101
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Abstract
Linked Article: https://doi.org/10.1111/bjd.17535.
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Affiliation(s)
- C Jonak
- Department of Dermatology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
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102
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Scleromyxedematous Changes in a Patient With Long-Standing Mycosis Fungoides Who Progressed to Sézary Syndrome. Am J Dermatopathol 2019; 41:e139-e143. [PMID: 31169525 DOI: 10.1097/dad.0000000000001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mycosis fungoides (MF) variants with different clinicopathologic and immunohistochemical features have been well-delineated. We report a case of scleromyxedematous changes arising in a patient with long-standing MF who progressed to Sézary syndrome (SS) shortly afterward. Total-skin electron-beam radiation therapy resulted in an excellent response, controlling both the MF/SS and the scleromyxedematous lesions; however, the patient died few months later. Although mucin deposition has been described in association with MF/SS (mainly follicular mucinosis in folliculotropic MF), there are limited reports in the literature on dermal mucinosis and scleromyxedematous changes in MF/SS. The mechanism of this association and its prognostic implications requires further investigation.
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103
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Pawlitschek T, Hajar T, Fett N. Abrupt Onset of Dysphagia, Arthritis, Joint Contractures, and Sheets of Monomorphous Waxy Papules. JAMA Dermatol 2019; 155:737-738. [DOI: 10.1001/jamadermatol.2018.5627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Tamar Hajar
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Nicole Fett
- Department of Dermatology, Oregon Health and Science University, Portland
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104
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Cowan N, Coman G, Duffy K, Wada DA. Treatment of recalcitrant mycosis fungoides with topical gentian violet. JAAD Case Rep 2019; 5:413-415. [PMID: 31049384 PMCID: PMC6479111 DOI: 10.1016/j.jdcr.2019.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Natasha Cowan
- School of Medicine, University of California San Diego, San Diego, California
| | - Garrett Coman
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Keith Duffy
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - David A Wada
- Department of Dermatology, University of Utah, Salt Lake City, Utah
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105
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Kaplan MH, Kaminski M, Estes JM, Gitlin SD, Zahn J, Elder JT, Tejasvi T, Gensterblum E, Sawalha AH, McGowan JP, Dosik MH, Direskeneli H, Direskeneli GS, Adebamowo SN, Adebamowo CA, Sajadi M, Contreras-Galindo R. Structural variation of centromeric endogenous retroviruses in human populations and their impact on cutaneous T-cell lymphoma, Sézary syndrome, and HIV infection. BMC Med Genomics 2019; 12:58. [PMID: 31046767 PMCID: PMC6498702 DOI: 10.1186/s12920-019-0505-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
Background Human Endogenous Retroviruses type K HML-2 (HK2) are integrated into 117 or more areas of human chromosomal arms while two newly discovered HK2 proviruses, K111 and K222, spread extensively in pericentromeric regions, are the first retroviruses discovered in these areas of our genome. Methods We use PCR and sequencing analysis to characterize pericentromeric K111 proviruses in DNA from individuals of diverse ethnicities and patients with different diseases. Results We found that the 5′ LTR-gag region of K111 proviruses is missing in certain individuals, creating pericentromeric instability. K111 deletion (−/− K111) is seen in about 15% of Caucasian, Asian, and Middle Eastern populations; it is missing in 2.36% of African individuals, suggesting that the −/− K111 genotype originated out of Africa. As we identified the −/−K111 genotype in Cutaneous T-cell lymphoma (CTCL) cell lines, we studied whether the −/−K111 genotype is associated with CTCL. We found a significant increase in the frequency of detection of the −/−K111 genotype in Caucasian patients with severe CTCL and/or Sézary syndrome (n = 35, 37.14%), compared to healthy controls (n = 160, 15.6%) [p = 0.011]. The −/−K111 genotype was also found to vary in HIV-1 infection. Although Caucasian healthy individuals have a similar frequency of detection of the −/− K111 genotype, Caucasian HIV Long-Term Non-Progressors (LTNPs) and/or elite controllers, have significantly higher detection of the −/−K111 genotype (30.55%; n = 36) than patients who rapidly progress to AIDS (8.5%; n = 47) [p = 0.0097]. Conclusion Our data indicate that pericentromeric instability is associated with more severe CTCL and/or Sézary syndrome in Caucasians, and appears to allow T-cells to survive lysis by HIV infection. These findings also provide new understanding of human evolution, as the −/−K111 genotype appears to have arisen out of Africa and is distributed unevenly throughout the world, possibly affecting the severity of HIV in different geographic areas. Electronic supplementary material The online version of this article (10.1186/s12920-019-0505-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark H Kaplan
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mark Kaminski
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Judith M Estes
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Scott D Gitlin
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, 48105, USA
| | - Joseph Zahn
- Division of Dermatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - James T Elder
- Division of Dermatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, 48105, USA
| | - Trilokraj Tejasvi
- Division of Dermatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA.,Ann Arbor Veterans Affairs Hospital, Ann Arbor, MI, 48105, USA
| | - Elizabeth Gensterblum
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Amr H Sawalha
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joseph Patrick McGowan
- Division of Infectious Diseases, The Feinstein Institute for Medical research, Manhasset, NY, 11030, USA
| | | | - Haner Direskeneli
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | | | - Sally N Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Clement A Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Mohammad Sajadi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Rafael Contreras-Galindo
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 48109, USA. .,Hormel Institute, University of Minnesota, Austin, MN, 55912, USA.
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106
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Wartewig T, Ruland J. PD-1 Tumor Suppressor Signaling in T Cell Lymphomas. Trends Immunol 2019; 40:403-414. [PMID: 30979616 DOI: 10.1016/j.it.2019.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 12/15/2022]
Abstract
The inhibitory receptor PD-1 is critical to balancing antigen-induced T cell activation; its inhibition is currently being explored to enhance antitumor T cell immunity with certain successful outcomes. However, PD-1 has also emerged as a central tumor suppressor in T cell lymphomas, where the tumor cell originates from a T cell itself. These aggressive cancers are frequently characterized by oncogenic mutations in T cell receptor (TCR) signaling pathways. PD-1 activity within malignant T cells can negatively regulate the PI3K/AKT and PKCθ/NF-κB tumor survival pathways and PD-1 is frequently inactivated in this human malignancy. This review summarizes current insights into oncogenic T cell signaling, discusses tumor-suppressive functions and mechanisms of PD-1 in T cell lymphomagenesis, and addresses potential unwanted effects caused by PD-1 checkpoint inhibition.
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Affiliation(s)
- Tim Wartewig
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (TranslaTUM), Munich, Germany
| | - Jürgen Ruland
- Institute of Clinical Chemistry and Pathobiochemistry, School of Medicine, Technical University of Munich, Munich, Germany; Center for Translational Cancer Research (TranslaTUM), Munich, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Center for Infection Research (DZIF), partner site, Munich, Germany.
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107
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Partial trisomy 21 contributes to T-cell malignancies induced by JAK3-activating mutations in murine models. Blood Adv 2019; 2:1616-1627. [PMID: 29986854 DOI: 10.1182/bloodadvances.2018016089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/17/2018] [Indexed: 02/05/2023] Open
Abstract
JAK3-activating mutations are commonly seen in chronic or acute hematologic malignancies affecting the myeloid, megakaryocytic, lymphoid, and natural killer (NK) cell compartment. Overexpression models of mutant JAK3 or pharmacologic inhibition of its kinase activity have highlighted the role that these constitutively activated mutants play in the T-cell, NK cell, and megakaryocytic lineages, but to date, the functional impact of JAK3 mutations at an endogenous level remains unknown. Here, we report a JAK3A572V knockin mouse model and demonstrate that activated JAK3 leads to a progressive and dose-dependent expansion of CD8+ T cells in the periphery before colonization of the bone marrow. This phenotype is dependent on the γc chain of cytokine receptors and presents several features of the human leukemic form of cutaneous T-cell lymphoma (L-CTCL), including skin involvements. We also showed that the JAK3A572V-positive malignant cells are transplantable and phenotypically heterogeneous in bone marrow transplantation assays. Interestingly, we revealed that activated JAK3 functionally cooperates with partial trisomy 21 in vivo to enhance the L-CTCL phenotype, ultimately leading to a lethal and fully penetrant disorder. Finally, we assessed the efficacy of JAK3 inhibition and showed that CTCL JAK3A572V-positive T cells are sensitive to tofacitinib, which provides additional preclinical insights into the use of JAK3 inhibitors in these disorders. Altogether, this JAK3A572V knockin model is a relevant new tool for testing the efficacy of JAK inhibitors in JAK3-related hematopoietic malignancies.
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108
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Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come? Am J Clin Dermatol 2019; 20:217-236. [PMID: 30652265 DOI: 10.1007/s40257-018-00416-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drug reaction with eosinophilia and systemic symptoms (DReSS), also known as drug-induced hypersensitivity syndrome (DiHS), is an uncommon severe adverse reaction to medications. It is important to recognize it as it is potentially fatal and can cause significant morbidity. From the first reports of drug reactions related to certain anticonvulsants characterized by fever, liver enzyme elevation, and skin changes, our continuously growing understanding of this entity has allowed us to describe its physiopathology and clinical features even further. The relationship of genetic factors, viral activation, and specific drug exposure is now known to play a role in this disease. There is still not a widely accepted marker for DReSS/DiHS, but the spectrum of clinical and laboratory features has now been better outlined. The mainstay of treatment is the use of systemic corticosteroids, but other options such as intravenous immunoglobulin, cyclosporine, mycophenolate mofetil, rituximab, and cyclophosphamide have been described. We present a comprehensive review of the literature on DReSS/DiHS, focusing on its history, etiopathogenesis, diagnosis, therapeutic approach, and outcome.
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109
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Damasco FM, Geskin LJ, Akilov OE. Nail Changes in Sézary Syndrome: A Single-Center Study and Review of the Literature. J Cutan Med Surg 2019; 23:380-387. [DOI: 10.1177/1203475419839937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The onychodystrophies associated with Sézary syndrome (SzS) have rarely been described in the literature. We performed a retrospective analysis of SzS patients at a single institution and compared our data with previous publications. Objectives: The objectives of this study were to identify and describe the most frequent nail alterations in patients with SzS. Methods: A retrospective analysis was performed with some prospective observations at the University of Pittsburgh from 1989 to 2017. Results: We identified 54 patients with SzS out of 535 patients with cutaneous T-cell lymphoma. Nineteen patients with SzS had photos of their nail. All those patients exhibited some type of onychodystrophy. The most common types were paronychia (63.2%; 12/19), leukonychia (42.1%; 8/19), onycholysis (42.1%; 8/19), trachyonychia (31.6%; 6/19), and subungual hyperkeratosis (26.3; 5/19). Cluster analysis of our data in comparison with published data on the psoriatic nails indicated that while leukonychia, onycholysis, subungual hyperkeratosis, and nail discoloration were frequently observed in psoriasis, onychauxis, anonychia, distal notching, and onychoschizia occurred more commonly in patients with SzS. Conclusions: The most common nail manifestations in SzS patients included paronychia, leukonychia, and onycholysis. The nail manifestations in SzS patients appeared to be heterogeneous, while onychauxis, anonychia, distal notching, and onychoschizia seem to be specific to SzS in comparison with psoriasis.
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Affiliation(s)
- Fabiana M. Damasco
- Cutaneous Lymphoma Program, Department of Dermatology, University of Pittsburgh Medical Center, PA, USA
| | - Larisa J. Geskin
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Oleg E. Akilov
- Cutaneous Lymphoma Program, Department of Dermatology, University of Pittsburgh Medical Center, PA, USA
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110
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Soltan MY, Sumarni U, Assaf C, Langer P, Reidel U, Eberle J. Key Role of Reactive Oxygen Species (ROS) in Indirubin Derivative-Induced Cell Death in Cutaneous T-Cell Lymphoma Cells. Int J Mol Sci 2019; 20:ijms20051158. [PMID: 30866411 PMCID: PMC6429192 DOI: 10.3390/ijms20051158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 02/27/2019] [Accepted: 03/02/2019] [Indexed: 01/05/2023] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) may develop a highly malignant phenotype in its late phase, and patients may profit from innovative therapies. The plant extract indirubin and its chemical derivatives represent new and promising antitumor strategies. This first report on the effects of an indirubin derivative in CTCL cells shows a strong decrease of cell proliferation and cell viability as well as an induction of apoptosis, suggesting indirubin derivatives for therapy of CTCL. As concerning the mode of activity, the indirubin derivative DKP-071 activated the extrinsic apoptosis cascade via caspase-8 and caspase-3 through downregulation of the caspase antagonistic proteins c-FLIP and XIAP. Importantly, a strong increase of reactive oxygen species (ROS) was observed as an immediate early effect in response to DKP-071 treatment. The use of antioxidative pre-treatment proved the decisive role of ROS, which turned out upstream of all other proapoptotic effects monitored. Thus, reactive oxygen species appear as a highly active proapoptotic pathway in CTCL, which may be promising for therapeutic intervention. This pathway can be efficiently activated by an indirubin derivative.
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Affiliation(s)
- Marwa Y Soltan
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
- Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt.
| | - Uly Sumarni
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Chalid Assaf
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
- Clinic for Dermatology and Venereology, Helios Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany.
| | - Peter Langer
- Institute of Chemistry, University of Rostock, Albert-Einstein-Str. 3a, 18059 Rostock, Germany.
- Leibniz Institute of Catalysis at the University of Rostock e.V., Albert-Einstein-Str. 29a, 18059 Rostock, Germany.
| | - Ulrich Reidel
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Jürgen Eberle
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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111
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Wain T, Venning VL, Consuegra G, Fernandez‐Peñas P, Wells J. Management of cutaneous T‐cell lymphomas: Established and emergent therapies. Australas J Dermatol 2019; 60:200-208. [DOI: 10.1111/ajd.13011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/28/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Thevaki Wain
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
| | - Victoria L Venning
- The Skin Hospital WestmeadNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
| | - Germana Consuegra
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
| | - Pablo Fernandez‐Peñas
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
- The Skin Hospital WestmeadNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
| | - Jillian Wells
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
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112
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Mycosis Fungoides: Analysis of Ophthalmologic Findings in a Series of Cases. Case Rep Dermatol Med 2019; 2019:2380598. [PMID: 30805223 PMCID: PMC6360538 DOI: 10.1155/2019/2380598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/08/2019] [Indexed: 11/22/2022] Open
Abstract
Background Ophthalmic findings in mycosis fungoides (MF) can be highly variable. It seems that the prevalence of ophthalmic findings could be much more common than previously assumed. Objective To present case series examined in the last 12 months, together with a literature review. Methods Symptomatic patients with biopsy-proven mycosis fungoides were examined ophthalmologically in a 12-month period. The medical records of affected patients were reviewed. Results Eight patients were examined. Of these, 75% were male, all were Caucasian, and average age was 58.2 years. Blepharitis (50.0%), thickened eyelids (37.5%), and flaking (25.0%) were the most prevalent findings. Conclusion Incidence of MF affecting the eyes and surrounding structures may be greater than estimated. Early case management offers means to reduce difficulties experienced with later diagnosis. Regular monitoring by an ophthalmologist is justified, including that of asymptomatic cases.
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113
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McCaffrey S, Black RA, Nagao M, Sepassi M, Sharma G, Thornton S, Kim YH, Braverman J. Measurement of Quality of Life in Patients with Mycosis Fungoides/Sézary Syndrome Cutaneous T-Cell Lymphoma: Development of an Electronic Instrument. J Med Internet Res 2019; 21:e11302. [PMID: 30617041 PMCID: PMC6329422 DOI: 10.2196/11302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/23/2018] [Accepted: 09/23/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although the quality of life (QoL) plays an important role in treatment decision making and clinical management of mycosis fungoides (MF) or Sézary syndrome (SS) subtypes of cutaneous T-cell lymphomas (MF/SS-CTCLs), an MF- or SS-specific measure of QoL does not exist. OBJECTIVE The objective of this research was to develop and validate the first QoL instrument for MF/SS-CTCL using a patient-centered approach. METHODS A conceptual framework for the MF/SS-CTCL QoL was developed through a literature review and interviews with key opinion leaders. Concept elicitation with patients was utilized to refine the conceptual model and generate preliminary items. The items were then revised based on qualitative and quantitative feedback obtained through cognitive debriefing surveys and interviews with patients. Next, participants (N=126) completed the preliminary MF/SS-CTCL QoL and a comparator measure of health-related QoL (Skindex-29) through the PatientsLikeMe Open Research Exchange. The MF/SS-CTCL QoL was completed again 5 days later by 66 participants for the purposes of evaluating test-retest reliability. The MF/SS-CTCL QoL was finalized based on results from an empirical evaluation, which included both classical and modern test theory approaches. Specifically, this included evaluation of (1) the optimal item response theory measurement model; (2) item fit; (3) unidimensionality; (4) rating scale performance; (5) reliability; (6) test information (precision); (7) person-to-item map; (8) convergent and discriminant validity; and (9) presence of bias via differential item function. RESULTS Results from the comprehensive psychometric evaluation utilizing a Rasch-Grouped Rating Scale model yielded a final 12-item instrument. The rating scale functioned as expected, and the instrument exhibited adequate person reliability (.87), good to excellent test-retest reliability (r=.89, P<.001), high levels of measurement precision, and good person-to-item targeting. The correlation between the MF/SS-CTCL QoL and the Skindex-29 (r=.852, P<.001) was significantly greater than the correlation between the MF/SS-CTCL QoL and syndrome stage (r=.260, P<.001), providing support for convergent and discriminant validity. Items did not show significant bias based on gender, age, or race. Rasch scores were converted to scaled scores with qualitative descriptive categories for ease of interpretation. CONCLUSIONS Empirical evaluation demonstrated strong evidence of excellent psychometric properties. Utilizing a patient-centered measure development approach ensures that this QoL instrument captures the information that is most meaningful and clinically relevant to patients.
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Affiliation(s)
| | - Ryan A Black
- Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Mitchell Nagao
- Actelion (US), Inc, South San Francisco, CA, United States
| | - Marjan Sepassi
- Actelion (US), Inc, South San Francisco, CA, United States
| | - Gaurav Sharma
- Actelion (US), Inc, South San Francisco, CA, United States
| | - Susan Thornton
- Cutaneous Lymphoma Foundation, Birmingham, MI, United States
| | - Youn H Kim
- Stanford University, Stanford, CA, United States
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Abstract
Adequate therapeutic management of cutaneous T-cell lymphoma (CTCL) requires the identification of the exact CTCL stage and entity within the current WHO classification. There is no curative therapy for CTCL yet, so that treatment currently aims at improving symptoms and quality of life as well as reducing relapse rates. The treatment has to be stage-adapted. Therapeutic options comprise skin-directed as well as systemic treatment. In early stages, phototherapy and local steroids are the first-line therapeutic options. For the therapy of higher stages, interferon alpha and the RXR-specific retinoid bexarotene are used as first-line medications. Second-line treatment comprises monochemotherapy with agents like gemcitabine or liposomal doxorubicine. Nevertheless, the high relapse rates in higher stages make novel alternative treatment options necessary. As future therapy, especially the fusion protein brentuximab-vedotin directed against CD30 shows promising potential in clinical studies.
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Affiliation(s)
- J P Nicolay
- Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland.
| | - C Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld, Krefeld, Deutschland
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115
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Strategies for Successful Management of Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1-16. [DOI: 10.1016/j.jaip.2018.10.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
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116
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Tsang M, Gantchev J, Netchiporouk E, Moreau L, Ghazawi FM, Glassman S, Sasseville D, Litvinov IV. A study of meiomitosis and novel pathways of genomic instability in cutaneous T-cell lymphomas (CTCL). Oncotarget 2018; 9:37647-37661. [PMID: 30701021 PMCID: PMC6340880 DOI: 10.18632/oncotarget.26479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/04/2018] [Indexed: 12/31/2022] Open
Abstract
Genomic instability is a hallmark of cancer and an enabling factor for genetic alterations that drive cancer development and progression. The clashing of mitosis and aberrantly expressed meiosis machineries, which may contribute to genomic instability, has been coined cancer “meiomitosis”. LINE-1 retrotransposition, a process active in germ cells, acts outside of the meiotic machinery to create DNA double strand breaks (DNA DSBs) and has played an important role in the evolution of the human genome. We have previously demonstrated that in CTCL several cancer testis/meiotic genes are expressed. Furthermore, this cancer exhibits extensive and ongoing chromosomal/microsatellite instability. In this study we analyzed immortalized patient-derived cells and primary CTCL patient samples using RT-PCR, western blotting and confocal microscopy and found that proteins critically involved in meiosis and LINE-1 retrotransposition are expressed and are associated with chromosomal instability and DNA DSB formation. Using cell cycle synchronization, we show G1/S phase-transition-specific expression of meiosis proteins. Using the Alu retrotransposition assay, we demonstrate the functional activity of LINE-1 retrotransposon in CTCL. Histone acetyltransferase inhibition results in downregulation of the ectopic germ cell programs and concomitant decrease in DNA DSBs foci formation. Notably, LINE-1 and meiosis genes were expressed across a panel of other solid tumor cell lines. Taken together, our results indicate that malignant cells in culture undergo “cancer meiomitosis” rather than the classic mitosis division. The ectopic expression of meiosis genes and reactivation of LINE-1 may be contributing to genomic instability and represent novel targets for immunotherapy in this and other cancers.
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Affiliation(s)
- Matthew Tsang
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Jennifer Gantchev
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Linda Moreau
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Steven Glassman
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
| | - Ivan V Litvinov
- Division of Dermatology, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada.,Division of Dermatology, McGill University, Montréal, Québec H4A 3J1, Canada
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117
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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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118
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Zoumberos NA, McMullen E, Wang L, Wang X, Harms KL, Tejasvi T, Chan MP, Fullen DR, Hristov AC, Harms PW. Merkel cell carcinoma arising in association with cutaneous T-cell lymphoma: A potential diagnostic pitfall. J Cutan Pathol 2018; 46:199-203. [PMID: 30561044 DOI: 10.1111/cup.13404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine carcinoma with increased prevalence in patients with immunosuppression or B-cell neoplasms. To the best of our knowledge, an association with cutaneous T-cell lymphoma (CTCL) has not been previously described. In this report, we present two cases of MCC arising in the setting of CTCL. The first case was a female during her 70s with previously diagnosed stage IVA1 Sezary syndrome. Biopsy of a scaly patch showed two distinct abnormal cell populations. The first population consisted of hyperchromatic dermal and epidermotropic lymphocytes, expressing CD3 and CD4 with diminished CD7. The second population consisted of intraepidermal clusters of larger atypical cells that expressed synaptophysin, neurofilament, CK20, and Merkel cell polyomavirus transcript. The combination of findings was consistent with intraepidermal MCC in a background of CTCL. Excision showed residual intraepidermal MCC without dermal involvement. The second case was a male during his 50s with a longstanding history of mycosis fungoides, who presented with a new lesion on his right thigh. Biopsy and excision showed dermal MCC without secondary involvement by CTCL. Our cases show that MCC may rarely occur in the setting of T-cell lymphoma, and that intraepidermal MCC may mimic epidermotropic T-cells.
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Affiliation(s)
| | - Emily McMullen
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Lisha Wang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Xiaoming Wang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Kelly L Harms
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | | | - May P Chan
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Alexandra C Hristov
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Paul W Harms
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan
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119
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Roda Â, Travassos AR, Soares-de-Almeida L, Kutzner H. Lupus erythematosus mimicking mycosis fungoides: CD123 + plasmacytoid dendritic cells as a useful diagnostic clue. J Cutan Pathol 2018; 46:167-170. [PMID: 30430606 DOI: 10.1111/cup.13395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/20/2018] [Accepted: 10/06/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Ângela Roda
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Lisbon, Portugal
| | - Ana Rita Travassos
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Lisbon, Portugal
| | - Luís Soares-de-Almeida
- Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Lisbon, Portugal.,Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia, Laboratório de Histopatologia Cutânea, Lisbon, Portugal.,Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa, Portugal
| | - Heinz Kutzner
- Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa, Portugal.,Dermatopathologie Friedrichshafen, Friedrichshafen, Germany
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120
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Quality of Life in Patients with Cutaneous T-Cell Lymphoma. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:511-513. [PMID: 30509758 DOI: 10.1016/j.ad.2018.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/28/2017] [Accepted: 02/11/2018] [Indexed: 11/24/2022] Open
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121
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Mycosis fungoides in Taiwan shows a relatively high frequency of large cell transformation and CD56 expression. Pathology 2018; 50:718-724. [DOI: 10.1016/j.pathol.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 12/23/2022]
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122
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Demina OM, Akilov OE, Rumyantsev AG. Cutaneous T-cell lymphomas: modern data of pathogenesis, clinics and therapy. ONCOHEMATOLOGY 2018. [DOI: 10.17650/1818-8346-2018-13-3-25-38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of extranodal non-Hodgkin’s lymphomas that are characterized by skin infiltration with malignant monoclonal T lymphocytes. More common in adults aged 55 to 60 years, the annual incidence is about 0.5 per 100 000 people. Mycosis fungoides, Sézary syndrome and CD30+ lymphoproliferative diseases are the main subtypes of CTCL. To date, CTCL have a complex concept of etiopathogenesis, diagnosis, therapy and prognosis. The article presented summary data on these issues.
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Affiliation(s)
- O. M. Demina
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Health of Russia
| | - O. E. Akilov
- University of Pittsburgh, Department of Dermatology, Cutaneous Lymphoma Clinics
| | - A. G. Rumyantsev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Ministry of Health of Russia
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123
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Horna P, Moscinski LC, Sokol L, Shao H. Naïve/memory T-cell phenotypes in leukemic cutaneous T-cell lymphoma: Putative cell of origin overlaps disease classification. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:234-241. [PMID: 30328260 DOI: 10.1002/cyto.b.21738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mycosis fungoides (MF) and Sézary Syndrome (SS) are clinically distinct cutaneous T-cell lymphomas with strikingly similar morphologic and phenotypic features. Prior studies have suggested phenotypic differences based on markers of antigen experience, suggesting a different cell of origin. METHODS Seventy-nine involved peripheral blood or bone marrow samples from 33 patients with SS and 19 patients with MF were studied by 10-color flow cytometry, including CD62L, CD45RA, CCR4, and PD-1. Gated tumor events were classified as naïve (TN ), central memory (TCM ), effector memory (TEM ), or effector memory with reacquired CD45RA (TEMRA ); based on CD62L+ /CD45RA+ , CD62L+ /CD45RA- , CD62L- /CD45RA- , or CD62L- /CD45RA+ phenotype, respectively. Sequential specimens were compared to assess for phenotypic stability. RESULTS The naïve/memory phenotype of the neoplastic T-cells was markedly heterogeneous, with a dominant TN , TCM , TEM , or TEMRA subset on 11 (14%), 32 (41%), 30 (38%), and 6 (8%) cases, respectively. There was no correlation between the diagnosis of MF or SS and putative cell of origin (P = 0.4). Overexpression of CCR4 and PD1 was observed in most cases, with higher intensity in SS compared to MF. The naïve/memory phenotype remained the same for 10 patients up to 273 days after the initial analysis; while on six patients, the naïve/memory phenotype was different from the original phenotype. CONCLUSIONS Both SS and MF can have phenotypic features of any of the major naïve/memory T-cell subsets, which questions the current principle of "cell-of-origin" distinction between SS and MF. Phenotypic shifts within these subsets are common, suggesting a functional state rather than a cell-of-origin surrogate. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Lynn C Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
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124
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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: 16] [Impact Index Per Article: 2.7] [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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125
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126
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Extensive Cutaneous T-Cell Lymphoma of the Feet Treated with High-Dose-Rate Brachytherapy and External Beam Radiation. Case Rep Dermatol Med 2018; 2018:5610925. [PMID: 30174962 PMCID: PMC6106951 DOI: 10.1155/2018/5610925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a chronic, debilitating disease that has a severe impact on quality of life. We present a patient with multiple CTCL lesions on the bilateral feet, which impaired his ability to ambulate. His lesions on both feet were successfully treated with a total of 8 Gy in two fractions via high-dose-rate surface brachytherapy using the Freiburg Flap applicator. The deeper aspects of the bulkier lesions on the left foot were boosted with electron beam therapy. The radiation therapy was well tolerated, and the patient was able to regain his mobility after completing radiation therapy. To our knowledge, there are few reports utilizing brachytherapy in treating CTCL. Our case describes treatment of larger, more extensive CTCL lesions than previously reported.
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127
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Cho A, Jantschitsch C, Knobler R. Extracorporeal Photopheresis-An Overview. Front Med (Lausanne) 2018; 5:236. [PMID: 30211164 PMCID: PMC6119964 DOI: 10.3389/fmed.2018.00236] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/03/2018] [Indexed: 12/23/2022] Open
Abstract
Extracorporeal photopheresis (ECP) has been in clinical use for over three decades after receiving FDA approval for the palliative treatment of the Sézary Syndrome variant of cutaneous T-cell lymphoma (CTCL) in 1988. After the first positive experiences with CTCL, additional indications have been successfully explored including areas such as graft-vs.-host disease (GVHD), scleroderma, and solid organ transplantation. The mechanism of action is still not fully resolved, but important steps in understanding ECP in recent years have been very informative. Originally, the primary hypothesis stated that psoralen and ultraviolet A (UVA) in combination induce apoptosis in the treated immune cells. This view shifted in favor of dendritic cell initiation, modification of the cytokine profile and stimulation of several T-cell lineages, in particular regulatory T-cells. A number of ECP guidelines have been produced to optimize treatment regimens in the clinical context. In CTCL, enough evidence is available for the use of ECP as a first line treatment for Sézary Syndrome (SS), but also as a second line or rescue treatment in therapy-refractory forms of mycosis fungoides (MF). ECP in the treatment of acute and chronic GVHD has shown promising results as second line therapy in steroid-refractory presentations. In solid organ transplantation, ECP has been used to increase tissue tolerance and decrease infections with opportunistic pathogens, attributed to the use of high doses of immunosuppressive medication. Infection with cytomegalovirus (CMV) remains a limiting factor affecting survival in solid organ transplantation and the role of ECP will be discussed in this review. A trend toward prophylactic use of ECP can be observed and may further contribute to improve the outcome in many patients. To further deepen our knowledge of ECP and thus facilitate its use in patients that potentially benefit most from it, future prospective randomized trials are urgently needed in this rapidly growing field. The aim of this review is to (1) introduce the method, (2) give an overview where ECP has shown promising effects and has become an essential part of treatment protocols, and (3) to give recommendations on how to proceed in numerous indications.
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Affiliation(s)
| | | | - Robert Knobler
- Department of Dermatology, Medizinische Universität Wien, Vienna, Austria
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128
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Palliative Radiotherapy for Disfiguring Mycosis Fungoides Lesion: A Key Treatment to Reduce Psychological and Social Impact. Case Rep Dermatol Med 2018; 2018:1762050. [PMID: 30147966 PMCID: PMC6083556 DOI: 10.1155/2018/1762050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
Mycosis Fungoides (MF) is a rare disease with a relatively good prognosis at early stage. However, skin lesions can impair quality of life due to extensive skin lesions. In some cases, skin lesions, and especially those of the face, become visible and change the physical appearance of the patients. This aspect can deeply affect patients psychologically and can impact their social life. Here, we report the case of a patient with multiple lesions including a disfiguring lesion arising from the nose. The extent of his skin lesions gave a palliative intent to his treatment project. The patient underwent several lines of chemotherapy and immunotherapy with poor results. He was then referred to our radiotherapy and received localized radiotherapy. Lesions disappeared completely within a few weeks. The patient reported a psychological relief. This case highlights the fact that radiotherapy can be done in a “palliative” intent in order to improve esthetic aspects of lesions that can dramatically impact the psychosocial side of patient's life. Clinicians can consider radiotherapy as treatment of some MF lesions as far as they impair the patient's comfort from a psychological and social point of view.
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129
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Patrushev AV, Samtsov AV, Nikitin VY, Ivanov AМ, Gumilevskaya OР, Sukharev AV, Sukhina IA. Origin, function and role in the development of skin diseases CLA+T-lymphocytes. VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-3-20-29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The idea of CLA+T-lymphocytes, which are a special subpopulation of cells with a tropic to the skin, is given. The issues of maturation, migration and functional features of CLA+T-cells are considered. Special attention is paid to the different phenotype of memory T-cells. Modern data concerning the role of CLA+T-cells in the pathogenesis of autoimmune and allergic dermatoses, as well as malignant skin tumors are also presented. The conclusion about the necessity of further study of CLA +T-lymphocytes for detailed understanding of pathogenesis and search of variants of targeted therapy in psoriasis, atopic dermatitis, skin lymphomas and other skin diseases is made.
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130
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Rohl R, Bax D, Schierer S, Bogner PN, Hernandez-Ilizaliturri F, Paragh G. A case for histologic verification of the diagnosis of atypical psoriasis before systemic therapy. JAAD Case Rep 2018; 4:465-467. [PMID: 29984284 PMCID: PMC6031587 DOI: 10.1016/j.jdcr.2018.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ruth Rohl
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York
| | - Daniel Bax
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, New York
| | - Shirley Schierer
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York
| | - Paul N Bogner
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Pathology, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Cancer Institute, Buffalo, New York.,Department of Cell Stress Biology, Roswell Park Cancer Institute, Buffalo, New York
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131
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Amorim GM, Niemeyer-Corbellini JP, Quintella DC, Cuzzi T, Ramos-e-Silva M. Clinical and epidemiological profile of patients with early stage mycosis fungoides. An Bras Dermatol 2018; 93:546-552. [PMID: 30066762 PMCID: PMC6063099 DOI: 10.1590/abd1806-4841.20187106] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mycosis fungoides is the most common form of primary cutaneous lymphoma, with an indolent, slowly progressive course and 88% five-year survival rate. The diagnosis is challenging, especially in the early stages, and usually relies on a good clinical-histopathological correlation. OBJECTIVE The aim was to establish the clinical and epidemiological profile of patients with early-stage mycosis fungoides. METHODS This was a retrospective cross-sectional observational study with an exploratory analysis. Outcome variables were disease progression and mycosis fungoides-related death. RESULTS One hundred and two patients were included. The majority were white males, with a mean age of 55.6 years. Mean time from onset of lesions to diagnosis was 51.08 months. The majority of patients were classified as IB stage according to TNMB. Mean follow-up time was 7.85 years. Disease progression was seen in 29.4% of the patients. Death related to the disease occurred in 7.9% of patients. Plaque lesions, involvement of more than 10% of the body surface, altered lactate dehydrogenase and beta-2-microglobulin, and stage IB were significantly associated with disease progression, and altered lactate dehydrogenase and beta-2-microglobulin also correlated with higher frequency of deaths. STUDY LIMITATIONS Small sample and retrospective design. CONCLUSIONS The clinical and epidemiological profile of patients with early-stage mycosis fungoides in our sample corroborates reports in the literature. Diagnostic delay in our series is also consistent with previous findings, but the rate of disease progression, despite treatment, was higher than reported in the literature.
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Affiliation(s)
- Gustavo Moreira Amorim
- Master’s student, Postgraduate Program in Anatomical Pathology,
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Hospital
Universitário Clementino Fraga Filho, Rio de Janeiro (RJ), Brazil
- Dermatology Outpatient Clinic, Faculdade de Medicina, Universidade
do Sul de Santa Catarina, Palhoça (SC), Brazil
| | - João Paulo Niemeyer-Corbellini
- Dermatology Service, Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Danielle Carvalho Quintella
- Pathology Service, Hospital Federal de Bonsucesso, Rio de Janeiro
(RJ), Brazil
- Department of Pathology, Universidade Federal do Rio de Janeiro,
Rio de Janeiro (RJ), Brazil
| | - Tullia Cuzzi
- Department of Pathology, Universidade Federal do Rio de Janeiro,
Rio de Janeiro (RJ), Brazil
- Instituto Nacional de Infectologia Evandro Chagas -
Fundação Oswaldo Cruz, Rio de Janeiro (RJ), Brazil
| | - Márcia Ramos-e-Silva
- Dermatology Service, Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
- Discipline of Dermatology, Faculdade de Medicina da Universidade
Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
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132
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Geller S, Pitter K, Moskowitz A, Horwitz SM, Yahalom J, Myskowski PL. Treatment of Vulvar Mycosis Fungoides Tumors With Localized Radiotherapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e279-e281. [PMID: 29752211 DOI: 10.1016/j.clml.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY.
| | - Ken Pitter
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY
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133
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Fanok MH, Sun A, Fogli LK, Narendran V, Eckstein M, Kannan K, Dolgalev I, Lazaris C, Heguy A, Laird ME, Sundrud MS, Liu C, Kutok J, Lacruz RS, Latkowski JA, Aifantis I, Ødum N, Hymes KB, Goel S, Koralov SB. Role of Dysregulated Cytokine Signaling and Bacterial Triggers in the Pathogenesis of Cutaneous T-Cell Lymphoma. J Invest Dermatol 2018; 138:1116-1125. [PMID: 29128259 PMCID: PMC5912980 DOI: 10.1016/j.jid.2017.10.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/02/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022]
Abstract
Cutaneous T-cell lymphoma is a heterogeneous group of lymphomas characterized by the accumulation of malignant T cells in the skin. The molecular and cellular etiology of this malignancy remains enigmatic, and what role antigenic stimulation plays in the initiation and/or progression of the disease remains to be elucidated. Deep sequencing of the tumor genome showed a highly heterogeneous landscape of genetic perturbations, and transcriptome analysis of transformed T cells further highlighted the heterogeneity of this disease. Nonetheless, using data harvested from high-throughput transcriptional profiling allowed us to develop a reliable signature of this malignancy. Focusing on a key cytokine signaling pathway previously implicated in cutaneous T-cell lymphoma pathogenesis, JAK/STAT signaling, we used conditional gene targeting to develop a fully penetrant small animal model of this disease that recapitulates many key features of mycosis fungoides, a common variant of cutaneous T-cell lymphoma. Using this mouse model, we show that T-cell receptor engagement is critical for malignant transformation of the T lymphocytes and that progression of the disease is dependent on microbiota.
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Affiliation(s)
- Melania H Fanok
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Amy Sun
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Laura K Fogli
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Vijay Narendran
- Department of Medicine, Division of Hematology-Oncology, New York University School of Medicine, New York, New York, USA
| | - Miriam Eckstein
- Department of Basic Science and Craniofacial Biology, NYU College of Dentistry, New York, New York, USA
| | - Kasthuri Kannan
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Office of Collaborative Science, New York University School of Medicine, New York, New York, USA
| | - Igor Dolgalev
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Office of Collaborative Science, New York University School of Medicine, New York, New York, USA
| | - Charalampos Lazaris
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Laura and Isaac Perlmutter Cancer Institute, New York University School of Medicine, New York, New York, USA
| | - Adriana Heguy
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Office of Collaborative Science, New York University School of Medicine, New York, New York, USA
| | - Mary E Laird
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Mark S Sundrud
- Department of Immunology and Microbiology, The Scripps Research Institute, Jupiter, Florida, USA
| | - Cynthia Liu
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Jeff Kutok
- Department of Pathology, Brigham and Women's Hospital; Boston, Massachusetts, USA
| | - Rodrigo S Lacruz
- Department of Basic Science and Craniofacial Biology, NYU College of Dentistry, New York, New York, USA
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Iannis Aifantis
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Laura and Isaac Perlmutter Cancer Institute, New York University School of Medicine, New York, New York, USA
| | - Niels Ødum
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth B Hymes
- Department of Medicine, Division of Hematology-Oncology, New York University School of Medicine, New York, New York, USA; Department of Pathology, Brigham and Women's Hospital; Boston, Massachusetts, USA
| | - Swati Goel
- Department of Medicine, Division of Hematology-Oncology, New York University School of Medicine, New York, New York, USA
| | - Sergei B Koralov
- Department of Pathology, New York University School of Medicine, New York, New York, USA; Laura and Isaac Perlmutter Cancer Institute, New York University School of Medicine, New York, New York, USA.
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Seyed Jafari SM, Cazzaniga S, Hunger RE. Photodynamic therapy as an alternative treatment for mycosis fungoides: a systemic review and meta-analysis. GIORN ITAL DERMAT V 2018; 153:827-832. [PMID: 29683282 DOI: 10.23736/s0392-0488.18.05977-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Mycosis fungoides is the most common cutaneous T cell lymphoma. Selection of appropriate treatment for mycosis fungoides (MF) is based on prognostic factors and overall clinical stage at diagnosis. In the past decade, clinical success has been reported using photodynamic therapy (PDT) as an alternative target-specific therapy to treat mycosis fungoides. This review aimed to summarize the current advances in management of mycosis fungoides by administration of photodynamic therapy. EVIDENCE ACQUISITION Twenty-four articles, published between 1994 and 2017, were reviewed to assess the efficacy of PDT for MF. EVIDENCE SYNTHESIS Methyl-aminolevulinic acid has increased lipophilic properties; red light at around 630 nm achieves deepest and best tissue penetration. However, the total number of PDT sessions depends on the clinical response. CONCLUSIONS Further multicenter clinical studies are warranted to assess the cost-effectiveness of PDT.
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Affiliation(s)
- S Morteza Seyed Jafari
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simone Cazzaniga
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Centro Studi GISED, Bergamo, Italy
| | - Robert E Hunger
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland -
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135
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Rea B, Haun P, Emerson R, Vignali M, Farooqi M, Samimi S, Elenitsas R, Kirsch I, Bagg A. Role of high-throughput sequencing in the diagnosis of cutaneous T-cell lymphoma. J Clin Pathol 2018; 71:814-820. [DOI: 10.1136/jclinpath-2018-205004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/27/2018] [Accepted: 03/17/2018] [Indexed: 11/04/2022]
Abstract
AimsSubstantial clinicopathological overlap exists between cutaneous T-cell lymphoma (CTCL) and benign conditions, leading to diagnostic difficulties. We sought to delineate the utility of high-throughput sequencing (HTS) across a spectrum of histological findings in CTCL and reactive mimics.MethodsOne hundred skin biopsies obtained for clinical concern for CTCL were identified, comprising 25 cases each from four histological categories: ‘definitive CTCL’, ‘atypical lymphoid infiltrate, concerning for CTCL’, ‘atypical lymphoid infiltrate, favour reactive’ or ‘reactive lymphoid infiltrate’. T-cell receptor gamma chain gene (TRG) PCR and T-cell receptor beta chain gene HTS were performed on both skin biopsy and concurrently collected peripheral blood; most peripheral blood samples were also analysed by flow cytometry.ResultsHistologically defined CTCL specimens had significantly higher clonality scores and T-cell fractions via HTS than all other groups (all p<0.002 and p<0.03, respectively). HTS was more diagnostically specific than TRG PCR in skin (100% vs 88%), while diagnostic sensitivity (68% vs 72%) and accuracy (84% vs 80%) were similar. TRG PCR and flow cytometry performed on blood were the least diagnostically useful assays. Some identically sized peaks detected by TRG PCR in concurrent skin and peripheral blood specimens were non-identical by HTS analysis.ConclusionsHTS, by assessing both clonality and T-cell fractions in skin biopsies, is a powerful tool to aid in the diagnosis of CTCL. It is more specific than TRG PCR in distinguishing definitive CTCL from reactive and indeterminate histology. Identically sized peaks by TRG PCR, typically interpreted to be clonally related, are not always clonally identical by sequencing.
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136
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Maher AM, Ward CE, Glassman S, Litvinov IV. The Importance of Excluding Cutaneous T-Cell Lymphomas in Patients with a Working Diagnosis of Papuloerythroderma of Ofuji: A Case Series. Case Rep Dermatol 2018; 10:46-54. [PMID: 29606946 PMCID: PMC5869582 DOI: 10.1159/000487473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
Papuloerythroderma of Ofuji (PEO) is an erythroderma-like eruption with flat-topped papules that spare the skin folds (a "deck-chair sign" finding). Many infections, medications, and systemic diseases have been associated with PEO, including cutaneous T-cell lymphomas (CTCL). The relationship between the clinical presentation of PEO and CTCL remains poorly elucidated. Clinical, laboratory, and histopathological data were obtained from the Lymphoma Clinic at the Ottawa Hospital, Canada. We report 5 patients with deck-chair-sign-positive CTCL, mycosis fungoides, and Sézary syndrome variants. We contend that PEO should be viewed as a diagnosis of exclusion and that these patients should be monitored carefully for possible emergence of CTCL. Skin biopsy alone is not sufficient to exclude CTCL in these patients. A skin eruption demonstrating a positive deck-chair sign may signify systemic/leukemic CTCL and, therefore, warrants a thorough investigation, including skin biopsy, flow cytometry, and T-cell receptor clonality studies.
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Affiliation(s)
- Anthony M Maher
- Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada
| | - Chloé E Ward
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Glassman
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ivan V Litvinov
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.,Division of Dermatology, McGill University Health Centre, Montreal, Québec, Canada
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137
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Allogeneic hematopoietic stem cell transplantation in Primary Cutaneous T Cell Lymphoma. Ann Hematol 2018; 97:1041-1048. [PMID: 29442161 DOI: 10.1007/s00277-018-3275-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/02/2018] [Indexed: 11/12/2022]
Abstract
In our retrospective study, 16 patients affected by advanced cutaneous T cell lymphoma (CTCL) underwent allogeneic hematopoietic stem cell transplantation (HSCT). Two patients (12.5%) were in complete remission (CR), nine (56.3%) in partial remission (PR), and five (31.2%) with active disease. The patients were transplanted from an HLA-identical (n = 7) from a mismatched (n = 1) or haploidentical (n = 1) sibling, from matched unrelated donor (n = 5), or from a single cord blood unit (n = 2). Conditioning regimen was standard myeloablative in 6 patients and at reduced intensity in 10. Seven patients died from non relapse mortality (NRM) and four patients relapsed or progressed, three of them achieved a second CR after donor lymphocyte infusion (DLI) or chemotherapy plus DLI. To date, with a median follow-up of 76 months (range 6-130), nine patients are alive, eight in CR, and one with active disease. Overall survival (OS) and disease-free survival (DFS) at 1 and 10 years are 61% (95% CI 40-91%) and 54% (95% CI 33-86%), 40% (95% CI 22-74%), and 34% (95% CI 16-68%), respectively. The time from diagnosis to transplant seems to influence negatively both OS (log-rank p < 0.04) and DFS (log-rank p < 0.05). Our results confirm on a long follow-up that CTCL appears particularly susceptible to the graft versus lymphoma (GVL) effect, so that allogeneic HSCT represents a possibility of cure for advanced CTCL. The timing of HSCT in the clinical course of disease remains an open issue.
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138
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Amorim GM, Niemeyer-Corbellini JP, Quintella DC, Cuzzi T, Ramos-e-Silva M. Hypopigmented mycosis fungoides: a 20-case retrospective series. Int J Dermatol 2018; 57:306-312. [DOI: 10.1111/ijd.13855] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/02/2017] [Accepted: 11/10/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Gustavo M. Amorim
- Sector of Dermatology and Post Graduation Program in Medical Clinics; HUCFF-UFRJ and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Joao P. Niemeyer-Corbellini
- Sector of Dermatology and Post-Graduation Course in Dermatology; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Danielle C. Quintella
- Department of Pathology; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Tullia Cuzzi
- Department of Pathology; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
| | - Marcia Ramos-e-Silva
- Sector of Dermatology; Post-Graduation Course in Dermatology and Post Graduation Program in Medical Clinics; University Hospital and School of Medicine; Federal University of Rio de Janeiro; Rio de Janeiro Brazil
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139
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TOX as a diagnostic and prognostic marker for mycosis fungoides. JOURNAL OF THE EGYPTIAN WOMENʼS DERMATOLOGIC SOCIETY 2018. [DOI: 10.1097/01.ewx.0000525982.47129.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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140
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Bulur I, Erdogan HK, Aksu AE, Karapınar T, Saracoglu ZN. The efficacy and safety of phototherapy in geriatric patients: a retrospective study. An Bras Dermatol 2018; 93:33-38. [PMID: 29641694 PMCID: PMC5871359 DOI: 10.1590/abd1806-4841.20185468] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/09/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND While phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited. OBJECTIVE In this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group. METHODS This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. RESULTS Phototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect. STUDY LIMITATIONS The limitations of our study are that it was retrospective and the remission durations of the patients are not known. CONCLUSION This study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.
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Affiliation(s)
- Isil Bulur
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi
University, Eskişehir, Turkey
| | - Hilal Kaya Erdogan
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi
University, Eskişehir, Turkey
| | - Ayse Esra Aksu
- Deparrment of Dermatology, Istanbul Training and Research Hospital,
Istanbul, Turkey
| | - Tekden Karapınar
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi
University, Eskişehir, Turkey
| | - Zeynep Nurhan Saracoglu
- Department of Dermatology, Faculty of Medicine, Eskisehir Osmangazi
University, Eskişehir, Turkey
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141
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The role of regulatory T cells and genes involved in their differentiation in pathogenesis of selected inflammatory and neoplastic skin diseases. Part II: The Treg role in skin diseases pathogenesis. Postepy Dermatol Alergol 2017; 34:405-417. [PMID: 29507554 PMCID: PMC5835974 DOI: 10.5114/ada.2017.71105] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/10/2017] [Indexed: 12/22/2022] Open
Abstract
Regulatory FOXP3+ T cells (Tregs) constitute 5% to 10% of T cells in the normal human skin. They play an important role in the induction and maintenance of immunological tolerance. The suppressive effects of these cells are exerted by various mechanisms including the direct cytotoxic effect, anti-inflammatory cytokines, metabolic disruption, and modulation of the dendritic cells function. The deficiency of Treg cells number or function are one of the basic elements of the pathogenesis of many skin diseases, such as psoriasis, atopic dermatitis, bacterial and viral infections. They also play a role in the pathogenesis of T cell lymphomas of the skin (cutaneous T cell lymphomas - CTCL), skin tumors and mastocytosis. Here, in the second part of the cycle, we describe dysfunctions of Tregs in selected skin diseases.
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142
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Lebas E, Chian C, Nikkels-Tassoudji N, Arrese JE, Nikkels AF. Pachyderma in Primary Cutaneous NK and T-Cell Lymphoma and Leukemia Cutis. Case Rep Dermatol 2017; 9:151-157. [PMID: 29033820 PMCID: PMC5637003 DOI: 10.1159/000480068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/02/2017] [Indexed: 11/19/2022] Open
Abstract
Background Pachyderma is defined as severely thickened skin with deep folds and is occasionally observed with primary cutaneous NK and T-cell lymphoma (pCNKTCL), primary cutaneous B-cell lymphoma (pCBCL), and leukemia cutis (LC). Aim To describe the clinical, histological, and therapeutic particularities of a series of pCNKTCL, pCBCL, and LC patients with pachyderma. Results In a series of pCNKTCL (n = 70), pCBCL (n = 12), and LC (n = 2) patients followed up during 9 years, 6 cases of pachyderma were observed. Pachyderma occurred on the arms (n = 2), thighs (n = 1), forehead (n = 1), and face (n = 2). The mean age of the patients was 69 years (51–82). The stages were erythrodermic (T4) mycosis fungoides (MF) (n = 1), folliculotropic MF (FMF) (n = 2), classic (T2) MF (n = 2), and chronic myeloid leukemia (n = 1). The erythrodermic MF patient with acute pachyderma on the right arm responded rapidly to oral steroids. The other cases were indolent, appeared progressively, and were highly treatment resistant. Histology revealed dense dermal neoplastic infiltration. The immunohistological profile of the pachydermic lesions was similar to common MF and LC. Conclusion Pachyderma is an atypical manifestation of MF and LC and may occur on the face (FMF) or the extremities (MF). The rapidly appearing pachyderma may be transitory and responds readily to oral steroids.
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Affiliation(s)
- Eve Lebas
- Department of Dermatology, Liège University Hospital, Liège, Belgium
| | - Cesar Chian
- Department of Pathology, Hospital Arzobispo Loayza, Lima, Peru
| | | | - Jorge E Arrese
- Department of Dermatopathology, Liège University Hospital, Liège, Belgium
| | - Arjen F Nikkels
- Department of Dermatology, Liège University Hospital, Liège, Belgium
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143
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Netchiporouk E, Gantchev J, Tsang M, Thibault P, Watters AK, Hughes JDM, Ghazawi FM, Woetmann A, Ødum N, Sasseville D, Litvinov IV. Analysis of CTCL cell lines reveals important differences between mycosis fungoides/Sézary syndrome vs. HTLV-1+ leukemic cell lines. Oncotarget 2017; 8:95981-95998. [PMID: 29221181 PMCID: PMC5707075 DOI: 10.18632/oncotarget.21619] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/26/2017] [Indexed: 11/25/2022] Open
Abstract
HTLV-1 is estimated to affect ~20 million people worldwide and in ~5% of carriers it produces Adult T-Cell Leukemia/Lymphoma (ATLL), which can often masquerade and present with classic erythematous pruritic patches and plaques that are typically seen in Mycosis Fungoides (MF) and Sézary Syndrome (SS), the most recognized variants of Cutaneous T-Cell Lymphomas (CTCL). For many years the role of HTLV-1 in the pathogenesis of MF/SS has been hotly debated. In this study we analyzed CTCL vs. HTLV-1+ leukemic cells. We performed G-banding/spectral karyotyping, extensive gene expression analysis, TP53 sequencing in the 11 patient-derived HTLV-1+ (MJ and Hut102) vs. HTLV-1- (Myla, Mac2a, PB2B, HH, H9, Hut78, SZ4, Sez4 and SeAx) CTCL cell lines. We further tested drug sensitivities to commonly used CTCL therapies and studied the ability of these cells to produce subcutaneous xenograft tumors in NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ mice. Our work demonstrates that unlike classic advanced MF/SS cells that acquire many ongoing balanced and unbalanced chromosomal translocations, HTLV-1+ CTCL leukemia cells are diploid and exhibit only a minimal number of non-specific chromosomal alterations. Our results indicate that HTLV-1 virus is likely not involved in the pathogenesis of classic MF/SS since it drives a very different pathway of lymphomagenesis based on our findings in these cells. This study also provides for the first time a comprehensive characterization of the CTCL cells with respect to gene expression profiling, TP53 mutation status, ability to produce tumors in mice and response to commonly used therapies.
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Affiliation(s)
| | - Jennifer Gantchev
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | - Matthew Tsang
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Philippe Thibault
- Université de Sherbrooke Rnomics Platform, Sherbrooke, Québec, Canada
| | - Andrew K Watters
- Department of Pathology, McGill University Health Centre, Montreal, Québec, Canada
| | | | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
| | - Anders Woetmann
- Department of International Health, Immunology, and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Niels Ødum
- Department of International Health, Immunology, and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, Québec, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, Québec, Canada.,Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
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144
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Rezk Hassan GF, Marey K. Immunohistopathological Study of c-FLIP Protein in Mycosis Fungoides. Asian Pac J Cancer Prev 2017; 18:2493-2499. [PMID: 28952283 PMCID: PMC5720656 DOI: 10.22034/apjcp.2017.18.9.2493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Mycosis fungoides (MF) is the commonest variant of primary cutaneous T cell lymphoma with several clinicopathologic variants. Defective apoptotic mechanism may be important in the pathogenesis and progression of MF. c-FLIP protein is an important anti-apoptotic marker and chemotherapeutic resistant factor. This study aimed to evaluate the c-FLIP expression in MF and its role in the pathogenesis of MF. Methods: Twenty patients of MF and ten normal persons were included in this study. Skin biopsies were obtained from both patients and controls. They were studied and examined immunohistochemically for the expression of CD4 and c-FLIP. Results: c-FLIP expression was significantly increased in patients when compared to controls in both epidermis and dermis. There were positive correlations between c-FLIP expression and CD4+ expression in both epidermal and dermal lesions of patients group. There were statistically significant positive correlations between c-FLIP expression (in both dermal and epidermal lesions) and the age of patients. c-FLIP expression increased with the tumor progression but with no statistical significance. Conclusion: Defective regulation of apoptosis has been considered as a main cause for accumulation of clonal T cells, and it was related to an increased expression of c-FLIP which may have a role in the pathogenesis of MF. Also, c-FLIP may have prognostic information in MF as its level increased with both age of the patients and tumor progression.
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Affiliation(s)
- Ghada Fawzy Rezk Hassan
- Lecturer of Dermatology and Venereology, Faculty of medicine, Tanta University, 31111, Tanta, Egypt.
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Abstract
T-cell lymphoma, a collection of subtypes of Non-Hodgkin lymphoma, is a rare malignancy. The low prevalence of this disease has made it challenging to identify subtype-specific risk factors. Potential risk factors could enable us to identify high-risk patients and predict patient outcomes. Here, we report on the current epidemiologic and prognostic factors data associated with the individual subtypes both of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) found in large cohort and case studies. Additionally, with recent findings, as well as updates in the new World Health Organization (WHO) classification of lymphoid neoplasms, we consider what this could do to change our approach to this group of diseases.
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146
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Porntharukcharoen S, Rutnin S, Rajatanavin N. Large-Cell Transformed Mycosis Fungoides Coexisting with Mycosis Fungoides Bullosa: A Case Report and Review of the Literature. Case Rep Dermatol 2017; 9:243-248. [PMID: 29515392 PMCID: PMC5836154 DOI: 10.1159/000484472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/22/2017] [Indexed: 11/28/2022] Open
Abstract
Mycosis fungoides is the most common form of cutaneous T-cell lymphoma. Both large-cell transformed mycosis fungoides and mycosis fungoides bullosa are rare presentations and predict unfavorable prognosis. We report the case of a 61-year-old woman who presented with generalized erythematous scaly annular plaques, and histopathology confirmed the diagnosis of mycosis fungoides. She was treated with various conventional therapies but only achieved partial response and always relapsed after discontinuation of treatment. Her last treatment was combined chemotherapy (CHOP regimen) followed by romidepsin. However, 1 month after the last cycle of romidepsin, she developed multiple ulcerative masses and nodules. Skin biopsy was compatible with CD30+ large cell transformation, and she was treated with a new combination of chemotherapy (ifosfamide, carboplatin, etoposide). One day after receiving chemotherapy, multiple tense bullae on normal-appearing skin and mycosis fungoid plaques erupted. A histological study demonstrated subepidermal blistering with epidermotropism of atypical lymphocytes. Direct immunofluorescence study was negative. The results confirmed the diagnosis of mycosis fungoides bullosa. We present the first reported case of large-cell transformed mycosis fungoides coexisting with mycosis fungoides bullosa.
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Affiliation(s)
- Saneerat Porntharukcharoen
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Schmitt C, Marie-Cardine A, Bensussan A. Therapeutic Antibodies to KIR3DL2 and Other Target Antigens on Cutaneous T-Cell Lymphomas. Front Immunol 2017; 8:1010. [PMID: 28912774 PMCID: PMC5582066 DOI: 10.3389/fimmu.2017.01010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
KIR3DL2 is a member of the killer cell immunoglobulin-like receptor (KIR) family that was initially identified at the surface of natural killer (NK) cells. KIR3DL2, also known as CD158k, is expressed as a disulfide-linked homodimer. Each chain is composed of three immunoglobulin-like domains and a long cytoplasmic tail containing two immunoreceptor tyrosine-based inhibitory motifs. Beside its expression on NK cells, it is also found on rare circulating T lymphocytes, mainly CD8+. Although the KIR gene number varies between haplotype, KIR3DL2 is a framework gene present in all individuals. Together with the presence of genomic regulatory sequences unique to KIR3DL2, this suggests some particular functions for the derived protein in comparison with other KIR family members. Several ligands have been identified for KIR3DL2. As for other KIRs, binding to HLA class I molecules is essential for NK development by promoting phenomena such as licensing and driving NK cell maturation. For KIR3DL2, this includes binding to HLA-A3 and -A11 and to the free heavy chain form of HLA-B27. In addition, KIR3DL2 binds to CpG oligonucleotides (ODN) and ensures their transport to endosomal toll-like receptor 9 that promotes cell activation. These characteristics have implicated KIR3DL2 in several pathologies: ankylosing spondylitis and cutaneous T-cell lymphomas such as Sézary syndrome, CD30+ cutaneous lymphoma, and transformed mycosis fungoides. Consequently, a new generation of humanized monoclonal antibodies (mAbs) directed against KIR3DL2 has been helpful in the diagnosis, follow-up, and treatment of these diseases. In addition, preliminary clinical studies of a novel targeted immunotherapy for cutaneous T-cell lymphomas using the anti-KIR3DL2 mAb IPH4102 are now underway. In this review, we discuss the various aspects of KIR3DL2 on the functions of CD4+ T cells and how targeting this receptor helps to develop innovative therapeutic strategies.
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Affiliation(s)
- Christian Schmitt
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Anne Marie-Cardine
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | - Armand Bensussan
- INSERM U976, Hôpital Saint-Louis, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, Paris, France
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Duvic M, Bates SE, Piekarz R, Eisch R, Kim YH, Lerner A, Robak T, Samtsov A, Becker JC, McCulloch W, Waksman J, Whittaker S. Responses to romidepsin in patients with cutaneous T-cell lymphoma and prior treatment with systemic chemotherapy. Leuk Lymphoma 2017; 59:880-887. [PMID: 28853310 DOI: 10.1080/10428194.2017.1361022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a group of non-Hodgkin lymphomas that typically present in the skin but can progress to systemic involvement. The optimal treatment for patients who relapse from or are refractory to systemic chemotherapy remains unclear. Romidepsin is a potent, class-I selective histone deacetylase inhibitor approved for the treatment of patients with CTCL who have had ≥1 prior systemic therapy. Here, we present a subanalysis of two phase-2 trials (NCT00106431, NCT00007345) of romidepsin in patients with CTCL who had prior treatment with systemic chemotherapy. Patients with prior chemotherapy were able to achieve durable responses to romidepsin, and response rates were similar to those in patients who were chemotherapy naïve. Overall, no new safety signals emerged in patients who had received prior chemotherapy. The data presented here suggest that romidepsin is safe and effective in patients with CTCL who received prior systemic chemotherapy.
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Affiliation(s)
- Madeleine Duvic
- a The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Susan E Bates
- b Department of Hematology/Oncology , Columbia University , New York , NY , USA
| | - Richard Piekarz
- c Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis , National Cancer Institute , Bethesda , MD , USA
| | - Robin Eisch
- d National Cancer Institute , Bethesda , MD , USA
| | - Youn H Kim
- e Department of Dermatology , Stanford University , Stanford , CA , USA
| | | | - Tadeusz Robak
- g Department of Hematology , Medical University of Lodz, Copernicus Memorial Hospital , Lodz , Poland
| | - Alexey Samtsov
- h State Educational Institution of Military Medicine , St. Petersburg , Russia
| | - Jürgen C Becker
- i Translational Skin Cancer Research, German Cancer Consortium (DKTK) , University Clinic Essen , Germany
| | | | - Joel Waksman
- k Brightech International LLC , Somerset , NJ , USA
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149
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Affiliation(s)
- Mauro Alaibac
- Unit of Dermatology, Department of Medicine, University of Padua, Padua, Italy
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150
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Chang TW, Weaver AL, Shanafelt TD, Habermann TM, Wriston CC, Cerhan JR, Call TG, Brewer JD. Risk of cutaneous T-cell lymphoma in patients with chronic lymphocytic leukemia and other subtypes of non-Hodgkin lymphoma. Int J Dermatol 2017; 56:1125-1129. [PMID: 28685851 DOI: 10.1111/ijd.13653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/28/2017] [Accepted: 04/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Second hematologic cancers in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) are well documented and include Hodgkin lymphoma, therapy-related acute myeloid leukemia/myelodysplastic syndromes, and transformation to diffuse large B-cell lymphoma. Although cutaneous T-cell lymphoma (CTCL) has been reported in patients with CLL, the incidence and comparison to expected rates are unknown. We evaluated the incidence of CTCL among patients with CLL or other non-Hodgkin lymphoma (NHL) subtypes using data from the Surveillance, Epidemiology, and End Results (SEER) Program. METHODS We searched the SEER 13 registries for patients with a diagnosis of CLL and NHL between 1992 and 2008. Among patients identified, we evaluated the incidence of CTCL. RESULTS Among 31,286 patients with CLL, the incidence of CTCL was not significantly higher in men than women: 104.2 (95% CI, 50.0-191.8) and 28.1 (95% CI, 3.4-101.3) per 1,000,000 person-years, respectively (P = 0.06). Among 97,691 patients with NHL, the incidence of CTCL was similar in men and women (97.9 [95% CI, 62.0-146.9] and 92.0 [95% CI, 56.2-142.1] per 1,000,000 person-years, respectively; P = 0.84). The incidence of CTCL among males with CLL (standardized incidence ratio [SIR], 3.0 [95% CI, 1.4-5.5]), males with NHL (SIR, 3.7 [95% CI, 2.3-5.5]), and females with NHL (SIR, 5.9 [95% CI, 3.6-9.1]) was significantly higher than expected in the general population (all P < 0.001). CONCLUSION The risk of CTCL is greater in men with CLL than in the general population. In patients with NHL, both men and women are at greater risk for CTCL than in the general population.
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Affiliation(s)
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Cooper C Wriston
- Department of Dermatology, Mayo Clinic Health System, Owatonna, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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