-DA model. A total of 51 CTCL-regulated metabolites were identified, among which 15 differential metabolites have an AUC > 0.9 in receiver operating characteristic (ROC) curve analysis. Glycerophospholipid metabolism, tryptophan metabolism and purine metabolism were highlighted as 3 major altered pathways in CTCL serum. These alterations revealed impacts to membrane stability and weakened immune as well as ATP depletion associated with CTCL. Overall, these results aid in improving understanding of the mechanism related to CTCL, and demonstrate this multiplatform approach is suitable for serum metabolomics researches.
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Affiliation(s)
- Guoting Jiang
- School of Pharmacy, Fudan University, Shanghai 201203, PR China
| | - Xiaoyan Shen
- Department of Dermatology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - Hongyan Kang
- School of Pharmacy, Fudan University, Shanghai 201203, PR China
| | - Kejia Li
- Department of Dermatology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China
| | - Jie Zheng
- Department of Dermatology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, PR China.
| | - Yunqiu Yu
- School of Pharmacy, Fudan University, Shanghai 201203, PR China.
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100
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Ghazawi FM, Netchiporouk E, Rahme E, Tsang M, Moreau L, Glassman S, Provost N, Gilbert M, Jean SE, Roshdy O, Pehr K, Sasseville D, Litvinov IV. Distribution and Clustering of Cutaneous T-Cell Lymphoma (CTCL) Cases in Canada During 1992 to 2010. J Cutan Med Surg 2017; 22:154-165. [PMID: 29241349 DOI: 10.1177/1203475417745825] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clustering of patients with cutaneous T-cell lymphoma (CTCL) was reported in several jurisdictions around the world. This rare cancer is known to affect spouses and in some cases multiple members of the same family. These combined results suggest the existence of external disease triggers/promoters. We recently conducted the first comprehensive analysis of CTCL incidence and mortality in Canada, which revealed case clustering in several regions. OBJECTIVES To extend our previous analysis on CTCL incidence across Canada and to provide all the collected data on CTCL patient incidence in Canada during the period of 1992 to 2010. METHODS Clinical parameters for patients with CTCL in Canada were analyzed using 2 independent population-based cancer registries: Canadian Cancer Registry and Le Registre Québécois du Cancer. The CTCL incidence rates were examined on different geographical levels, including provinces/territories, cities, and forward sortation areas. RESULTS Our findings further corroborate our earlier observations of higher CTCL incidence in Newfoundland and Labrador, maritime provinces (Nova Scotia and New Brunswick), and prairie provinces (Manitoba and Saskatchewan). Also, most cities with high CTCL incidence were located in these provinces. Extensive mapping of high-incidence postal codes supports case clustering in a number of communities that are located in the proximity of industrial centres and seaports. CONCLUSIONS Detailed analysis of CTCL incidence in Canada is critical to fully understand the burden of this disease in our country, to begin the search for a possible external trigger for this lymphoma, and to reform how health care resources are distributed throughout the country to better serve Canadian patients with CTCL.
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Affiliation(s)
- Feras M Ghazawi
- 1 Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.,2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Elena Netchiporouk
- 2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Elham Rahme
- 3 Division of Clinical Epidemiology, McGill University, Montréal, Québec, Canada
| | - Matthew Tsang
- 1 Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Moreau
- 2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Steven Glassman
- 1 Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie Provost
- 4 Division of Dermatology, University of Montréal, Montréal, Québec, Canada
| | - Martin Gilbert
- 5 Division of Dermatology, Université Laval, Québec City, Québec, Canada
| | - Sara-Elizabeth Jean
- 6 Division of Dermatology, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Osama Roshdy
- 2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Kevin Pehr
- 2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Denis Sasseville
- 2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Ivan V Litvinov
- 1 Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.,2 Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
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