101
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Lee SY, Kwon HC, Cho YS, Nam KH, Ihm CW, Kim JS. The three dimensional conformal radiotherapy for hyperkeratotic plantar mycosis fungoides. Ann Dermatol 2011; 23 Suppl 1:S57-60. [PMID: 22028574 PMCID: PMC3199424 DOI: 10.5021/ad.2011.23.s1.s57] [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: 07/27/2010] [Revised: 09/10/2010] [Accepted: 09/10/2010] [Indexed: 11/09/2022] Open
Abstract
The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.
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Affiliation(s)
- Sun Young Lee
- Department of Radiation Oncology, Chonbuk National University Medical School, Jeonju, Korea
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102
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Ward DM. Extracorporeal photopheresis: How, when, and why. J Clin Apher 2011; 26:276-85. [DOI: 10.1002/jca.20300] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 07/05/2011] [Indexed: 12/14/2022]
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103
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Geddes A, Savin J, White SJ, Gibson J. Primary cutaneous cd8-positive t-cell lymphoma: a case report of a rare and aggressive disease with oral presentation. ACTA ACUST UNITED AC 2011; 38:472-4, 476. [DOI: 10.12968/denu.2011.38.7.472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A Geddes
- SHO in Oral and Maxillofacial Surgery, Ninewells Hospital Dundee
| | - J Savin
- Surgical Specialist, Community Dental Services, NHS Fife
| | - SJ White
- Clinical Lecturer/Honorary Specialist Registrar in Pathology, Ninewells Hospital Dundee
| | - J Gibson
- Consultant and Honorary Senior Lecturer in Oral Medicine
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104
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Abbott RA, Sahni D, Robson A, Agar N, Whittaker S, Scarisbrick JJ. Poikilodermatous mycosis fungoides: A study of its clinicopathological, immunophenotypic, and prognostic features. J Am Acad Dermatol 2011; 65:313-319. [DOI: 10.1016/j.jaad.2010.05.041] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 04/28/2010] [Accepted: 05/13/2010] [Indexed: 11/25/2022]
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105
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Grover S, Verma R, Mani NS, Grewal RS, Singh GK. Primary Cutaneous T-cell Lymphoma: Two Rare Presentations. Med J Armed Forces India 2011; 66:73-5. [PMID: 27365711 DOI: 10.1016/s0377-1237(10)80103-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/07/2009] [Indexed: 10/18/2022] Open
Affiliation(s)
- S Grover
- Classified Specialist (Dermatology), 5 Air Force Hospital, C/o 99 APO
| | - R Verma
- Senior Advisor (Dermatology), Command Hospital (EC), Kolkata
| | - N S Mani
- Prof & Head (Dept of Pathology), AFMC, Pune- 40
| | - R S Grewal
- Senior Advisor (Dermatology), Command Hospital (SC), Pune-40
| | - G K Singh
- Graded Specialist (Dermatology), 153 GH, C/o 56 APO
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106
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Marta GN, Gouvêa CBD, Ferreira SBE, Hanna SA, Haddad CMK, Silva JLFD. Mycosis fungoides: case report treated with radiotherapy. An Bras Dermatol 2011; 86:561-4. [PMID: 21738977 DOI: 10.1590/s0365-05962011000300022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Accepted: 05/13/2010] [Indexed: 11/22/2022] Open
Abstract
Mycosis fungoides is a rare type of non-Hodgkin's lymphoma of T cells that primarily affects the skin. It is characterized by the presence of erythematous plaques that evolve into ulcerated lesions, tumors throughout the skin or even bone marrow infiltration in advanced stages. Chemotherapy and topical steroids, phototherapy and radiotherapy are treatment options for early cases. This study reports the case of patient with multiple tumor lesions in the skin already biopsied with diagnosis of mycosis fungoides. The patient was refractory to both treatments with topical chemotherapy and phototherapy. It was then indicated total skin irradiation with electrons.
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Affiliation(s)
- Gustavo Nader Marta
- Department of Radiotherapy of the Oncology Center from the Sírio Libanês Hospital – São Paulo (SP), Brazil.
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107
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Trautinger F. Phototherapy of mycosis fungoides. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:68-74. [PMID: 21392108 DOI: 10.1111/j.1600-0781.2011.00559.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Among the primary cutaneous T-cell lymphomas, mycosis fungoides (MF) is the most common disease entity. Recently, an improved understanding of the pathology, clinical presentation, and prognosis of MF has lead to the development of new and practically useful classification and staging systems. In most patients, MF presents with patches and plaques and remains confined to the skin for years and decades, making it an ideal target for phototherapy. However, treatment schedules vary widely and this review describes the current knowledge about phototherapy of MF focusing mainly on narrow- and broadband UVB and 8-methoxypsoralen plus UVA, its indications, practical aspects, and clinical outcome. METHODS Review and summary of the pertinent literature. RESULTS AND CONCLUSIONS Since 1976, when the first report on phototherapy for MF was published, sufficient evidence has accumulated to make narrowband UVB and PUVA safe and effective treatment options for early stages of the disease. In refractory cases or more advanced stages, combination of phototherapy with systemic treatments including mainly interferons and retinoids might be valuable. Additional research is required to further define the optimal treatment schedules and the role of maintenance.
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Affiliation(s)
- Franz Trautinger
- Karl Landsteiner Institute for Dermatological Research, St. Pölten, Austria.
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108
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109
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Romidepsin (Istodax, NSC 630176, FR901228, FK228, depsipeptide): a natural product recently approved for cutaneous T-cell lymphoma. J Antibiot (Tokyo) 2011; 64:525-31. [PMID: 21587264 DOI: 10.1038/ja.2011.35] [Citation(s) in RCA: 220] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Romidepsin (Istodax), a selective inhibitor of histone deacetylases (HDACs), was approved for the treatment of cutaneous T-cell lymphoma in November 2009 by the US Food and Drug Administration. This unique natural product was discovered from cultures of Chromobacterium violaceum, a Gram-negative bacterium isolated from a Japanese soil sample. This bicyclic compound acts as a prodrug, its disulfide bridge being reduced by glutathione on uptake into the cell, allowing the free thiol groups to interact with Zn ions in the active site of class I and II HDAC enzymes. Due to the synthetic complexity of the compound, as well as the low yield from the producing organism, analogs are sought to create synthetically accessible alternatives. As a T-cell lymphoma drug, romidepsin offers a valuable new treatment for diseases with few effective therapies.
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110
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Sánchez MA, González T, Gaitán MF, Zuluaga A, Jiménez SB, de Galvis YT. Is PUVA maintenance therapy necessary in patients with early-stage mycosis fungoides? Evaluation of a treatment guideline over a 28-month follow-up. Int J Dermatol 2011; 50:1086-93. [PMID: 21375528 DOI: 10.1111/j.1365-4632.2010.04833.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphoma is a rare condition that represents 2% of all lymphomas and 75-80% of primary cutaneous lymphomas. The objective of the present study is to evaluate a clinical practice guideline. METHODS This paper reports a prospective cohort study with a five-year follow-up. This is the second report to describe the analysis of data obtained during follow-up of 28 months. To date, 40 patients diagnosed with early-stage mycosis fungoides (stage IA, n = 20; stage IB, n = 20) have been enrolled. All patients have been treated with a minimum of 58 sessions of psoralen and long-wave ultraviolet radiation, with complete clinical and histological clearance of lesions. Variables considered include disease duration, treatment time, treatment dose, and history of relapse. Complete physical examinations and diverse complementary examinations were performed. A tumor-node-metastasis-blood staging system was applied. The population was divided into two groups according to results consisting, respectively, of those who relapsed during follow-up (n = 12) and those who did not (n = 28). RESULTS History of relapse was the variable most strongly associated with future relapse (relative risk = 10.38, 95% confidence interval 2.64-40.72). No statistically significant difference between the groups according to receipt of maintenance therapy was found (P = 0.161). CONCLUSIONS Our results strongly suggest that maintenance therapy does not prevent future relapse. However, history of relapse is a strong predictor for future relapse.
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Affiliation(s)
- María A Sánchez
- Department of Dermatology, Faculty of Medicine, Universidad CES (CES University), Medellín, Colombia.
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111
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Weberschock T, Rehberger P, Röllig C, Bunch C, Schmitt J, Bauer A. Interventions for mycosis fungoides. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd008946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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112
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Brattseva EV, Rotanov SV, Bratseva EV, Rotanov SV. Current approaches to diagnostics of mycosis fungoides. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The authors describe strong and weak sides of current methods for diagnostics of mycosis fungoides.
Diagnostics of mycosis fungoides is mainly based on the clinical presentation of this disease, which is a significant problem for
a dermatovenerologist, especially at early stages of the disease when rashes are of different types. Laboratory methods used to
confirm the diagnosis are microscopic examination and immunophenotypic analysis of skin biopsy samples from the affected
region as well as determination of clonality of T-lymphocytes in the skin using the PCR method.
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113
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Sokołowska-Wojdyło M, Trzeciak M, Roszkiewicz J. 2-Chlorodeoxyadenosine treatment for cutaneous T-cell lymphoma. Dermatol Reports 2010; 2:e12. [PMID: 25386249 PMCID: PMC4211472 DOI: 10.4081/dr.2010.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 04/16/2010] [Accepted: 07/26/2010] [Indexed: 11/26/2022] Open
Abstract
The primary cutaneous lymphomas are often indolent but difficult to treat. In the early stages psoralen and ultraviolet-A therapy is the standard treatment whereas at the tumor stage chemotherapy (e.g. pegylated doxorubicin) is often used for debulking. The purine analog 2-chlorodeoxyadenosine (2CdA) acts in non-Hodgkin’s lymphoma and has been used in our center for the treatment of advanced primary cutaneous T-cell lyphomas (CTCL). Here, we report on the efficacy and side effects of 2CdA in six patients with CTCL. One patient died owing to myelosuppression. Partial responses were seen in four cases but full remission was observed in only one case. We concluded that 2CdA has a limited usefulness in the management of advanced CTCL.
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Affiliation(s)
| | - Magdalena Trzeciak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jadwiga Roszkiewicz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
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114
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Balogun RA, Kaplan A, Ward DM, Okafor C, Burns TM, Torloni AS, Macik BG, Abdel-Rahman EM. Clinical applications of therapeutic apheresis. J Clin Apher 2010; 25:250-64. [DOI: 10.1002/jca.20249] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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115
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Duarte RF, Canals C, Onida F, Gabriel IH, Arranz R, Arcese W, Ferrant A, Kobbe G, Narni F, Deliliers GL, Olavarría E, Schmitz N, Sureda A. Allogeneic hematopoietic cell transplantation for patients with mycosis fungoides and Sézary syndrome: a retrospective analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2010; 28:4492-9. [PMID: 20697072 DOI: 10.1200/jco.2010.29.3241] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To analyze the outcome of allogeneic transplantation for mycosis fungoides and Sézary syndrome (MF/SS) in terms of nonrelapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) and to identify factors associated with the outcome. PATIENT AND METHODS Sixty patients with MF (n = 36) and SS (n = 24) who received a first allogeneic hematopoietic cell transplantation (HCT) from a matched related (mRD; n = 45) or unrelated donor (mUD; n = 15) between 1997 and 2007 and who were registered in the European Group for Blood and Marrow Transplantation database were analyzed: 37 men and 23 women, median age 46.5 years (range, 22 to 66 years). Forty-four patients had TNM stage IV, and 40 patients were at advanced phase at transplantation. Forty-four patients received reduced-intensity conditioning (RIC) regimens, and 25 underwent T-cell depletion (TCD). RESULTS Allogeneic transplantation in MF/SS offers an estimated OS of 66% at 1 year and 54% at 3 years, primarily driven by donor type, disease phase, and type of conditioning. RIC decreased NRM (relative risk [RR] = 4.7; P = .008) without increasing REL, leading to a higher OS (RR = 2.8; P = .03). Advanced-phase disease increases REL (RR = 3.0; P = .03) and reduces PFS (RR = 4.4; P = .002) and OS (RR = 3.5; P = .023). Recipients of mRD allogeneic HCT had better PFS (RR = 2.7; P = .006) and OS (RR = 4.0; P = .001) than their mUD counterparts. The risk of REL increases with TCD (RR = 3.2; P = .005). Some patients who experience relapse can successfully undergo rescue treatment with donor lymphocyte infusions. CONCLUSION Allogeneic transplantation is a valid therapeutic alternative for high-risk patients with advanced-stage MF/SS. Our data also suggest the existence of a clinically relevant graft-versus-lymphoma effect in MF/SS.
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Affiliation(s)
- Rafael F Duarte
- Department of Hematology, ICO-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.
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116
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Hegde R. Radiotherapy in cutaneous anaplastic large cell lymphoma. J Cutan Aesthet Surg 2010; 3:52. [PMID: 20606998 PMCID: PMC2890140 DOI: 10.4103/0974-2077.63258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Raj Hegde
- William Buckland Radiotherapy Centre, Alfred Hospital, Melbourne 3004, Victoria, Australia. E-mail:
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117
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Willemze R, Dreyling M. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v177-80. [DOI: 10.1093/annonc/mdq183] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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118
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Hymes KB. The Role of Histone Deacetylase Inhibitors in the Treatment of Patients With Cutaneous T-Cell Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2010; 10:98-109. [DOI: 10.3816/clml.2010.n.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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119
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Suh KS, Kang JS, Baek JW, Kim TK, Lee JW, Jeon YS, Jang MS, Kim ST. Efficacy of ultraviolet A1 phototherapy in recalcitrant skin diseases. Ann Dermatol 2010; 22:1-8. [PMID: 20548873 DOI: 10.5021/ad.2010.22.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 06/07/2009] [Accepted: 07/22/2009] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ultraviolet (UV) radiation has been used for decades to treat a variety of skin diseases. UVA1 was used initially as an effective treatment for acute exacerbated atopic dermatitis. Since then, UVA1 has been attempted for recalcitrant skin diseases. OBJECTIVE This study examined the efficacy of UVA1 phototherapy in three recalcitrant skin diseases. METHODS This retrospective study reviewed the efficacy and follow-up of 26 patients with atopic dermatitis (AD), mycosis fungoides (MF) and localized scleroderma (LS). SUPUVASUN 3000 (Mutzhas Co., Munich, Germany) and SELLAMED 3000 (Sellas Medizinische Gerate GmbH, Gevelsberg, Germany) were the UVA1 equipment used. Irradiation was performed in accordance with the disease. Low-dose (20 J/cm(2)), medium-dose (65 J/cm(2)) and high-dose regimens (100 J/cm(2)) of UVA1 therapy were employed. The frequency of the therapy ranged from 3 to 5 times weekly. The therapeutic effectiveness was assessed according to the clinical examination before and after the last treatment. RESULTS In patients with AD, complete and partial remission was achieved in four (80%) and one (20%) patient, respectively. In patients with MF, complete and partial remission was observed in thirteen (86.7%) and two (13.3%) patients, respectively. In patients with LS, complete and partial remission was observed in three (50%) and three (50%) patients, respectively. CONCLUSION UVA1 phototherapy is an effective treatment modality for acute exacerbated AD, MF and LS.
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Affiliation(s)
- Kee Suck Suh
- Department of Dermatology, Kosin University College of Medicine, Busan, Korea
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120
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Zinzani PL, Venturini F, Stefoni V, Fina M, Pellegrini C, Derenzini E, Gandolfi L, Broccoli A, Argnani L, Quirini F, Pileri S, Baccarani M. Gemcitabine as single agent in pretreated T-cell lymphoma patients: evaluation of the long-term outcome. Ann Oncol 2009; 21:860-863. [PMID: 19887465 DOI: 10.1093/annonc/mdp508] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Peripheral T-cell lymphoma unspecified (PTCLU) and mycosis fungoides (MF) often show resistance to conventional chemotherapy. Gemcitabine should be considered a suitable option. We report the long-term update of 39 pretreated T-cell lymphoma patients treated with gemcitabine. PATIENTS AND METHODS From May 1997 to September 2007, 39 pretreated MF and PTCLU patients received gemcitabine. Inclusion criteria were as follows: histologic diagnosis of MF or PTCLU; relapsed/refractory disease; age > or =18 years; and World Health Organization performance status of two or less. Nineteen patients had MF and 20 PTCLU. All patients with MF had a T3-T4, N0, and M0 disease and patients with PTCLU had stage III-IV disease. Gemcitabine was given on days 1, 8, and 15 on a 28-day schedule (1200 mg/m(2)/day) for a total of three to six cycles. RESULTS Overall response rate was 51% (20 of 39 patients); complete response (CR) and partial response (PR) rates were 23% (9 of 39 patients) and 28% (11 of 39 patients), respectively. Patients with MF had a CR rate of 16% and a PR rate of 32% compared with a CR rate of 30% and a PR rate of 25% of PTCLU patients. Among the CR patients, 7 of 9 are in continuous complete response with a variable disease-free interval (15-120 months). CONCLUSION In our experience, gemcitabine proved to be effective in pretreated MF and PTCLU patients, even in the long term.
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Affiliation(s)
- P L Zinzani
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy.
| | - F Venturini
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - V Stefoni
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - M Fina
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - C Pellegrini
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - E Derenzini
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - L Gandolfi
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - A Broccoli
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - L Argnani
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - F Quirini
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - S Pileri
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
| | - M Baccarani
- Institute of Hematology and Medical Oncology 'L. e A. Seràgnoli', University of Bologna, Bologna, Italy
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121
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Mestel D, Beyer M, Steinhoff M, Sterry W. Treatment of Cutaneous Lymphomas: Today and Tomorrow. ACTAS DERMO-SIFILIOGRAFICAS 2009; 100 Suppl 1:18-32. [DOI: 10.1016/s0001-7310(09)73165-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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122
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Piccinno R, Caccialanza M, Percivalle S. Minimal stage IA mycosis fungoides. Results of radiotherapy in 15 patients. J DERMATOL TREAT 2009; 20:165-8. [DOI: 10.1080/09546630802516571] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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123
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124
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Kim ST, Sim HJ, Jeon YS, Lee JW, Roh HJ, Choi SY, Kim YJ, Suh KS. Clinicopathological features and T-cell receptor gene rearrangement findings of mycosis fungoides in patients younger than age 20 years. J Dermatol 2009; 36:392-402. [PMID: 19583687 DOI: 10.1111/j.1346-8138.2009.00665.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma that usually arises in middle-aged or older people. The incidence of childhood MF is low, but studies in childhood MF suggests that the incidence is rising. The number of studies in childhood MF are few and there are currently no studies about childhood MF in Asians. We investigated the clinicopathological features, T-cell receptor (TCR) gene rearrangement findings, treatment and follow up in childhood MF. The retrospective study was performed on a population consisting of 23 MF patients aged 4-19 years. The duration of the disease ranged from 1 month to 10 years (mean, 2.7 years). In Tumor-Node-Metastasis classifications, all cases were confined to stage IA or IB. Histopathological findings revealed epidermotropism and perivascular infiltrates, epidermotropism in the infundibulum, Pautrier's microabscess, haloed lymphocytes, epidermal lymphocytes larger than dermal lymphocytes, atypical cells with hyperchromatic nuclei and wiry bundles of collagen. TCRgamma gene rearrangement was performed except for four patients, and monoclonality was detected in 16 of 19 cases (84%). Treatment was done with psoralen and ultraviolet (UV)A, UVA1, narrow-band UVB, topical steroid, retinoic acid and calcipotriol. Most patients showed a good response. At a mean follow up of 90.4 months, no patient had either an exacerbation of the disease or extracutaneous involvement. Compared with adult-onset MF, MF in children may show a variety of clinical features. It is considered to have a good prognosis. Moreover, histopathological study and TCR gene rearrangement study can help in the diagnosis of MF in children.
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Affiliation(s)
- Sang-Tae Kim
- Department of Dermatology, Kosin University College of Medicine, Busan 602-702, Korea
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125
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Extracorporeal photopheresis: From solid organs to face transplantation. Transpl Immunol 2009; 21:117-28. [DOI: 10.1016/j.trim.2009.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/19/2009] [Accepted: 04/24/2009] [Indexed: 12/21/2022]
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126
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Willemze R, Dreyling M. Primary cutaneous lymphoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 Suppl 4:115-8. [DOI: 10.1093/annonc/mdp147] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sampogna F, Frontani M, Baliva G, Lombardo G, Alvetreti G, Di Pietro C, Tabolli S, Russo G, Abeni D. Quality of life and psychological distress in patients with cutaneous lymphoma. Br J Dermatol 2009; 160:815-22. [DOI: 10.1111/j.1365-2133.2008.08992.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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128
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Musolino A, Panebianco M, Zendri E, Santini M, Di Nuzzo S, Ardizzoni A. Hypertriglyceridaemia with bexarotene in cutaneous T cell lymphoma: the role of omega-3 fatty acids. Br J Haematol 2009; 145:84-6. [DOI: 10.1111/j.1365-2141.2009.07596.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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129
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Place de l’électronthérapie dans la prise en charge du mycosis fongoïde : des indications à optimiser et un accès à faciliter. Ann Dermatol Venereol 2009; 136:235-7. [DOI: 10.1016/j.annder.2008.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/28/2008] [Indexed: 11/17/2022]
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130
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131
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Arulogun S, Prince HM, Gambell P, Lade S, Ryan G, Eaton E, McCormack C. Extracorporeal photopheresis for the treatment of Sézary syndrome using a novel treatment protocol. J Am Acad Dermatol 2008; 59:589-95. [DOI: 10.1016/j.jaad.2008.05.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/14/2008] [Accepted: 05/27/2008] [Indexed: 11/25/2022]
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132
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Pérez-Barrio S, Izu R, García-Ruiz J, Acebo E, Martínez De Lagrán Z, Díaz-Pérez J. Trasplante autólogo de progenitores hematopoyéticos seguido de bexaroteno oral en paciente con micosis fungoide avanzada. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74742-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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133
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European Organization for Research and Treatment of Cancer and International Society for Cutaneous Lymphoma consensus recommendations for the management of cutaneous B-cell lymphomas. Blood 2008; 112:1600-9. [PMID: 18567836 DOI: 10.1182/blood-2008-04-152850] [Citation(s) in RCA: 266] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Primary cutaneous B-cell lymphomas (CBCL) represent approximately 20% to 25% of all primary cutaneous lymphomas. With the advent of the World Health Organization-European Organization for Research and Treatment of Cancer (EORTC) Consensus Classification for Cutaneous Lymphomas in 2005, uniform terminology and classification for this rare group of neoplasms were introduced. However, staging procedures and treatment strategies still vary between different cutaneous lymphoma centers, which may be because consensus recommendations for the management of CBCL have never been published. Based on an extensive literature search and discussions within the EORTC Cutaneous Lymphoma Group and the International Society for Cutaneous Lymphomas, the present report aims to provide uniform recommendations for the management of the 3 main groups of CBCL. Because no systematic reviews or (randomized) controlled trials were available, these recommendations are mainly based on retrospective studies and small cohort studies. Despite these limitations, there was consensus among the members of the multidisciplinary expert panel that these recommendations reflect the state-of-the-art management as currently practiced in major cutaneous lymphoma centers. They may therefore contribute to uniform staging and treatment and form the basis for future clinical trials in patients with a CBCL.
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Bagot M. Structuration d’un réseau national et d’une réunion de concertation pluridisciplinaire nationale de recours pour la prise en charge des lymphomes cutanés rares. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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135
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Scarisbrick J, Taylor P, Holtick U, Makar Y, Douglas K, Berlin G, Juvonen E, Marshall S. U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease. Br J Dermatol 2008; 158:659-78. [DOI: 10.1111/j.1365-2133.2007.08415.x] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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136
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Haematopoietic stem cell transplantation for patients with primary cutaneous T-cell lymphoma. Bone Marrow Transplant 2008; 41:597-604. [PMID: 18176611 DOI: 10.1038/sj.bmt.1705968] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is no standard of care for patients with advanced forms of mycosis fungoides, Sézary syndrome and other less common subtypes of primary cutaneous T-cell lymphoma. Expected median survival for such patients with conventional therapy is only 1-4 years. As a result of such dismal prognosis, alternative strategies based on autologous and allogeneic transplantation have been explored, and a relatively small number of case reports and small series communicated to date have provided evidence for the potential role of haematopoietic transplantation in these patients. High-dose radio-chemotherapy and autologous rescue has been shown to induce complete responses in the majority of patients. Disappointingly though, these responses were very short-lived in nearly all cases. On the contrary, the use of allogeneic transplantation has provided solid evidence for an allogeneic GVL effect in these malignancies. In fact, more than two-thirds of the allogeneic transplant recipients reported in the literature experienced long-term durable remissions of more than 3 years, which would appear superior to the expected median survival for such patients. This review summarizes the experience published to date in this setting and highlights main areas that would merit further investigation.
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137
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Autologous Hematopoietic Stem Cell Transplantation Followed by Oral Bexarotene in a Patient With Advanced Mycosis Fungoides. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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138
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Avilés A, Nambo MJ, Neri N, Castañeda C, Cleto S, Gonzalez M, Huerta-Guzmán J. Interferon and Low Dose Methotrexate Improve Outcome in Refractory Mycosis Fungoides/Sézary Syndrome. Cancer Biother Radiopharm 2007; 22:836-40. [DOI: 10.1089/cbr.2007.0402] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, Nacional Medical Center, IMSS, México, D.F. Mexico
| | - M. Jesús Nambo
- Department of Hematology, Oncology Hospital, Nacional Medical Center, IMSS, México, D.F. Mexico
| | - Natividad Neri
- Department of Hematology, Oncology Hospital, Nacional Medical Center, IMSS, México, D.F. Mexico
| | - Claudia Castañeda
- Department of Hematology, Oncology Hospital, Nacional Medical Center, IMSS, México, D.F. Mexico
| | - Sergio Cleto
- Department of Hematology, Oncology Hospital, Nacional Medical Center, IMSS, México, D.F. Mexico
| | - Martha Gonzalez
- Department of Hematology, Oncology Hospital, Nacional Medical Center, IMSS, México, D.F. Mexico
| | - Judith Huerta-Guzmán
- Department of Hematology, Oncology Hospital, Nacional Medical Center, IMSS, México, D.F. Mexico
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139
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Karenko L, Hahtola S, Ranki A. Molecular cytogenetics in the study of cutaneous T-cell lymphomas (CTCL). Cytogenet Genome Res 2007; 118:353-61. [DOI: 10.1159/000108320] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/30/2006] [Indexed: 01/06/2023] Open
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140
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Dummer R, Assaf C, Bagot M, Gniadecki R, Hauschild A, Knobler R, Ranki A, Stadler R, Whittaker S. Maintenance therapy in cutaneous T-cell lymphoma: Who, when, what? Eur J Cancer 2007; 43:2321-9. [PMID: 17707638 DOI: 10.1016/j.ejca.2007.06.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 06/26/2007] [Accepted: 06/27/2007] [Indexed: 11/27/2022]
Abstract
The aim of current therapy for cutaneous T-cell lymphoma (CTCL) is to induce clinically meaningful remission, provide symptom relief, improve patient quality of life (QoL) and prolong disease-free and overall survival. A key research question is whether such remissions or minimal disease status can be maintained in the long term. There have been few formal studies of maintenance therapy in CTCL. Some skin-directed therapies such as total-skin electron-beam therapy and high-dose psoralen plus ultraviolet A may not be considered suitable, because of the risk of long-term cumulative toxicities. Other therapies such as nitrogen mustard, interferon (IFN)-alpha and bexarotene have demonstrated positive effects in prolonging remissions in small numbers of patients. Large longitudinal studies are required to investigate the efficacy of maintenance treatments in CTCL and their impact on patients' QoL and overall survival. Of the systemic therapies currently approved for the treatment of CTCL, bexarotene and IFN-alpha are obvious candidates for testing, because they can be self-administered by the patient and provide good long-term tolerability.
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Affiliation(s)
- R Dummer
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, CH-8091 Zürich, Switzerland.
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141
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Mann BS, Johnson JR, He K, Sridhara R, Abraham S, Booth BP, Verbois L, Morse DE, Jee JM, Pope S, Harapanhalli RS, Dagher R, Farrell A, Justice R, Pazdur R. Vorinostat for treatment of cutaneous manifestations of advanced primary cutaneous T-cell lymphoma. Clin Cancer Res 2007; 13:2318-22. [PMID: 17438089 DOI: 10.1158/1078-0432.ccr-06-2672] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE To discuss vorinostat approval for treatment of cutaneous manifestations of advanced cutaneous T-cell lymphoma (CTCL). EXPERIMENTAL DESIGN Data from 1 single-arm, open-label, multicenter pivotal trial and 11 other trials submitted to support the new drug application for vorinostat in the treatment of advanced primary CTCL were reviewed. The pivotal trial assessed responses by changes in overall skin disease score using a severity-weighted assessment tool (SWAT). Vorinostat could be considered active in CTCL if observed response rate was at least 20% and the lower bound of the corresponding 95% confidence interval (95% CI) excluded 5%. Patients reported pruritus relief using a questionnaire and a visual analogue scale. RESULTS The pivotal trial enrolled 74 patients with stage IB or higher CTCL. Median number of prior treatments was 3, and 61 patients (82%) had stage IIB or higher disease. The objective response rate in the skin disease assessed by change in the overall SWAT score from the baseline was 30% (95% CI, 18.5 to 42.6) in patients with stage IIB or higher disease. Median response duration (end of response defined by 50% increase in SWAT score from the nadir) was 168 days. Median time to tumor progression was 148 days for overall population and 169 days for patients with stage IIB or higher disease. Assessment of pruritus relief was considered unreliable. CONCLUSIONS Vorinostat showed activity in CTCL, and skin responses were a clinical benefit. Vorinostat was approved for treatment of cutaneous manifestations of CTCL. A nonblinded, single-arm trial did not allow a reliable assessment of pruritus relief.
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Affiliation(s)
- Bhupinder S Mann
- Food and Drug Administration, Silver Spring, Maryland 20993, USA.
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142
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Gniadecki R, Assaf C, Bagot M, Dummer R, Duvic M, Knobler R, Ranki A, Schwandt P, Whittaker S. The optimal use of bexarotene in cutaneous T-cell lymphoma. Br J Dermatol 2007; 157:433-40. [PMID: 17553039 DOI: 10.1111/j.1365-2133.2007.07975.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The management goal in cutaneous T-cell lymphomas (CTCLs) is to improve symptoms and induce remission. Early-stage disease is generally treated with skin-directed therapies. However, if these do not control the disease, systemic therapy becomes necessary. Bexarotene, a novel rexinoid, is an oral, noncytotoxic drug that has been approved in Europe for the treatment of refractory advanced-stage CTCL and in the U.S.A. for refractory CTCL. We provide guidance on the use of bexarotene in the management of CTCL, based on data from phase II/III clinical trials and the authors' clinical experience, and suggest how the potential of the drug can be maximized. The clinical trial results with bexarotene are reviewed, especially in comparison with interferon-alpha, which is the other commonly used noncytotoxic systemic therapy for CTCL. A treatment algorithm for bexarotene in refractory CTCL is suggested. As bexarotene may take time to achieve a maximum response, this algorithm recommends that therapy should be continued for a sufficient period to allow for a delayed onset of action. In addition, possible combination therapies with bexarotene are discussed. We conclude that bexarotene is effective in the management of CTCL, and has the advantage of oral administration. An on-going randomized clinical trial comparing psoralen plus ultraviolet A (PUVA) with PUVA plus bexarotene will provide valuable information about this combination regimen in early-stage disease, but further data are needed on the relative efficacies of other combination therapies with bexarotene in CTCL.
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Affiliation(s)
- R Gniadecki
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Bispebjerg bakke 23, DK-2400 Copenhagen, Denmark.
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143
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Abstract
PURPOSE OF REVIEW The purpose of this review is to educate the reader about two cutaneous lymphoproliferative diseases in childhood: pityriasis lichenoides and cutaneous T-cell lymphoma. Pityriasis lichenoides has traditionally been divided into acute and chronic subtypes. The two forms of the disease, however, are best thought of as two ends of a benign lymphoproliferative spectrum. Cutaneous T-cell lymphoma is a rare but underrecognized cutaneous malignancy in children. Early stage disease and hypopigmented presentation are characteristic of pediatric cutaneous T-cell lymphoma. The optimal investigation and treatment plans are still controversial. RECENT FINDINGS This article will summarize recent articles on pityriasis lichenoides and pediatric cutaneous T-cell lymphoma, including recent findings from an international registry of pediatric cutaneous T-cell lymphoma. SUMMARY After reading this review, the reader should be able to recognize the clinical presentation of pityriasis lichenoides, to understand the overlap between its acute and chronic forms, and to recognize its relationship with cutaneous T-cell lymphoma. In addition, the reader will appreciate the challenges in diagnosing and treating pediatric cutaneous T-cell lymphoma.
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Affiliation(s)
- Joseph Lam
- Rady Children's Hospital, University of California, San Diego, San Diego, California, USA
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144
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Panwalkar AW, Armitage JO. T-cell/NK-cell lymphomas: A review. Cancer Lett 2007; 253:1-13. [PMID: 17196327 DOI: 10.1016/j.canlet.2006.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 11/17/2006] [Accepted: 11/21/2006] [Indexed: 11/26/2022]
Abstract
T-cell neoplasms are a group of heterogeneous neoplasms that present a challenge in management. Accurate diagnosis and classification are necessary for proper treatment. This dilemma is exemplified by continuous upgrading of classification systems in an effort to better understand these diseases. The spectrum of management varies from observation and monitoring to prompt aggressive multimodality treatment to achieve optimal outcomes. Allogeneic transplant has been successful in a minority of cases with the possibility of cure; however this approach is still largely experimental. Molecular studies such as gene expression profiling are expected to offer exciting insight into the biology of these diseases. Novel therapeutic approaches continue to be explored, however will probably require larger clinical trials to establish their utility over the current standard.
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Affiliation(s)
- Amit W Panwalkar
- University of Nebraska Medical Center, Department of Oncology/Hematology, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, United States.
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145
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Bertele' V, Banzi R, Capasso F, Tafuri G, Trotta F, Apolone G, Garattini S. Haematological anticancer drugs in Europe: any added value at the time of approval? Eur J Clin Pharmacol 2007; 63:713-9. [PMID: 17530236 DOI: 10.1007/s00228-007-0296-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 03/07/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Current European regulations only require drugs to be safe and effective, although there is heavy demand for comparative efficacy data to demonstrate the added value of new drugs. The objective of the analysis reported here was to assess the added value of new anticancer drugs for haematological malignancies that have been approved by the European Medicines Agency (EMEA) based on the clinical data provided at the time of submission. METHODS Information on the evidence supporting the approval was extracted from the European Public Assessment Reports (EPARs). Documents were surveyed for new applications and for subsequent extensions between January 1995, when the EMEA was set up, and May 2006. The added value of newly approved drugs was assessed by an algorithm that evaluates the strength of evidence based on methodological appropriateness (randomised comparison) and the importance of clinical advantage (in terms of the magnitude of benefit, hardness of outcome measures, adequacy of comparator). RESULTS Eleven anticancer drugs were analysed. Of 17 indications, nine (53%) were approved on the basis of single-arm trials (SATs), and eight (47%) were approved on the basis of randomised controlled (clinical) trials (RCTs). The most frequently used endpoint was response rate (12 of 17 indications, 70%). On the basis of our criteria, only four of the 11 drugs show a consistent added value. CONCLUSION We were unable to establish an added value for about two thirds of the drugs evaluated in this study, primarily due to methodological aspects related to study design and endpoint robustness.
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Affiliation(s)
- Vittorio Bertele'
- Laboratory of Regulatory Policies, Mario Negri Institute for Pharmacological Research, Via Eritrea 62, 20157 Milan, Italy.
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146
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Tratamiento con UVB de banda estrecha de los estadios iniciales de la micosis fungoide. Estudio de 23 pacientes. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70059-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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147
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Coronel-Pérez I, Carrizosa-Esquivel A, Camacho-Martínez F. Narrow Band UVB Therapy in Early Stage Mycosis Fungoides. A Study of 23 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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148
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Gökdemir G, Barutcuoglu B, Sakiz D, Köşlü A. Narrowband UVB phototherapy for early-stage mycosis fungoides: evaluation of clinical and histopathological changes. J Eur Acad Dermatol Venereol 2006; 20:804-9. [PMID: 16898902 DOI: 10.1111/j.1468-3083.2006.01635.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early-stage (IA, IB, IIA) mycosis fungoides (MF) has long been treated with various agents including topical potent steroids, nitrogen mustard, carmustine, oral psoralen plus UVA (PUVA), broadband UVB, electron-beam radiotherapy, interferon-alpha and retinoids. However, each of these modalities is associated with various side-effects. Narrowband UVB (NB-UVB) therapy has the same effect but is safer to use than the other methods. OBJECTIVE Our purpose in this prospective study was to determine the effects of NB-UVB in early-stage MF both clinically and histopathologically. MATERIALS AND METHODS Twenty-three patients (20 men, three women, aged 27-78 years) with clinically and histologically confirmed MF were enrolled. Patients received NB-UVB therapy three times a week. Clinical and histological responses, cumulative doses, total number of treatments, side-effects and duration of remission period were noted. RESULTS Six patients had stage IA MF, 15 patients stage IB and two patients stage IIA. Eighteen patients had patch stage and five patients had plaque stage histopathologically. All of the patients in the patch group had a complete response (CR). In the plaque group, three patients (60%) had a CR and two (40%) had partial (PR) or no clinical response (NR). The clinical response between patch and plaque groups was statistically significant. Regarding the histopathological findings, 17 (94.4%) had complete clearing and only one (5.6%) patient had a partial improvement in the patch group. In the plaque group, one (20%) patient had complete clearing and four (80%) patients had partial or no improvement. The difference between the two groups was statistically significant. In the patch group, the mean cumulative dose was 90.15 J/cm(2) and the mean number of treatments was 35.33. In the plaque group, the mean cumulative dose was 90.67 J/cm(2) and the mean total number of treatments was 39.40. The differences were not statistically significant, either between the mean cumulative dose or the mean number of treatments. The mean duration of follow-up was 10.87 months (range 1-25 months). Only one of the patients had a relapse. CONCLUSIONS NB-UVB therapy for patients with early-stage MF is an effective and safe treatment with the effect lasting for months. We suggest that clinical clearance correlates with histological improvement except for patients in the plaque stage.
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Affiliation(s)
- G Gökdemir
- Dermatology Clinic, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.
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149
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Ortiz-Romero PL, Sánchez-Largo ME, Sanz H, García-Romero D, Rosales B, Valverde R, Arrue I, Polo I, Ruiz D, Fernández-Herrera J, Vanaclocha F. Tratamiento de micosis fungoide con PUVA más bexaroteno. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:311-8. [PMID: 16956562 DOI: 10.1016/s0001-7310(06)73408-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The combined use of bexarotene and PUVA is a treatment that is currently being investigated. In this paper, six patients treated with this combination are presented. OBJECTIVES To assess the efficacy and safety of treatment with PUVA + bexarotene in patients with mycosis fungoides (MF). Patients, material and methods. Six patients diagnosed with MF in different stages, who received three sessions of PUVA treatment a week (initially 2.35 J/cm 2, with progressive increases to a maximum of 23.5 J/cm 2) + bexarotene (initial dose 300 mg/m 2/day, decreasing to 200, 150 or 75 mg/m 2 if signs of toxicity appeared). All received atorvastatin. RESULTS Stage at the start of treatment: two patients IIb, one patient Ib with B2 blood involvement, two patients Ib, one patient Ia. Five of the six patients responded to the treatment (three full remissions [FR], two partial remissions [PR]). One patient did not respond. In those in whom FR was achieved, the time required for the response was 10, 20 and 24 weeks. All presented with hypertriglyceridemia (maximum 1194 mg/ dL). It was necessary to administer thyroid hormone supplements to four of the patients. Two of them had alterations in the hepatic biochemistry values, and two others presented with alterations in the muscle profile analysis. CONCLUSION The combination of PUVA and bexarotene is a safe and effective treatment for MF. It will be necessary to await the results of the clinical trials currently underway to see if their combined use is better than treatment with PUVA alone. The response rate (RR) was 86 % (three FR and two PR out of six patients).
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150
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Assaf C, Bagot M, Dummer R, Duvic M, Gniadecki R, Knobler R, Ranki A, Schwandt P, Whittaker S. Minimizing adverse side-effects of oral bexarotene in cutaneous T-cell lymphoma: an expert opinion. Br J Dermatol 2006; 155:261-6. [PMID: 16882161 DOI: 10.1111/j.1365-2133.2006.07329.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bexarotene is an oral retinoid therapy that is effective for the treatment of early and advanced-stage cutaneous T-cell lymphoma (CTCL) in patients who have failed on other therapies. However, bexarotene treatment is associated with unavoidable side-effects, in particular hypertriglyceridaemia and hypothyroidism, which are manageable with adequate concomitant medications and are reversible on cessation of treatment. A pragmatic strategy for minimizing bexarotene-associated hypertriglyceridaemia and hypothyroidism is suggested, based on data from the studies with bexarotene in CTCL and on day-to-day experience with this agent in the clinical setting. The strategy anticipates that these common adverse events are likely to occur and recommends the early use of preventive therapy to lower triglycerides and elevate thyroid hormone levels in the blood, followed by subsequent monitoring, dose adjustment during bexarotene treatment, and titration of the daily bexarotene dose from 150 to 300 mg m(-2), which is optimal for most patients. When further information becomes available on how bexarotene interacts with lipid metabolism and thyroid function, the management approach suggested here may need to be changed.
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Affiliation(s)
- C Assaf
- Department of Dermatology and Allergy, Skin Cancer Center Charité, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, 10117 Berlin, Germany.
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