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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Versorgungsstruktur der Patienten mit Mycosis fungoides und Sézary-Syndrom in Deutschland - Versorgungsforschung auf Basis von GKV-Routinedaten. J Dtsch Dermatol Ges 2022; 20:643-652. [PMID: 35578415 DOI: 10.1111/ddg.14725_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin.,Hopital Saint-Louis, AP-HP, Paris, Frankreich
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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Care structure of patients with mycosis fungoides and Sézary syndrome in Germany - Care research based on SHI claims data. J Dtsch Dermatol Ges 2022; 20:643-651. [PMID: 35499207 DOI: 10.1111/ddg.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCLs) are rare forms of non-Hodgkin's lymphoma of T-cell origin that occur mainly in the skin. The most common form is mycosis fungoides (MF), but Sézary syndrome (SS), a more aggressive form of CTCL, is another relevant subgroup. Due to the rare nature of the disease, population-based studies of the epidemiology and disease burden and insights into care delivery are limited. PATIENTS AND METHODS Based on an anonymized, age and sex-adjusted routine dataset comprising approximately five million people with statutory health insurance, a retrospective, longitudinal healthcare research study was conducted over a six-year period (2012-2017). RESULTS In 55 % of patients with MF and SS, the initial diagnosis was documented in an outpatient setting; in 59 % of cases by a dermatologist. Immunophenotyping by flow cytometry is considered an important investigative tool for the detection and follow-up surveillance of blood involvement of cutaneous lymphomas, as the disease stage is the most important prognostic factor in MF and SS; this was performed in only 10 % of patients. The first-line treatment was topical (76 %), in particular with corticosteroids (66 %). CONCLUSIONS The findings from this healthcare research point to the need for increased guideline-based care.
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Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin]
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin].,Hopital Saint-Louis, AP-HP, Paris, France
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[Current therapeutic options in Mycosis fungoides and Sézary syndrome]. Hautarzt 2022; 73:75-85. [PMID: 34988613 DOI: 10.1007/s00105-021-04924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Driven by the approval of new targeted therapies, significant progress has been made in recent years in the clinical management of cutaneous T‑cell lymphomas. Although there are no curative treatment options for cutaneous T‑cell lymphomas, response rates are often encouraging, in particular when using combination therapies. The decision for the appropriate form of treatment depends on the specific diagnosis, disease stage, and the history of prior therapies. This article provides a comprehensive overview of current treatment options in mycosis fungoides and Sézary syndrome, based on the recently published, revised German S2k guidelines on cutaneous lymphomas (update 2021). In addition, we present promising, yet-to-be-approved therapies that at least in part can be already used off-label in clinical practice today.
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Wilhelm R, Eckes T, Imre G, Kippenberger S, Meissner M, Thomas D, Trautmann S, Merlio JP, Chevret E, Kaufmann R, Pfeilschifter J, Koch A, Jäger M. C6 Ceramide (d18:1/6:0) as a Novel Treatment of Cutaneous T Cell Lymphoma. Cancers (Basel) 2021; 13:E270. [PMID: 33450826 PMCID: PMC7828274 DOI: 10.3390/cancers13020270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/01/2021] [Accepted: 01/11/2021] [Indexed: 01/09/2023] Open
Abstract
Cutaneous T cell lymphomas (CTCLs) represent a heterogeneous group of T cell lymphomas that primarily affect the skin. The most frequent forms of CTCL are mycosis fungoides and Sézary syndrome. Both are characterized by frequent recurrence, developing chronic conditions and high mortality with a lack of a curative treatment. In this study, we evaluated the effect of short-chain, cell-permeable C6 Ceramide (C6Cer) on CTCL cell lines and keratinocytes. C6Cer significantly reduced cell viability of CTCL cell lines and induced cell death via apoptosis and necrosis. In contrast, primary human keratinocytes and HaCaT keratinocytes were less affected by C6Cer. Both keratinocyte cell lines showed higher expressions of ceramide catabolizing enzymes and HaCaT keratinocytes were able to metabolize C6Cer faster and more efficiently than CTCL cell lines, which might explain the observed protective effects. Along with other existing skin-directed therapies, C6Cer could be a novel well-tolerated drug for the topical treatment of CTCL.
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Affiliation(s)
- Raphael Wilhelm
- Department of General Pharmacology and Toxicology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (T.E.); (G.I.); (J.P.); (A.K.)
| | - Timon Eckes
- Department of General Pharmacology and Toxicology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (T.E.); (G.I.); (J.P.); (A.K.)
| | - Gergely Imre
- Department of General Pharmacology and Toxicology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (T.E.); (G.I.); (J.P.); (A.K.)
| | - Stefan Kippenberger
- Department of Dermatology, Venerology and Allergology, Goethe University Hospital, 60590 Frankfurt am Main, Germany; (S.K.); (M.M.); (R.K.); (M.J.)
| | - Markus Meissner
- Department of Dermatology, Venerology and Allergology, Goethe University Hospital, 60590 Frankfurt am Main, Germany; (S.K.); (M.M.); (R.K.); (M.J.)
| | - Dominique Thomas
- Department of Clinical Pharmacology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.T.); (S.T.)
| | - Sandra Trautmann
- Department of Clinical Pharmacology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (D.T.); (S.T.)
| | - Jean-Philippe Merlio
- Cutaneous Lymphoma Oncogenesis Team, INSERM U1053 Bordeaux Research in Translational Oncology, Bordeaux University, 33076 Bordeaux, France; (J.-P.M.); (E.C.)
| | - Edith Chevret
- Cutaneous Lymphoma Oncogenesis Team, INSERM U1053 Bordeaux Research in Translational Oncology, Bordeaux University, 33076 Bordeaux, France; (J.-P.M.); (E.C.)
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, Goethe University Hospital, 60590 Frankfurt am Main, Germany; (S.K.); (M.M.); (R.K.); (M.J.)
| | - Josef Pfeilschifter
- Department of General Pharmacology and Toxicology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (T.E.); (G.I.); (J.P.); (A.K.)
| | - Alexander Koch
- Department of General Pharmacology and Toxicology, Goethe University Hospital and Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (T.E.); (G.I.); (J.P.); (A.K.)
| | - Manuel Jäger
- Department of Dermatology, Venerology and Allergology, Goethe University Hospital, 60590 Frankfurt am Main, Germany; (S.K.); (M.M.); (R.K.); (M.J.)
- Hautklinik, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, 76133 Karlsruhe, Germany
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Wobser M, Goebeler M. [Cutaneous lymphomas : Clinical presentation - diagnosis - treatment]. DER PATHOLOGE 2020; 41:79-94. [PMID: 31932947 DOI: 10.1007/s00292-019-00743-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cutaneous lymphomas comprise different subgroups with distinct biological behavior. Mycosis fungoides, the most common cutaneous lymphoma, presents with patches, plaques, tumors and erythroderma. Therapeutic options depend on stage and comprise local skin-directed treatment in early stages, while later stages and Sézary syndrome require systemic therapies including bexarotene, interferon or brentuximab vedotin. While the rare CD4-positive lymphoproliferation and acral CD8-positive lymphoma present with an invariably indolent course, cutaneous peripheral T‑cell lymphomas exhibit an aggressive clinical behavior. Among the subgroup of cutaneous B‑cell lymphomas, primary cutaneous marginal zone lymphoma and follicle center cell lymphoma belong to indolent entities with almost unrestricted overall survival, whereas cutaneous large B‑cell lymphoma presents with a significant risk of systemic dissemination and is associated with high lethality.
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Affiliation(s)
- Marion Wobser
- Universitätshautklinik Würzburg, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
| | - Matthias Goebeler
- Universitätshautklinik Würzburg, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
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Singer S, Berneburg M. Phototherapy. J Dtsch Dermatol Ges 2019; 16:1120-1129. [PMID: 30179320 DOI: 10.1111/ddg.13646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/19/2018] [Indexed: 12/19/2022]
Abstract
The efficacy of phototherapy is based on the interaction between ultraviolet (UV) radiation and the skin. The photobiological effects thus achieved depend on the wavelengths used. Targeted use of UVA and UVB, where indicated in combination with a photosensitizer such as psoralen, provides the dermatologist with a broad armamentarium for the treatment of a multitude of skin diseases. The spectrum of indications ranges from superficial dermatitis, psoriasis, and malignancies, such as cutaneous T-cell lymphoma, to deep sclerosing conditions such as morphea. The objective of the present review is to highlight the photobiological effects of the various types of UV radiation as well as the resultant clinical indications for phototherapy.
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Affiliation(s)
- Sebastian Singer
- Department of Dermatology, Regensburg University Medical Center, Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, Regensburg University Medical Center, Regensburg, Germany
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Singer S, Berneburg M. Phototherapie. J Dtsch Dermatol Ges 2019; 16:1120-1131. [PMID: 30179327 DOI: 10.1111/ddg.13646_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
Abstract
Die Phototherapie nutzt die photobiologische Wirkung von ultravioletter (UV-)Strahlung auf unseren Organismus. Die verschiedenen Wellenlängen der Strahlung rufen dabei ganz unterschiedliche Effekte hervor. Der gezielte Einsatz von UV-A und UV-B, gegebenenfalls auch in Kombination mit dem Photosensibilisator Psoralen im Rahmen einer PUVA-Therapie, ermöglicht dem Dermatologen die effektive Behandlung der verschiedensten Hautkrankheiten. Das Indikationsspektrum der Phototherapie reicht von oberflächlichen Ekzemerkrankungen, Psoriasis, malignen Erkrankungen wie dem kutanen T-Zell-Lymphom, bis hin zu tief in der Dermis lokalisierten sklerosierenden Erkrankungen wie der Sklerodermie. Das Verständnis der zugrunde liegenden photobiologischen Wirkmechanismen der verschiedenen Bereiche der UV-Strahlung und die sich daraus ableitenden Indikationen für eine Phototherapie soll der folgende Artikel ermöglichen.
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Affiliation(s)
- Sebastian Singer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
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Wobser M, Goebeler M. [Cutaneous lymphomas : Clinical presentation - diagnosis - treatment]. DER HAUTARZT 2019; 70:815-830. [PMID: 31511903 DOI: 10.1007/s00105-019-04469-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cutaneous lymphomas comprise different subgroups with distinct biological behavior. Mycosis fungoides, the most common cutaneous lymphoma, presents with patches, plaques, tumors and erythroderma. Therapeutic options depend on stage and comprise local skin-directed treatment in early stages, while later stages and Sézary syndrome require systemic therapies including bexarotene, interferon or brentuximab vedotin. While the rare CD4-positive lymphoproliferation and acral CD8-positive lymphoma present with an invariably indolent course, cutaneous peripheral T‑cell lymphomas exhibit an aggressive clinical behavior. Among the subgroup of cutaneous B‑cell lymphomas, primary cutaneous marginal zone lymphoma and follicle center cell lymphoma belong to indolent entities with almost unrestricted overall survival, whereas cutaneous large B‑cell lymphoma presents with a significant risk of systemic dissemination and is associated with high lethality.
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Affiliation(s)
- Marion Wobser
- Universitätshautklinik Würzburg, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
| | - Matthias Goebeler
- Universitätshautklinik Würzburg, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
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