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Feletti MP, Ramos AMDA, Novo VM, Costa BS, Scardua EFDP, Marcondes SS, Camisasca DR, Grão-Velloso TR. Mycosis fungoides refractory to treatment - importance of a multidisciplinary approach. Oral Maxillofac Surg 2024:10.1007/s10006-024-01264-9. [PMID: 38822949 DOI: 10.1007/s10006-024-01264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/26/2024] [Indexed: 06/03/2024]
Abstract
We report a case of difficult-to-control mycosis fungoides (MF), where the role of the dental surgeon was crucial for the control and prognosis of the disease. A 62-year-old female patient diagnosed with MF had a previous record of red patches and small raised bumps on the face, along with a cancerous growth in the cervical and vulvar region. The patient was initially treated with methotrexate and local radiotherapy without resolution. Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone was then started (CHOP protocol). The dental team of a reference hospital was consulted to evaluate swelling in the anterior region of the palate, which had been developing for two months, reporting discomfort when eating. The role of the dentistry team was fundamental in the differential diagnosis of oral lesions with dental infections, second neoplasia, or even a new site of disease manifestation, in addition to controlling mucosal changes resulting from chemotherapy. After ruling out dental infection, the dentistry team performed a lesion biopsy to confirm the diagnosis. The histopathological and immunohistochemical analysis showed atypical lymphoid infiltration of T cells (CD3+/CD4+/CD7-/CD8-), coexpression of CD25, and presence of CD30 cells, corresponding to the finding for MF. Identifying CD30 + allowed for a new chemotherapy protocol with brentuximab vedotin (BV) combined with gemcitabine. This protocol effectively controlled MF, which previous protocols had failed to do. The diagnosis by the dental team was essential for therapeutic change and improvement of the patient's clinical condition without the need for invasive medical procedures.
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Affiliation(s)
- Mariana Pires Feletti
- Pós Graduate Program in Dental Sciences, Federal University of Espírito Santo, Av. Marechal Campos, 1468 - Maruípe CEP 29, Vitoria (City), 040-090, Brazil
| | | | - Vinicius Matos Novo
- Pós Graduate Program in Dental Sciences, Federal University of Espírito Santo, Av. Marechal Campos, 1468 - Maruípe CEP 29, Vitoria (City), 040-090, Brazil
| | | | | | | | - Danielle Resende Camisasca
- Pós Graduate Program in Dental Sciences, Federal University of Espírito Santo, Av. Marechal Campos, 1468 - Maruípe CEP 29, Vitoria (City), 040-090, Brazil
- Department of Clinical Dentistry, Federal University of Espírito Santo, Vitoria (City), Brazil
| | - Tânia Regina Grão-Velloso
- Pós Graduate Program in Dental Sciences, Federal University of Espírito Santo, Av. Marechal Campos, 1468 - Maruípe CEP 29, Vitoria (City), 040-090, Brazil.
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Mills K, Sigler E, Snell M, Regehr J, Moore D, Ablah E, Gilbert L. Tumor Stage Mycosis Fungoides with Lymph Node Involvement. Kans J Med 2024; 17:39-40. [PMID: 38694178 PMCID: PMC11060780 DOI: 10.17161/kjm.vol17.21453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/27/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Kale Mills
- University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Edith Sigler
- University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Mikaela Snell
- Family Medicine Residency Program at Ascension Via Christi Health, Wichita, KS
| | - Jared Regehr
- University of Kansas School of Medicine-Wichita, Wichita, KS
- Family Medicine Residency Program at Ascension Via Christi Health, Wichita, KS
| | | | - Elizabeth Ablah
- University of Kansas School of Medicine-Wichita, Wichita, KS
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Lisa Gilbert
- University of Kansas School of Medicine-Wichita, Wichita, KS
- Family Medicine Residency Program at Ascension Via Christi Health, Wichita, KS
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Taş-Aygar G, Ataş H, Gönül M, Kartal SP. Importance of the C-Reactive Protein to Albumin Ratio in the Diagnosis and Prognosis of Mycosis Fungoides. Dermatol Pract Concept 2024; 14:dpc.1402a97. [PMID: 38810087 PMCID: PMC11135996 DOI: 10.5826/dpc.1402a97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION The C-reactive protein to albumin ratio (CAR) lately has demonstrated as a prognostic factor and an indicator of disease activity, severity and prognosis in solid organ malignancies and inflammatory diseases. However, the effects of CAR have not been investigated in mycosis fungoides (MF) patients yet. OBJECTIVES This study aimed to determine the potential role of CAR as a diagnostic and a prognostic indicator in MF. METHODS We retrospectively investigated the electronic medical records of 97 patients with MF admitted to the Dermatology Clinic of Health Sciences University, Diskapi Yildirim Beyazit Training and Research Hospital between January 2014 and December 2020. In total, 60 patients with MF were enrolled in the study. CAR was evaluated, patient and control group. Also, the other clinicopathological factors including age, lactate dehydrogenase, stage of disease, beta-2-microglobulin levels, and sedimentation levels were evaluated. RESULTS The median value of CAR was 0.85 (0.10-7.51) in the patient group, whereas it was 0.39 (0.0-1.11) in the control group (P < 0.001). Patients with disease progression (N = 16, 13M, 3 F) had a median value of CAR 0.84 (0.10-7.51) and the median value of CAR (N = 44) was 0.86 (0.12-4.57) in the group of patients with stable disease. The CAR value had no prognostic significance (P > 0.05). CONCLUSIONS There is no association between the CAR and progression in the stage in MF patients. But the CAR is significantly higher in patients with MF than in the control group. The CAR can be a guide for us in cases where we have difficulty in diagnosing.
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Affiliation(s)
- Gamze Taş-Aygar
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
| | - Hatice Ataş
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
| | - Müzeyyen Gönül
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
| | - Selda Pelin Kartal
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, Turkey
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L’Orphelin JM. An occurrence of eosinophilic folliculitis and alopecia associated with a sustained complete response to mogamulizumab in Sézary syndrome: a case report. Ther Adv Hematol 2024; 15:20406207241235777. [PMID: 38456078 PMCID: PMC10919142 DOI: 10.1177/20406207241235777] [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: 02/17/2023] [Accepted: 02/03/2024] [Indexed: 03/09/2024] Open
Abstract
Mogamulizumab is a monoclonal antibody that binds to C-C chemokine receptor 4 (CCR4), initiating antibody-dependent cellular cytotoxicity. CCR4 is highly expressed in the cutaneous T-cell lymphoma subtypes mycosis fungoides and Sézary syndrome (SS), and mogamulizumab has been shown to be effective in patients with these conditions who were refractory to at least one prior systemic treatment. One of the more common adverse events encountered with mogamulizumab is rash, which may mimic disease progression and lead to premature discontinuation. Moreover, there has been some evidence to suggest that mogamulizumab-associated rash (MAR) is associated with improved outcomes in some patients, particularly those with SS. This report presents the case of a 72-year-old woman with SS, which manifested with macular and papular lesions and abnormal blood cytometry, who was treated with mogamulizumab after failure of bexarotene and photopheresis combination therapy. She achieved a complete response (CR), but experienced lymphopenia associated with histologically proven eosinophilic folliculitis (EF) of the scalp and alopecia. The EF responded well to initial topical corticosteroids, defined by regression of erythema and pustular involvement and reduction in pruritus-like symptoms, but without hair regrowth. Mogamulizumab was withdrawn after 32 cycles, but CR was maintained. To date, EF persists in the form of diffuse erythema without pustules or pruritus. A link between cluster of differentiation 4 lymphopenia and EF has previously been established; therefore, EF should be considered in patients who develop rash and lymphopenia while receiving treatment with mogamulizumab. MAR has been associated with clinical response to mogamulizumab, and this case report adds to the evidence that EF may also be associated with sustained clinical response following treatment cessation. However, regular monitoring is required to prevent a relapse of SS. Prospective studies are needed to confirm whether such an association between EF and CR following mogamulizumab exists.
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Affiliation(s)
- Jean-Matthieu L’Orphelin
- Department of Dermatology, Caen-Normandie University Hospital, Avenue de la Côte de Nacre, 14003 Caen, France
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Örnek S, Ozekinci S, Ipin T, Kocaturk E. TOX, TWIST1, STAT4, and SATB1 protein expressions in early-stage mycosis fungoides. J Cutan Pathol 2024; 51:232-238. [PMID: 37932931 DOI: 10.1111/cup.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Diagnosis of early mycosis fungoides (eMF) is challenging and often delayed as many of its clinical and histopathologic features may mimic various benign inflammatory dermatoses (BIDs). The products of the thymocyte selection-associated high mobility group box (TOX), twist family BHLH transcription factor 1 (TWIST1), signal transducer and activator of transcription 4 (STAT4), and special AT-rich sequence-binding protein 1 (SATB1) genes function as transcription factors and are involved in the pathogenesis of MF. OBJECTIVES We aim to determine the diagnostic value of TOX, TWIST1, STAT4, and SATB1 protein expressions in eMF. METHODS This non-randomized, controlled, prospective analytic study was conducted by performing immunohistochemistry staining with TOX, TWIST1, STAT4, and SATB1 polyclonal antibodies in lesional skin biopsies of eMF and BID patients. Nuclear staining of lymphocytes was compared between eMF and BIDs, and the capacity of these antibodies to predict eMF was determined. RESULTS Immunostainings with anti-TWIST1 showed an increase in protein expression (p = 0.003) and showed a decrease with anti-SATB1 antibodies in eMF compared to BIDs (p = 0.005) while anti-TOX and anti-STAT4 antibodies did not exhibit significant differences (p = 0.384; p = 0.150). Receiver operating characteristic analysis showed that immunohistochemical evaluations of TWIST1 and SATB1 protein expressions can differentiate eMF (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.605-0.851, p = 0.002; AUC: 0.686, 95% CI: 0.565-0.807, p = 0.013). CONCLUSIONS TWIST1 and SATB1 are potential diagnostic markers for the histologic diagnosis of eMF.
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Affiliation(s)
- Sinem Örnek
- Department of Dermatology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selver Ozekinci
- Department of Pathology, Dicle University Hospital, Diyarbakir, Turkey
| | - Tugba Ipin
- Department of Pathology, Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Koc University School of Medicine, Istanbul, Turkey
- Institute of Allergy, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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6
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Patil K, Sher G, Kuttikrishnan S, Moton S, Alam M, Buddenkotte J, Ahmad A, Steinhoff M, Uddin S. The cross-talk between miRNAs and JAK/STAT pathway in cutaneous T cell lymphoma: Emphasis on therapeutic opportunities. Semin Cell Dev Biol 2024; 154:239-249. [PMID: 36216715 DOI: 10.1016/j.semcdb.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 02/25/2023]
Abstract
Mycosis Fungoides (MF) and Sézary Syndrome (SS) belong to a wide spectrum of T cell lymphoproliferative disorders collectively termed cutaneous T cell lymphomas (CTCL). CTCLs represent an archetype of heterogeneous and dynamically variable lymphoproliferative neoplasms typified by distinct clinical, histological, immunophenotypic, and genetic features. Owing to its complex dynamics, the pathogenesis of CTCL remains elusive. However, in recent years, progress in CTCL classification combined with next-generation sequencing analyses has broadened the genetic and epigenetic spectrum of clearly defined CTCL entities such as MF and SS. Several large-scale genome studies have identified the polygenic nature of CTCL and unveiled an idiosyncratic mutational landscape involving genetic aberrations, epigenetic alterations, cell cycle dysregulation, apoptosis, and the constitutive activation of T cell/NF-κB/JAK-STAT signaling pathways. In this review, we summarize the evolving insights on how the intrinsic epigenetic events driven by dysregulated miRNAs, including the oncogenic and tumor-suppressive miRNAs, influence the pathogenesis of MF and SS. We also focus on the interplay between the JAK/STAT pathway and miRNAs in CTCL as well as the significance of the miRNA/STAT axis as a relevant pathogenetic mechanism underlying CTCL initiation and progression. Based on these biologic insights, the current status and recent progress on novel therapies with a strong biological rationale, including miRNA-targeted molecules and JAK/STAT-targeted therapy for CTCL management, are discussed.
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Affiliation(s)
- Kalyani Patil
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar
| | - Gulab Sher
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar
| | - Shilpa Kuttikrishnan
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar
| | - Safwan Moton
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33200, USA
| | - Majid Alam
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | - Joerg Buddenkotte
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | - Aamir Ahmad
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | - Martin Steinhoff
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha 3050, Qatar; Weill Cornell Medicine-Qatar, Medical School, Doha 24144, Qatar; Dept. of Dermatology, Weill Cornell Medicine-New York 10065, New York, USA.
| | - Shahab Uddin
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha 3050, Qatar; Laboratory Animal Research Center, Qatar University, Doha 2713, Qatar.
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7
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André R. Mycosis fungoides palmaris and plantaris. Ital J Dermatol Venerol 2024; 159:1-3. [PMID: 38015570 DOI: 10.23736/s2784-8671.23.07645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Mycosis fungoides (MF) palmaris and plantaris is a rare form of MF. Only few cases are reported in the literature. Different forms are described: eczematous lesions, dyshidrosis lesions, verrucous lesions, dry pulpitis, ulcerated lesions, pustulosis, and hyperkeratotic lesions. Histology is typical for MF with a positive T-cell receptor gene rearrangement in majority of cases. Prognosis is good. Resistance to topical steroids is common, and classical treatment consist of chlormethine gel and radiotherapy.
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Affiliation(s)
- Raphaël André
- Forever Institute, Geneva, Switzerland -
- Department of Dermatology, Annecy Hospital, Epagny Metz Tessy, France -
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8
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Bordeaux ZA, Reddy SV, Choi J, Braun G, McKeel J, Lu W, Yossef SM, Ma EZ, West CE, Kwatra SG, Kwatra MM. Transcriptomic and proteomic analysis of tumor suppressive effects of GZ17-6.02 against mycosis fungoides. Sci Rep 2024; 14:1955. [PMID: 38263212 PMCID: PMC10805783 DOI: 10.1038/s41598-024-52544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/19/2024] [Indexed: 01/25/2024] Open
Abstract
Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL). Despite having a wide variety of therapeutic agents available for the treatment of MF, patients often suffer from a significant decrease in quality of life and rarely achieve long-term remission or complete cure, highlighting a need to develop novel therapeutic agents for this disease. The present study was undertaken to evaluate the efficacy of a novel anti-tumor agent, GZ17-6.02, which is composed of curcumin, harmine, and isovanillin, against MF in vitro and in murine models. Treatment of HH and MyLa cells with GZ17-6.02 inhibited the growth of both cell lines with IC50 ± standard errors for growth inhibition of 14.37 ± 1.19 µg/mL and 14.56 ± 1.35 µg/mL, respectively, and increased the percentage of cells in late apoptosis (p = .0304 for HH; p = .0301 for MyLa). Transcriptomic and proteomic analyses revealed that GZ17-6.02 suppressed several pathways, including tumor necrosis factor (TNF)-ɑ signaling via nuclear factor (NF)-kB, mammalian target of rapamycin complex (mTORC)1, and Pi3K/Akt/mTOR signaling. In a subcutaneous tumor model, GZ17-6.02 decreased tumor volume (p = .002) and weight (p = .009) compared to control conditions. Proteomic analysis of tumor samples showed that GZ17-6.02 suppressed the expression of several proteins that may promote CTCL growth, including mitogen-activated protein kinase (MAPK)1, MAPK3, Growth factor receptor bound protein (GRB)2, and Mediator of RAP80 interactions and targeting subunit of 40 kDa (MERIT)40.
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Affiliation(s)
- Zachary A Bordeaux
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Sriya V Reddy
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Gabriella Braun
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Jaimie McKeel
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Weiying Lu
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Selina M Yossef
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
| | - Emily Z Ma
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Cameron E West
- Genzada Pharmaceuticals, Hutchinson, USA
- US Dermatology Partners, Wichita, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Cancer Research Building II, Suite 206 1550 Orleans Street, Baltimore, MD, 21231, USA.
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, USA
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, USA
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9
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Dong S, Zhu Y, Zhang F, Zhao Y, Zhou H. A case report of acute promyelocytic leukemia with mycosis fungoides. Medicine (Baltimore) 2024; 103:e36619. [PMID: 38181249 PMCID: PMC10766262 DOI: 10.1097/md.0000000000036619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/22/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE Acute promyelocytic leukaemia (APL) is a rare subtype of acute myelogenous leukaemia. With advances in treatment regimens, namely, introduction of all-trans-retinoicacid, outcomes have drastically improved, its side effects should not be ignored. Mycosis fungoides is one of the side effects of all-trans-retinoicacid treatment, but it may also be a clinical manifestation before disease progression. However, it rarely appears and is easily overlooked. This leads to being easily misled during the treatment process, affecting the treatment plan, and resulting in adverse consequences. Therefore, early identification and judgment can not only provide appropriate treatment options, but also prevent and treat further disease progression. PATIENT CONCERNS The patient was hospitalized for pancytopaenia. After completing the examination, the patient was finally diagnosed with acute promyelocytic leukaemia (acute myelogenous leukaemia-M3). We administered tretinoin and arsenous acid. Evaluation of the treatment effect on the 7th day after chemotherapy showed that the bone marrow morphology showed complete remission. After the second course of chemotherapy, the patient developed red miliary macular papules, which gradually worsened. After completing relevant inspections, Considering that the cases was complicated with skin mycosis fungoides, the patient was treated with budesonide ointment and methylprednisolone as chemotherapy. DIAGNOSES Upon examination, the patient was initially diagnosed with acute promyelocytic leukaemia. Evaluation of the treatment effect on the 7th day after chemotherapy showed that the bone marrow morphology showed complete remission. After the second course of chemotherapy, we discovered the patient was diagnosed with skin mycosis fungoides. INTERVENTIONS Systemic chemotherapy is first given when a patient was diagnosed with acute promyelocytic leukaemia. After the patient happened skin mycosis fungoides, We have adjusted the treatment plan and supplemented it with other treatment plans based on the original chemotherapy, After 2 months of treatment, his condition gradually improved. OUTCOMES All-trans-retinoicacid in the treatment of APL must be given attention because mycosis fungoides should not only be distinguished from infectious diseases but also be further assessed with regard to disease progression and metastasis. LESSONS Acute promyelocytic leukemia needs to be treated with arsenic trioxide. All-trans-retinoicacid in the treatment of APL must be given attention mycosis fungoides. Early diagnosis can guide accurate treatment, which is of great help in alleviating the pain of patients and improving the cure rate.
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Affiliation(s)
- Shasha Dong
- Jining NO. 1 People’s Hospital, Jining, Shandong, China
| | - Yejing Zhu
- Daizhuang Psychiatric Hospital, Jining, Shandong, China
| | - Fang Zhang
- Jining NO. 1 People’s Hospital, Jining, Shandong, China
| | - Yongqin Zhao
- Jining NO. 1 People’s Hospital, Jining, Shandong, China
| | - Hongjing Zhou
- Jining NO. 1 People’s Hospital, Jining, Shandong, China
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10
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Fujimura T, Ohuchi K, Ikawa T, Kambayashi Y, Amagai R, Furudate S, Asano Y. Possible effects of plasminogen activator inhibitor-1 on promoting angiogenesis through matrix metalloproteinase 9 in advanced mycosis fungoides. Hematol Oncol 2024; 42:e3244. [PMID: 38287534 DOI: 10.1002/hon.3244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/01/2023] [Accepted: 12/07/2023] [Indexed: 01/31/2024]
Abstract
Mycosis fungoides (MF) progresses slowly before advancing to skin tumors followed by lymph node and visceral involvement. Among MF progression, stage IIB is an initial time point of tumor formation in MF. Since MF in tumor stage possess abundant blood vessels, it is important to evaluate the pro-angiogenic factors before and after MF in stage IIB. In this report, we investigated pro-angiogenic soluble factors in MF patients, as well as its pro-angiogenetic effects on tumor cells and stroma cells. We first evaluated the serum levels of pro-angiogenic factors in 9 MF patients without tumor formation and 8 MF patients with tumor formation. Among them, the serum MMP-9 and plasminogen activator inhibitors 1 (PAI-1) was significantly increased in MF with tumor formation compared in MF without tumor formation, leading to favorable formation of human dermal microvascular endothelial cells tube networks. Moreover, PAI-1 stimulation significantly increased the mRNA expression and protein production MMP-9 on monocytes derived M2 macrophages and HUT-78. Furthermore, since MMP-9 production from tumor cells as well as stromal cells is suppressed by bexarotene, we evaluate the baseline serum pro-angiogenic factors including MMP-9 in 16 patients with advanced cutaneous T cell lymphoma treated with bexarotene. The serum levels of MMP-2 and MMP-9 was significantly increased in bexarotene non-responded patients compared to responded patients. Our present study suggested the significance of MMP-9 and PAI-1 for the progression of MF stage toward to the tumor stage, and could be a therapeutic target in future.
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Affiliation(s)
- Taku Fujimura
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kentaro Ohuchi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Ikawa
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yumi Kambayashi
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Amagai
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Sadanori Furudate
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshihide Asano
- Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Japan
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11
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Kudoh R, Komiya K, Takaki R, Yokoyama A, Hiramatsu K, Kadota JI. Pneumocystis jirovecii Pneumonia in a Patient With Localized Mycosis Fungoides Not Receiving Immunosuppressive Treatment. Cureus 2024; 16:e51724. [PMID: 38318593 PMCID: PMC10839542 DOI: 10.7759/cureus.51724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Pneumocystis jirovecii pneumonia (PCP) is the most common opportunistic infection in patients with human immunodeficiency virus (HIV), but it may develop in patients without HIV, whose immune system is suppressed by anticancer or immunosuppressive agents even when indicating normal counts of CD4+ T cells. Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma, which is believed not to cause immunosuppressive conditions unless it develops leukosis or metastasis or is treated with anticancer drugs or systemic immunosuppressants. Here, we report a case of PCP in a patient with localized MF not receiving immunosuppressive treatment. The patient, a woman in her 70s, presented with persistent dyspnea. High-resolution computed tomography (HRCT) showed diffuse ground-glass opacities in both lungs. Bronchoalveolar lavage fluid was positive for P. jirovecii. Moreover, the cytomegalovirus antigenemia test was positive, whereas tests for anti-HIV and antihuman T-cell lymphotropic virus antibodies were negative. The patient was treated with trimethoprim-sulfamethoxazole, prednisolone, and ganciclovir, which gradually improved the symptoms and diminished diffuse ground-glass opacities on HRCT. This case exemplifies a rare presentation of PCP with mild MF that was not treated with chemotherapy or immunosuppressants. The possible mechanisms for the development of PCP are discussed.
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Affiliation(s)
- Ryohei Kudoh
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, JPN
| | - Ryuichiro Takaki
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Atsushi Yokoyama
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, JPN
| | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
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12
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Tomacinschii V, Mosquera Orgueira A, Santos CA, Robu M, Buruiana S, Fraga Rodriguez MF. The implication of next-generation sequencing in the diagnosis and clinical management of non-Hodgkin lymphomas. Front Oncol 2023; 13:1275327. [PMID: 38023160 PMCID: PMC10663367 DOI: 10.3389/fonc.2023.1275327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Next generation sequencing (NGS) is a technology that broadens the horizon of knowledge of several somatic pathologies, especially in oncological and oncohematological pathology. In the case of NHL, the understanding of the mechanisms of tumorigenesis, tumor proliferation and the identification of genetic markers specific to different lymphoma subtypes led to more accurate classification and diagnosis. Similarly, the data obtained through NGS allowed the identification of recurrent somatic mutations that can serve as therapeutic targets that can be inhibited and thus reducing the rate of resistant cases. The article's purpose is to offer a comprehensive overview of the best ways of integrating of next-generation sequencing technologies for diagnosis, prognosis, classification, and selection of optimal therapy from the perspective of tailor-made medicine.
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Affiliation(s)
- Victor Tomacinschii
- Department of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
- Department of Hematology, Public Medical Sanitary Institution (PMSI) Institute of Oncology, Chisinau, Moldova
| | - Adrian Mosquera Orgueira
- University Hospital of Santiago de Compostela, Servizo Galego de Saude (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Aliste Santos
- University Hospital of Santiago de Compostela, Servizo Galego de Saude (SERGAS), Santiago de Compostela, Spain
| | - Maria Robu
- Department of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Sanda Buruiana
- Department of Hematology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Maximo Francisco Fraga Rodriguez
- University Hospital of Santiago de Compostela, Servizo Galego de Saude (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Forensic Sciences, Pathology, Ginecology and Obstetrics and Pediatrics, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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13
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Baykal C, Polat Ekinci A. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:692-711. [PMID: 37586571 DOI: 10.1016/j.clindermatol.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Determining the shape of a skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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14
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Roenneberg S, Braun SA, Garzorz-Stark N, Stark SP, Muresan AM, Schmidle P, Biedermann T, Guenova E, Eyerich K. Histology-based classifier to distinguish early mycosis fungoides from atopic dermatitis. J Eur Acad Dermatol Venereol 2023; 37:2284-2292. [PMID: 37422709 DOI: 10.1111/jdv.19325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Histopathological differentiation of early mycosis fungoides (MF) from benign chronic inflammatory dermatoses remains difficult and often impossible, despite the inclusion of all available diagnostic parameters. OBJECTIVE To identify the most impactful histological criteria for a predictive diagnostic model to discriminate MF from atopic dermatitis (AD). METHODS In this multicentre study, two cohorts of patients with either unequivocal AD or MF were evaluated by two independent dermatopathologists. Based on 32 histological attributes, a hypothesis-free prediction model was developed and validated on an independent patient's cohort. RESULTS A reduced set of two histological features (presence of atypical lymphocytes in either epidermis or dermis) was trained. In an independent validation cohort, this model showed high predictive power (95% sensitivity and 100% specificity) to differentiate MF from AD and robustness against inter-individual investigator differences. LIMITATIONS The study investigated a limited number of cases and the classifier is based on subjectively evaluated histological criteria. CONCLUSION Aiming at distinguishing early MF from AD, the proposed binary classifier performed well in an independent cohort and across observers. Combining this histological classifier with immunohistochemical and/or molecular techniques (such as clonality analysis or molecular classifiers) could further promote differentiation of early MF and AD.
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Affiliation(s)
- Sophie Roenneberg
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Stephan Alexander Braun
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Natalie Garzorz-Stark
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Unit of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Sebastian Paul Stark
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Ana-Maria Muresan
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Paul Schmidle
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Emmanuella Guenova
- Dermatology Department, University Hospital Zurich and Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kilian Eyerich
- Department of Dermatology and Venerology, Medical Center, University of Freiburg, Freiburg, Germany
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15
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Bachy E, Savage KJ, Huang H, Kwong YL, Gritti G, Zhang Q, Liberati AM, Cao J, Yang H, Hao S, Hu J, Zhou K, Petrini M, Russo F, Zhang H, Sang W, Ji J, Ferreri AJM, Damaj GL, Liu H, Zhang W, Ke X, Ghiggi C, Huang S, Li X, Yao H, Paik J, Novotny W, Zhou W, Zhu H, Zinzani PL. Treating relapsed/refractory mature T- and NK-cell neoplasms with tislelizumab: a multicenter open-label phase 2 study. Blood Adv 2023; 7:4435-4447. [PMID: 37276067 PMCID: PMC10440460 DOI: 10.1182/bloodadvances.2022009575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023] Open
Abstract
Patients with relapsed/refractory (R/R) mature T- and natural killer (NK)-cell neoplasms lack effective treatments after failure of standard therapies. This phase 2 study evaluated the efficacy and safety of the programmed cell death protein 1 inhibitor tislelizumab in these patients. Seventy-seven patients were treated with 200 mg tislelizumab every 3 weeks. Twenty-two patients with extranodal NK-/T-cell lymphomas were enrolled in cohort 1; 44 patients with peripheral T-cell lymphoma (PTCL) were enrolled in cohort 2 (21 patients had PTCL not otherwise specified, 11 patients had angioimmunoblastic T-cell lymphoma, and 12 patients had anaplastic large-cell lymphoma). Cohort 3 comprised 11 patients with cutaneous T-cell lymphoma, of which 8 patients had mycosis fungoides (MF) and 3 had Sézary syndrome. Of the 77 patients, 76.6% had advanced-stage disease, 51.9% had refractory disease, and 49.4% received ≥3 prior systemic regimens. Promising efficacy was observed in cohort 3 (median follow-up [FU], 16.6 months; overall response rate [ORR], 45.5%; complete response [CR], 9.1%; median duration of response [DOR], 11.3 months; median progression-free survival, 16.8 months; median overall survival, not reached). Modest efficacy was observed in cohort 1 (median FU, 8.4 months; ORR, 31.8%; CR, 18.2%; median DOR, not reached) and cohort 2 (median FU, 9.3 months; ORR, 20.5%; CR, 9.1%; median DOR, 8.2 months). Most treatment-related adverse events were grade 1 or 2, and the safety profile was consistent with the known safety profile of tislelizumab. In conclusion, tislelizumab was well tolerated, achieving modest efficacy in R/R mature T- and NK-cell neoplasms, with some long-lasting remissions. This trial was registered at www.clinicaltrials.gov as #NCT03493451.
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Affiliation(s)
- Emmanuel Bachy
- Hematology Department, Lyon Sud Hospital and Claude Bernard Lyon 1 University, Lyon, France
| | - Kerry J. Savage
- Division of Medical Oncology, University of British Columbia, BC Cancer, Vancouver, Canada
| | | | | | | | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | | | - Junning Cao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Haiyan Yang
- The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Siguo Hao
- Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianda Hu
- Fujian Medical University Union Hospital, Fujian Institute of Hematology, Fuzhou, China
| | - Keshu Zhou
- Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Mario Petrini
- Azienda Ospedaliero Universitaria Pisana, Stabilimento di Santa Chiara, Pisa, Italy
| | - Filomena Russo
- Ospedale Maggiore, Ematologia e Centro Trapianti Midollo Osseo (CTMO), AOU Parma, Parma, Italy
| | - Huilai Zhang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wei Sang
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Ji
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Hui Liu
- Beijing Hospital, Beijing, China
| | - Wei Zhang
- Peking Union Medical College Hospital, Beijing, China
| | - Xiaoyan Ke
- Peking University Third Hospital, Beijing, China
| | | | - Sha Huang
- BeiGene (Shanghai) Co Ltd, Shanghai, China
| | | | - Hui Yao
- BeiGene (Shanghai) Co Ltd, Shanghai, China
| | | | | | | | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
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16
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Sun J, You R, Lyu B, Li X, Gao Y, Wen Y, Qu C, Wang Y. HLA-DR Helps to Differentiate Erythrodermic Cutaneous T-cell Lymphoma from Erythrodermic Inflammatory Dermatoses in Flow Cytometry. Acta Derm Venereol 2023; 103:adv5668. [PMID: 37526291 PMCID: PMC10413871 DOI: 10.2340/actadv.v103.5668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/17/2023] [Indexed: 08/02/2023] Open
Abstract
Differential diagnosis of erythroderma is challenging in dermatology, especially in differentiating erythrodermic cutaneous T-cell lymphoma from erythrodermic inflammatory dermatoses. This study retrospectively reviewed the peripheral blood flow cytometric results of 73 patients diagnosed with erythroderma at Peking University First Hospital from 2014 to 2019. The flow cytometry antibody panel included white blood cell markers, T-cell markers, B-cell markers, T-cell activation markers, and T helper cell differentiation markers. Features of the cell surface antigens were compared between 34 patients with erythrodermic cutaneous T-cell lymphoma and 39 patients with erythrodermic inflammatory dermatoses. The percentage of HLA-DR+/CD4+T cells was the most pronounced marker to distinguish erythrodermic cutaneous T-cell lymphoma from erythrodermic inflammatory dermatoses, with a threshold of 20.85% (sensitivity 96.77%, specificity 70.37%, p = 0.000, area under the curve (AUC) 0.882), suggesting its potential capability in the differential diagnosis of erythrodermic cutaneous T-cell lymphoma from erythrodermic inflammatory dermatoses. Moreover, in contrast to erythrodermic inflammatory dermatoses, the percentage of Th17 cells was significantly downregulated in erythrodermic cutaneous T-cell lymphoma (p = 0.001), demonstrating a dysregulated immune environment in erythrodermic cutaneous T-cell lymphoma.
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Affiliation(s)
- Jingru Sun
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
| | - Ran You
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China
| | - Beini Lyu
- Peking University Institute for Global Health and Development, Beijing, China
| | - Xueying Li
- Department of Biostatistics, Peking University First Hospital, Beijing 100034, China
| | - Yumei Gao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
| | - Yujie Wen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China
| | - Chenxue Qu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China.
| | - Yang Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing 100034, China.
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17
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Lama CM, Hernandez-Rovira MA, Mehta-Shah N, Russell A, Musiek AC. Refractory mogamulizumab-associated rash responding to an oral Janus kinase inhibitor. JAAD Case Rep 2023; 38:64-67. [PMID: 37600742 PMCID: PMC10433291 DOI: 10.1016/j.jdcr.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Carine M. Lama
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Aaron Russell
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Amy C.M. Musiek
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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18
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Mirmovich Morvay O, Ramon M, Khamaysi Z, Avitan-Hersh E. Paediatric Mycosis Fungoides: Clinical Variants, Treatment Modalities and Response to Therapy. Acta Derm Venereol 2023; 103:adv6557. [PMID: 37449370 PMCID: PMC10391534 DOI: 10.2340/actadv.v103.6557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/28/2023] [Indexed: 07/18/2023] Open
Abstract
Mycosis fungoides is a rare cutaneous lymphoma in the paediatric population. The aim of this study was to examine the epidemiological, clinical, and histological characteristics, as well as the treatment modalities and response to therapy of paediatric patients with mycosis fungoides. This retrospective cohort study reviewed the records of 37 paediatric patients treated at Rambam Medical Center, Israel, between 2013 and 2021. Extracted data included epidemiology, clinical presentation, histological reports, infiltrate clonality status, treatment modalities and response to therapy. The mean follow-up period was 60 months. All patients were diagnosed with stage IA or IB disease. Folliculotropic mycosis fungoides was the most prevalent variant (49%). Most patients were treated with phototherapy (90%), with a response rate of 85%, and a complete response rate of 55% after the first course. There were no significant differences in response to phototherapy between the folliculotropic or other variants (p = 0.072). Similarly, delayed diagnosis, atopic diathesis, clonality, phototherapy type or number of treatments, were not associated with response to therapy, while protracted phototherapy was associated with prolonged remission. In conclusion, mycosis fungoides in the paediatric population is an indolent disease with a favourable prognosis and potentially prolonged response to phototherapy.
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Affiliation(s)
| | - Michal Ramon
- Department of dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Ziad Khamaysi
- Department of dermatology, Rambam Health Care Campus, Haifa, Israel
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19
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Wilkinson AJ, Nader ME, Roberts D, Duvic M, Gunther JR, Dabaja BS, Gidley PW. Survival Outcomes of Patients with Mycosis Fungoides Involving the External Ear and Ear Canal. Laryngoscope 2023; 133:1486-1491. [PMID: 36054317 PMCID: PMC9971327 DOI: 10.1002/lary.30377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Mycosis Fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma. Disease involvement of specific locations may be more significant than simply the symptoms associated with that site; it is possible that involvement of certain sites could be associated with poor prognosis. We aimed to evaluate the outcomes of patients with MF with documented involvement of the EAC and external ear. STUDY DESIGN Retrospective analysis. METHODS We retrospectively reviewed 40 patients with MF that were treated by otologists between 2012 and 2021. RESULTS We report the largest series of patients with MF involving the external ear and EAC. Of the 40 patients included in this study, 17 presented with Mycosis Fungoides in the otologic region (MFO). Of these 17 MFO patients, 2/17 had involvement of the external ear only, 3/17 of the EAC only, 11/17 of both the external ear and EAC, and 1/17 of the periauricular skin. Of note, 11/14 (79%) patients presenting with EAC disease died compared to11/26 (42%) of patients without involvement. In addition, eight of the 13 (62%) patients with external ear involvement died compared to 14/27 (52%) of patients without involvement. Ear canal involvement was associated with a statistically significant shorter overall survival duration in patients with MF (p = 0.03). Furthermore, disease in the EAC was found to have a hazard ratio value of 2.565 (CI 1.102-5.970). CONCLUSIONS Involvement of the EAC by MF portends a poor prognosis. This finding highlights the need for a more in-depth otologic evaluation of patients with MF. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1486-1491, 2023.
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Affiliation(s)
| | - Marc-Elie Nader
- Department of Head and Neck Surgery, MD Anderson Cancer Center
| | - Dianna Roberts
- Department of Head and Neck Surgery, MD Anderson Cancer Center
| | | | | | | | - Paul W Gidley
- Department of Head and Neck Surgery, MD Anderson Cancer Center
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20
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Baykal C, Ekinci AP. Annular skin tumors and lymphoproliferative diseases. Clin Dermatol 2023; 41:382-395. [PMID: 37421997 DOI: 10.1016/j.clindermatol.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Determining the shape of the skin lesion may provide a diagnostic clue in dermatology practice, more commonly for inflammatory diseases but also for skin tumors. The annular formation may develop by diverse mechanisms in skin tumors. Annular lesions may occur from the onset of the tumor as sparing the central area or depression and/or ulceration in the center of the tumor or outward expansion of the primary lesion. Clustering of multiple papulonodular lesions sparing the central area or relatively independent processes acting on the central and peripheral components of the tumor may also result in an annular appearance. We have explored a wide variety of benign and malignant skin tumors and lymphoproliferative diseases forming an annular shape.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Algün Polat Ekinci
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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21
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An update on genetic aberrations in T-cell neoplasms. Pathology 2023; 55:287-301. [PMID: 36801152 DOI: 10.1016/j.pathol.2022.12.350] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
T-cell neoplasms are a highly heterogeneous group of leukaemias and lymphomas that represent 10-15% of all lymphoid neoplasms. Traditionally, our understanding of T-cell leukaemias and lymphomas has lagged behind that of B-cell neoplasms, in part due to their rarity. However, recent advances in our understanding of T-cell differentiation, based on gene expression and mutation profiling and other high throughput methods, have better elucidated the pathogenetic mechanisms of T-cell leukaemias and lymphomas. In this review, we provide an overview of many of the molecular abnormalities that occur in various types of T-cell leukaemia and lymphoma. Much of this knowledge has been used to refine diagnostic criteria that has been included in the fifth edition of the World Health Organization. This knowledge is also being used to improve prognostication and identify novel therapeutic targets, and we expect this progress will continue, eventually resulting in improved outcomes for patients with T-cell leukaemias and lymphomas.
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22
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Beylot-Barry M, Booken N, Weishaupt C, Scarisbrick J, Wu W, Rosen JP, Medley MC. Impact of blood involvement on efficacy and time to response with mogamulizumab in mycosis fungoides and Sézary syndrome. J Eur Acad Dermatol Venereol 2023; 37:311-316. [PMID: 35993803 PMCID: PMC10087984 DOI: 10.1111/jdv.18549] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/05/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCL) are rare types of non-Hodgkin lymphoma, which present in skin. Mycosis fungoides (MF) and Sézary syndrome (SS) are subtypes which make up two-thirds of all CTCL cases. The phase 3 MAVORIC study (NCT01728805) compared mogamulizumab to vorinostat in MF and SS patients, with post hoc data showing a trend for higher efficacy in mogamulizumab-treated patients as baseline blood tumour burden increases. OBJECTIVES The aim of this study was to use updated post hoc analyses in order to examine the efficacy of mogamulizumab and vorinostat in MF patients when stratified by baseline blood involvement and to determine what factors affect time-to-global and time-to-skin response to inform clinical follow-up. METHODS Post hoc analyses were carried out using data from MAVORIC. Overall response rate (ORR), progression-free survival (PFS) and time-to-next-treatment (TTNT) data were used to assess efficacy in patients with MF. Time-to-global response (TTR) was examined by disease subtype, by blood involvement in MF patients, and time-to-skin response was examined by blood involvement in MF patients. RESULTS Numerically superior results were seen for ORR, PFS and TTNT in mogamulizumab-treated patients with MF compared with vorinostat, with a trend for outcomes improving with increasing baseline blood class. Statistically significant results for mogamulizumab compared with vorinostat were seen for MF B1 pts for PFS (8.43 vs. 2.83 months, p = 0.003) and TTNT (11.9 vs. 3.13 months, p = 0.002), and for MF B2 pts for ORR (46.2 vs. 9.1 months, p = 0.033). CONCLUSIONS In mogamulizumab-treated MF patients, ORR and PFS were seen to improve with increasing blood involvement, which led to improved TTNT. TTR was more predictable for mogamulizumab-treated MF patients with blood involvement, and skin response may take longer than previously reported in some patients.
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Affiliation(s)
- Marie Beylot-Barry
- University of Bordeaux, UMR 1312 INSERM, Bordeaux, France.,Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - Nina Booken
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Weishaupt
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | | | - Wende Wu
- Kyowa Kirin, Inc, Princeton, New Jersey, USA
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23
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Paraffin gauze bolus as tissue compensator in photon irradiation for mycosis fungoides – regarding a case study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396923000109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Abstract
Introduction:
Total skin electron beam therapy is a treatment option in patients with mycosis fungoides (MF) affecting a significant amount of the body surface. For patients with involvement of soles and interdigital folds, however, this approach is ineffective, requiring alternatives such as localised radiotherapy (RT). Although electron beams are well suited for superficial lesions, on irregular surfaces it provides inadequate tumour coverage and excess dose variance, requiring photon irradiation with tissue compensation.
Methods:
We present the case of a patient with extensive cutaneous MF with skin lesions spread over both lower limbs and treated on these affected areas with photon beam RT. Long sheets of paraffin gauze dressings were used to create a 0·5-cm-thick bolus. The patient received a single fraction of 8 Gy. In vivo dosimetry using Gafchromic films was performed.
Results:
After 3 months, a complete response was achieved. In this case, paraffin gauze bolus proved to be an inexpensive, convenient, effective and flexible method for irregular superficial cancer irradiations.
Conclusion:
Paraffin gauze bolus is a suitable option for irregular contours.
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Miyashiro D, Sanches JA. Mycosis fungoides and Sézary syndrome: clinical presentation, diagnosis, staging, and therapeutic management. Front Oncol 2023; 13:1141108. [PMID: 37124514 PMCID: PMC10140754 DOI: 10.3389/fonc.2023.1141108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are cutaneous T-cell lymphomas. MF is the most common cutaneous lymphoma, and it is classified into classic Alibert-Bazin MF, folliculotropic MF, pagetoid reticulosis, and granulomatous slack skin, each with characteristic clinical presentation, histopathological findings, and distinct clinical behaviors. SS is an aggressive leukemic variant of cutaneous lymphoma, and it is characterized by erythroderma, lymphadenopathy, and peripheral blood involvement by malignant cells. There is a wide range of dermatological manifestations of MF/SS, and prompt recognition is essential for early diagnosis. Skin biopsy for histopathology and immunohistochemical analysis is imperative to confirm the diagnosis of MF/SS. Histopathology may also provide information that may influence prognosis and treatment. Staging follows the TNMB system. Besides advanced stage, other factors associated with poorer prognosis are advanced age, male gender, folliculotropism in histopathology of patients with infiltrated plaques and tumors in the head and neck region, large cell transformation, and elevated lactate dehydrogenase. Treatment is divided into skin-directed therapies (topical treatments, phototherapy, radiotherapy), and systemic therapies (biological response modifiers, targeted therapies, chemotherapy). Allogeneic bone marrow transplantation and extracorporeal photopheresis are other treatment modalities used in selected cases. This review discusses the main clinical characteristics, the histopathological/immunohistochemical findings, the staging system, and the therapeutic management of MF/SS.
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Muacevic A, Adler JR, Desai SR, Chen PL, Seminario-Vidal L. Perspectives on and Quality of Life in Skin of Color Patients With Mycosis Fungoides/Sézary Syndrome: A Qualitative Analysis. Cureus 2023; 15:e34054. [PMID: 36824562 PMCID: PMC9941020 DOI: 10.7759/cureus.34054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/22/2023] [Indexed: 01/23/2023] Open
Abstract
Background Prior quantitative studies have described the diminished health-related quality of life (HRQoL) faced by the overall mycosis fungoides (MF)/Sézary syndrome (SS) population; yet, little is known about how the disease affects HRQoL in skin of color (SOC) patients. This qualitative study sought to explore the lived experiences of SOC patients with MF/SS and gain deeper insights into the impact the disease has on various facets of HRQoL. Methodology Interviews with SOC patients with MF/SS ≥18 were recruited from a cutaneous lymphoma clinic. A thematic analysis was performed to identify overarching themes. Results Ten patients were invited to participate from July to September 2021. One patient with SS and seven patients with MF (four in the early stage and four in the advanced stage), with a median age of 60.5 years, agreed to participate. Emerging themes included diagnostic and therapeutic delays frequently due to initial misdiagnoses with other skin conditions. Physical and functional burdens significantly hindered participants' abilities to carry out daily responsibilities and maintain employment, and impacts on physical appearance (e.g., darkened skin) led to increased self-consciousness and lack of social acceptance. Participants regarded family and faith as main sources of support in addition to developing healthy coping strategies, such as self-acceptance and adaptability. All participants reported feeling satisfied with their access to healthcare information and the quality of care received. Conclusions Our findings provide greater insights into how HRQoL is impacted across SOC patients with MF/SS, which can help raise awareness among healthcare providers and assist with creating interdisciplinary healthcare approaches to better support the needs of this population.
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Hodak E, Geskin L, Guenova E, Ortiz-Romero PL, Willemze R, Zheng J, Cowan R, Foss F, Mangas C, Querfeld C. Real-Life Barriers to Diagnosis of Early Mycosis Fungoides: An International Expert Panel Discussion. Am J Clin Dermatol 2023; 24:5-14. [PMID: 36399227 PMCID: PMC9673193 DOI: 10.1007/s40257-022-00732-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/19/2022]
Abstract
Mycosis fungoides (MF) is a rare, primary cutaneous T-cell lymphoma that is challenging to diagnose due to its heterogeneous clinical presentation and complex histology. The subtlety of the initial clinical appearance of MF can result in diagnostic delays and hesitancy to refer suspected cases to specialist clinics. An unmet need remains for greater awareness and education. Therefore, an international expert panel of dermatologists, oncologists, hematologists, and dermatopathologists convened to discuss and identify barriers to early and accurate MF diagnosis that could guide clinicians toward making a correct diagnosis. Confirmation of MF requires accurate assessment of symptoms and clinical signs, and subsequent correlation with dermatopathological findings. This review summarizes the expert panel's guidance, based on the literature and real-life experience, for dermatologists to help include MF in their list of differential diagnoses, along with simple clinical and histopathologic checklists that may help clinicians to suspect and identify potential MF lesions and reduce diagnostic delays.
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Affiliation(s)
- Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Tel Aviv University, 39 Jabotinsky Street, Petah Tiqva, 49100, Tel Aviv, Israel.
| | - Larisa Geskin
- Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Emmanuella Guenova
- University Hospital Lausanne (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Institute i+12, CIBERONC, Medical School, University Complutense, Madrid, Spain
| | - Rein Willemze
- Leiden University Medical Center, Leiden, The Netherlands
| | - Jie Zheng
- Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Richard Cowan
- Christie Hospital, The Christie School of Oncology, Manchester, UK
| | - Francine Foss
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Cristina Mangas
- Dermatology Department and Institute of Oncology of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Christiane Querfeld
- Division of Dermatology and Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
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Oral involvement of cutaneous T-cell lymphoma: A rare entity. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:e102-e107. [PMID: 36641326 DOI: 10.1016/j.oooo.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Mycosis fungoides (MF) is a rare cutaneous T-cell lymphoma (CTCL) with significant morbidity and mortality rates. Involvement of MF in the oral cavity is uncommon, often follows cutaneous involvement, and is usually associated with a poor prognosis. Herein, we describe a case of a 72-year-old White male with biopsy-proven oral T-cell lymphoma (TCL) in the setting of MF with systemic disease progression. Mycosis fungoides with oral involvement can often prove challenging to diagnose and manage. Thorough medical history intake and clinical examination supported by histopathologic and immunohistochemical analysis are imperative because delay in the diagnosis can lead to disease progression.
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Jfri A, Smith JS, Larocca C. Diagnosis of mycosis fungoides or Sézary syndrome after dupilumab use: A systematic review. J Am Acad Dermatol 2022; 88:1164-1166. [PMID: 36481378 DOI: 10.1016/j.jaad.2022.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Abdulhadi Jfri
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Jeffrey S Smith
- Harvard Medical School, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Dermatology Program, Boston Children's Hospital, Boston, Massachusetts; Division of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Cecilia Larocca
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Dana-Farber Cancer Institute, Boston, Massachusetts.
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Rodrigues-Fernandes CI, Vargas PA, de Aquino IG, Lopes MA, Santos-Silva AR. Sézary syndrome: Report of a rare case with perioral manifestation and review of the literature. Oral Oncol 2022; 134:106134. [PMID: 36183500 DOI: 10.1016/j.oraloncology.2022.106134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/09/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022]
Abstract
This report aimed to describe a rare case of Sézary syndrome (SS) diagnosed in an Oral Medicine service. A 54-year-old female presented a generalized pruritus and erythema of the skin of 2 years in duration, which had been treated with antihistamines, corticosteroids, and hydrating creams, without resolution. Extra-oral examination showed a painful lymphadenopathy on the right supraclavicular region. Ultrasound-guided fine-needle aspirationbiopsy did not detect any abnormalities. The patient's skin was remarkably dry and thickened, with erythroderma, fissures, and ulcerations. The perioral region exhibited extreme peeling and angular cheilitis. Immunophenotyping of peripheral blood revealed proliferation of undifferentiated T-cells and a massive proportion of TCD4+ cells relative to TCD8+ cells. PET/CT examination demonstrated multiple lymphadenopathies, and bone marrow biopsy was negative for neoplastic cell infiltration. A diagnosis of SS was established, and the patient is currently being treated with UVB phototherapy, methotrexate, doxepin, and folic acid, with mostly complete regression of signs and symptoms.
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Affiliation(s)
- Carla Isabelly Rodrigues-Fernandes
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil; Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Iara Gonçalves de Aquino
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Feng J, Xu H, Cinquina A, Wu Z, Zhang W, Sun L, Chen Q, Tian L, Song L, Pinz KG, Wada M, Jiang X, Hanes WM, Ma Y, Zhang H. Treatment of aggressive T-cell lymphoma/leukemia with anti-CD4 CAR T cells. Front Immunol 2022; 13:997482. [PMID: 36172388 PMCID: PMC9511023 DOI: 10.3389/fimmu.2022.997482] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
T-cell lymphomas are aggressive lymphomas that often resist current therapy options or present with relapsed disease, making the development of more effective treatment regimens clinically important. Previously, we have shown that CD4 CAR can effectively target T-cell malignancies in preclinical studies. As IL-15 has been shown to strengthen the anti-tumor response, we have modified CD4 CAR to secrete an IL-15/IL-15sushi complex. These CD4-IL15/IL15sushi CAR T cells and NK92 cells efficiently eliminated CD4+ leukemic cell lines in co-culture assays. Additionally, CD4-IL15/IL15sushi CAR out-performed CD4 CAR in in vivo models, demonstrating a benefit to IL-15/IL-15sushi inclusion. In a Phase I clinical trial, CD4-IL15/IL15sushi CAR T cells were tested for safety in three patients with different T-cell lymphomas. Infusion of CD4-IL15/IL15sushi CAR T cells was well-tolerated by the patients without significant adverse effects and led to the remission of their lymphomas. Additionally, infusion led to the depletion of CD4+ Treg cells and expansion of CD3+CD8+ T cells and NK cells. These results suggest that CD4-IL15/IL15sushi CAR T cells may be a safe and effective treatment for patients with relapsed or refractory T-cell lymphomas, where new treatment options are needed.
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Affiliation(s)
- Jia Feng
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Haichan Xu
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Andrew Cinquina
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, Stony Brook, NY, United States
| | - Zehua Wu
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Wenli Zhang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lihua Sun
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qi Chen
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lei Tian
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, China
| | - Kevin G. Pinz
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, Stony Brook, NY, United States
| | - Masayuki Wada
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, Stony Brook, NY, United States
| | - Xun Jiang
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, Stony Brook, NY, United States
| | - William M. Hanes
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, Stony Brook, NY, United States
| | - Yupo Ma
- iCell Gene Therapeutics LLC, Research & Development Division, Long Island High Technology Incubator, Stony Brook, NY, United States
- *Correspondence: Hongyu Zhang, ; Yupo Ma,
| | - Hongyu Zhang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Hongyu Zhang, ; Yupo Ma,
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Cutaneous Involvement of Extranodal NK/T Cell Lymphoma, Nasal Type, a Clinical and Histopathological Mimicker of Various Skin Diseases. Dermatopathology (Basel) 2022; 9:307-320. [PMID: 36135102 PMCID: PMC9497790 DOI: 10.3390/dermatopathology9030037] [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: 04/08/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Extranodal NK/T cell lymphoma, nasal type (ENK/T) with cutaneous involvement has various histopathological findings and diverse clinical manifestations. Methods: A retrospective study of cutaneous involvement of ENK/T lymphoma between 2006 and 2018 was conducted. Results: Twenty-two cases were eligible for this study. Twelve cases could be proven as secondary cutaneous involvement by ENK/T lymphoma, while the remaining could not be confirmed as primary cutaneous ENK/T lymphoma. The histopathological patterns included dermal and subcutaneous nodular infiltration pattern in 11/22 cases (50%), lobular panniculitis pattern in 6/22 cases (27.3%), interface dermatitis pattern in 4/22 cases (18.2%), and granulomatous dermatitis pattern in 1/22 case (4.5%). The median follow-up was 18.3 months. Overall, the one-year and five-year survival rates were 31.3% and 13.3%, respectively. Conclusions: A variety of histopathological patterns of cutaneous involvement by ENK/T lymphoma should be differentiated from other cutaneous lymphomas, dermatitis, and infection. When atypical medium or large-sized lymphoid cells are encountered within skin lesions, pathologists should realize these lesions can be ENK/T lymphoma, especially in cases with coexisting tumor necrosis or angioinvasion. A complete evaluation of the upper aerodigestive tract is mandatory to identify the occult primary site of ENK/T lymphoma before establishing primary cutaneous ENK/T lymphoma.
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Yu S, Zhang J, Ding Y, Kang X, Pu X. Genome-wide identification of alternative splicing associated with histone deacetylase inhibitor in cutaneous T-cell lymphomas. Front Genet 2022; 13:937623. [PMID: 36147491 PMCID: PMC9485882 DOI: 10.3389/fgene.2022.937623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a kind of non-Hodgkin lymphoma that originates from skin, which is difficult to treat with traditional drugs. Human histone deacetylase inhibitors (HDACi) targeted therapy has become a promising treatment strategy in recent years, but some patients can develop resistance to the drug, leading to treatment failure. There are no public reports on whether alternative splicing (AS) and RNA binding proteins (RBP) affect the efficacy of targeted therapy. Using data from the Gene Expression Omnibus (GEO) database, we established a co-change network of AS events and RBP in CTCLs for the first time, and analyzed the potential regulatory effects of RBP on HDACi-related AS events. The dataset GSE132053, which contained the RNA sequence data for 17 HDACi samples, was downloaded and clean reads were aligned to the human GRCh38 genome by hierarchical indexing for spliced alignment of the transcripts, allowing four mismatches. Gene expression levels were evaluated using exons per million fragments mapped for each gene. Student’s t-tests were performed to evaluate the significance of changes in ratios for AS events, and regulated alternative splicing events (RASEs) were defined as events with p values less than 0.05. To sort the differentially expressed genes functional categories, Gene Ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways were identified using the KOBAS 2.0 server. The regulatory mechanisms of the RASEs and RBPs were evaluated using Pearson’s correlation coefficient. Seven indirect events of HDACi resistance or sensitivity were identified: NIR_5151_RP11-977G19.10, NIR_4557_IRAG2, NIR_11870_SUMO1, NIR_5347_ING4, NIR_17935_DNAJC2, NIR_17974_CBLL1, and NIR_422_SLC50A1. The potential regulatory relationships between RBPs and HDACi-sensitive RASEs were also analyzed. LEPR and HNRNPAO significantly affected NIR_11870_SUMO1, suggesting a potential regulatory relationship. Additionally, CNN1 may regulate NIR_5347_ING4, CNOT3 may regulate NIR_17935_DNAJC2, and DQX1 and LENG9 may regulate NIR_422_SLC5A1. Overall, our findings establish a theoretical foundation for the precise targeted treatment of CTCLs with HDACi.
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Affiliation(s)
- Shirong Yu
- Xinjiang Medical University, Urumqi, China
| | | | - Yuan Ding
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, China
- Xinjiang Key Laboratory of Dermatology Research, Urumqi, China
| | - Xiaojing Kang
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, China
- Xinjiang Key Laboratory of Dermatology Research, Urumqi, China
| | - Xiongming Pu
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Dermatologic Diseases, Urumqi, China
- Xinjiang Key Laboratory of Dermatology Research, Urumqi, China
- *Correspondence: Xiongming Pu,
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Inpatient Considerations in the Diagnosis and Management of the Cutaneous T-Cell Lymphoma Patient. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00367-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Parsons MW, Wada DA, Halwani AS, Tao R, Gaffney DK. Improved overall survival over time in advanced stage mycosis fungoides: a cross-sectional study. Leuk Lymphoma 2022; 63:2428-2435. [DOI: 10.1080/10428194.2022.2081322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Matthew W. Parsons
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David A. Wada
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Ahmad S. Halwani
- Division of Hematology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David K. Gaffney
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
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Chen YW, Yang HZ, Zhao SS, Zhang Z, Chen ZM, Feng HH, An MH, Wang KK, Duan R, Chen BD. Ultrasound-guided microwave ablation as a palliative treatment for mycosis fungoides eyelid involvement: A case report. World J Clin Cases 2022; 10:5825-5832. [PMID: 35979116 PMCID: PMC9258385 DOI: 10.12998/wjcc.v10.i17.5825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/11/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is a form of lymphoma derived from heterogeneous T cells, and eyelid involvement is extremely rare. The common methods to treat eyelid involvement are radiotherapy and chemotherapy, but their efficacies are limited. Herein, we report a case of advanced-stage MF eyelid involvement, propose ultrasound (US)-guided microwave ablation (MWA) therapy and present a literature review.
CASE SUMMARY A male patient was admitted to our hospital in June 2018 and diagnosed with MF via radiological and histopathological examinations. The patient’s condition was not well controlled by various conventional chemotherapies. US-guided MWA was performed to relieve the patient’s symptoms and improve his quality of life, showing satisfactory efficacy.
CONCLUSION Eyelid involvement is one of the most troublesome clinical problems for advanced-stage MF patients. This is the first report on the use of US-guided MWA as a palliative therapy for MF eyelid involvement; the treatment successfully relieved the patient’s clinical symptoms and reduced his anxiety behaviours. Our study sheds new light on methods for improving the clinical management of eyelid involvement in MF.
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Affiliation(s)
- Yan-Wei Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Hai-Zhen Yang
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Shuang-Shuang Zhao
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Zheng Zhang
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Zhe-Ming Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Hua-Hui Feng
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Mao-Hui An
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Ke-Ke Wang
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Ran Duan
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Bao-Ding Chen
- Department of Medical Ultrasound, The Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
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36
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Photodynamic therapy in the treatment of patients with mycosis fungoides. BIOMEDICAL PHOTONICS 2022. [DOI: 10.24931/2413-9432-2022-11-1-27-36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The review highlights the current understanding of the epidemiology, etiology, pathogenesis, existing classifications of mycosis fungoides. Methods for diagnosis and treatment of the pathology are described, among which photodynamic therapy (PDT) plays an important role. The main advantages of PDT for mycosis fungoides include the absence of systemic toxicity, non-invasiveness, selectivity, absence of carcinogenic potential, the possibility of repeated courses of treatment, and good cosmetic results. This review collects and analyzes the results of clinical trials of PDT in patients with mycosis fungoides. The analysis showed high efficiency of PDT in patients with mycosis fungoides with isolated or limited spots and plaques. PDT can be considered as the therapy of choice in patients with facial lesions when a good cosmetic result is one of the main requirements, and radiation therapy, nitrogen mustard or carmustine can leave permanent and visible scars. Plaques located in the axillary or inguinal skin folds that are inaccessible to phototherapy can also be treated with PDT.
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37
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Photodynamic therapy in the treatment of patients with mycosis fungoides. BIOMEDICAL PHOTONICS 2022. [DOI: 10.24931/2413-9432-2022-11-1-27-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The review highlights the current understanding of the epidemiology, etiology, pathogenesis, existing classifications of mycosis fungoides. Methods for diagnosis and treatment of the pathology are described, among which photodynamic therapy (PDT) plays an important role. The main advantages of PDT for mycosis fungoides include the absence of systemic toxicity, non-invasiveness, selectivity, absence of carcinogenic potential, the possibility of repeated courses of treatment, and good cosmetic results. This review collects and analyzes the results of clinical trials of PDT in patients with mycosis fungoides. The analysis showed high efficiency of PDT in patients with mycosis fungoides with isolated or limited spots and plaques. PDT can be considered as the therapy of choice in patients with facial lesions when a good cosmetic result is one of the main requirements, and radiation therapy, nitrogen mustard or carmustine can leave permanent and visible scars. Plaques located in the axillary or inguinal skin folds that are inaccessible to phototherapy can also be treated with PDT.
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Chen C, Liu Z, Liu J, Zhang W, Zhou D, Zhang Y. Case Report: Outcome and Adverse Events of Anti-PD-1 Antibody Plus Chidamide for Relapsed/Refractory Sézary Syndrome: Case Series and A Literature Review. Front Oncol 2022; 12:842123. [PMID: 35387123 PMCID: PMC8977601 DOI: 10.3389/fonc.2022.842123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Sézary syndrome (SS) is an aggressive leukemic variant of cutaneous T-cell lymphoma with a poor prognosis and survival rate. Existing therapies for relapsed/refractory (R/R) SS have a low response rate with a short duration time. Herein, we presented three cases of R/R SS treated with the anti-PD-1 antibody and chidamide. Case 1 and case 2 showed the potential efficacy of this combination therapy with a long duration time. Case 2 and case 3 both showed that the patients developed acute and transient worsening of erythroderma and pruritus after anti-PD-1 antibody infusion, and this flare reaction was associated with transient decreased leukocytes and lymphocytes in peripheral blood. To the best of our knowledge, this is the first report of the anti-PD-1 antibody combined with chidamide for treatment of R/R SS. This report suggests that the combination therapy may be a new and effective treatment and that further clinical trials are needed to prove it and elucidate the mechanism of this combination therapy and its flare reaction.
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Affiliation(s)
- Chao Chen
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Zhaorui Liu
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
| | - Jie Liu
- Department of Dermatology, Peking Union Medical College Hospital, Beijing, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
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Yang Z, Gong D, Huang F, Sun Y, Hu Q. Epidemiological Characteristics and the Development of Prognostic Nomograms of Patients With HIV-Associated Cutaneous T-Cell Lymphoma. Front Oncol 2022; 12:847710. [PMID: 35372067 PMCID: PMC8965059 DOI: 10.3389/fonc.2022.847710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of human immunodeficiency virus (HIV) associated cutaneous T-Cell lymphoma (HIV-associated CTCL) is very low, and there is a lack of relevant epidemiological and clinical prognostic studies. Therefore, we aimed to study the epidemiological characteristics of HIV-associated CTCL and to construct and validate a nomogram predicting patient survival. Methods Demographic, clinical characteristics, and incidence data from the Surveillance, Epidemiology and End Results (SEER) database were screened for patients with HIV-associated CTCL. Independent prognostic factors in patients with HIV-associated CTCL were analyzed to establish nomograms of overall survival (OS) and disease-specific survival (DSS) rates of patients. The performance of the prediction model was validated by the consistency index (C-index), the area under the receiver operating characteristic curve (AUC), and calibration plots. Results A total of 883 eligible patients were screened for inclusion in this study and randomized to the training cohort (70%, n = 619) and the validation cohort (30%, n = 264). The age-adjusted average incidence rate per 100,000 persons per year for HIV-associated CTCL was 0.071 for the period 2004-2017, with an increasing incidence rate. The median age of the included patients was 59 years, of which male Caucasian held a majority. 99.5% of the patients had a tumor tissue subtype of mycosis fungoides, while the other tumor subtypes were sézary syndrome. The median OS for patients with HIV-associated CTCL was 162 months, and the OS rates at 1, 3, 5, and 10 years were 0.964, 0.904, 0.835, and 0.766, respectively. Univariate and multivariate COX regression analysis were performed, and prognostic indicators such as "Age", "Radiation", "Chemotherapy", "Summary stage", "Sequence number" were ultimately incorporated and used to establish nomograms of OS and DSS rates at 1, 3, 5 and 10 years for the training cohort. The C-index, AUC, and calibration plot confirmed that our prediction model had good accuracy. Conclusion While HIV-associated CTCL is very rare, its incidence has been on the rise in the last decade or so. We described the epidemiological characteristics and prognostic factors in patients with HIV-associated CTCL.
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Affiliation(s)
- Zheng Yang
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, China
| | - Daoqing Gong
- Teaching Office, Jingzhou Hospital, Yangtze University, Jingzhou, China
| | - Fei Huang
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hosiptal, Yangtze University, Jingzhou, China
| | - Qinming Hu
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, China
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Salant JA, Khan N, Nelson JE, Norton-Westbrook M, Desai AV. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Cutaneous T Cell Lymphoma. J Palliat Med 2021; 25:958-963. [PMID: 34978848 DOI: 10.1089/jpm.2021.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cutaneous T cell lymphoma and its subtypes, mycosis fungoides (MF) and Sézary syndrome (SS), comprise a spectrum of chronic lymphoproliferative disorders in which neoplastic T cells accumulate within the skin and visceral organs. This process is frequently characterized by severe pain, nonpain symptoms, and physical disfigurement. Significant emotional, spiritual, and existential distress is also felt by many of these patients as they experience a chronic, often incurable disease. Patients suffering from these diseases, though not commonly encountered, can benefit greatly from palliative care support. In this article, a team of palliative care clinicians, critical care physicians, and an oncologist specializing in lymphoma offer 10 tips to help palliative care teams to support these vulnerable and often-distressed patients and their caregivers.
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Affiliation(s)
- Jennifer A Salant
- Pediatric Advanced Care Team, Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Niloufer Khan
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Judith E Nelson
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Critical Care Service, Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moe Norton-Westbrook
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anjali V Desai
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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41
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Ba W, Yang HH, Wang W, Li C. CD8+ mycosis fungoides with ichthyosiform clinical presentation and angiocentric feature. J Cutan Pathol 2021; 49:487-490. [PMID: 34913182 DOI: 10.1111/cup.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
Mycosis fungoides (MF) is characterized by epidermotropic atypical lymphocytes infiltrate with α/β T-helper memory immunophenotype (βF1+, CD3+, CD4+, CD45Ro+, and CD8-). Angiocentricity is always associated with aggressive behavior or poor outcome in primary or secondary cutaneous lymphomas. Rare cases of angiocentric MF with a T-cytotoxic immunophenotype (CD3+, CD4-, CD8+, TIA-1+) have been described. Here, we report a 27-year-old man diagnosed with MF, clinically presenting with ichthyosiform lesions on his trunk and limbs. Biopsy demonstrated a CD3+ and CD8+ atypical lymphocytic infiltrate with marked epidermotropism and angiocentricity. Awareness of this rare MF variant with unusual clinicopathological characteristics is important to avoid misdiagnosis.
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Affiliation(s)
- Wei Ba
- Department of Dermatology, Chinese PLA General Hospital & Medical School, Beijing, China
| | - Henry Hongyu Yang
- Department of Pathology, St. Vincent Evansville Medical Center, Evansville, Indiana, USA
| | - Wenjuan Wang
- Department of Dermatology, Chinese PLA General Hospital & Medical School, Beijing, China
| | - Chengxin Li
- Department of Dermatology, Chinese PLA General Hospital & Medical School, Beijing, China
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Kim A, Insley A, West L, Woodworth Goff H. Need for Expansion of Coverage for Narrowband UVB Phototherapy in Mycosis Fungoides and Sézary Syndrome. AMERICAN HEALTH & DRUG BENEFITS 2021; 14:131-132. [PMID: 35261716 PMCID: PMC8844638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Agnes Kim
- Medical Student, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Lindsey West
- Resident, University of Texas Southwestern Medical Center
| | - Heather Woodworth Goff
- Associate Professor of Dermatology, University of Texas Southwestern Medical Center, Dallas
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Stamouli M, Gkirkas K, Karagiannidi A, Iliakis T, Chondropoulos S, Thomopoulos T, Nikolaou V, Pappa V, Papadavid E, Tsirigotis P. Allogeneic Stem Cell Transplantation with a Novel Reduced Intensity Conditioning Regimen for the Treatment of Patients with Primary Cutaneous T-cell Lymphomas. Clin Hematol Int 2021; 3:72-76. [PMID: 34595469 PMCID: PMC8432398 DOI: 10.2991/chi.k.210529.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/21/2021] [Indexed: 11/01/2022] Open
Abstract
The prognosis of patients with mycosis fungoides (MF) and Sezary Syndrome (SS) varies greatly, from near normal life expectancy in patients with early stage, to a median survival of less than 2 years for those diagnosed with advanced stage disease. Initial response to treatment is almost always followed by relapse and, finally, most of patients enter a phase of advanced multi-drug resistant disease with a short life expectancy after multiple lines of treatment. Allogeneic stem cell transplantation (allo-SCT) is usually limited to patients with advanced disease resistant to multiple treatments. Retrospective registry-based studies have shown increased Non-relapse Mortality (NRM) rates in patients with poor performance status, as well as in patients treated with myeloablative conditioning regimens. Another major limitation of allo-SCT is the increased relapse rate which occurs in nearly 50% of the cases, and is probably due to the fact that only heavily pretreated patients with advanced disease are referred for allo-SCT. Due to the paucity of data, the ideal conditioning regimen which will provide the maximum therapeutic benefit without the cost of increased NRM is not currently known. In this article we present our experience with a novel regimen in the treatment of patients with advanced MF/SS.
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Affiliation(s)
- Maria Stamouli
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Gkirkas
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Aggeliki Karagiannidi
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Theodoros Iliakis
- Hematology Division, 1st Department of Internal Medicine, Propaedeutic, LAIKON General Hospital, National and Kapodistrian University of Athens, Greece
| | - Spiros Chondropoulos
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Thomas Thomopoulos
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Vassiliki Nikolaou
- 1st Department of Dermatology, Syggros Hospital, National and Kapodistrian University of Athens, Greece
| | - Vassiliki Pappa
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Evangelia Papadavid
- 2nd Department of Dermatology, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
| | - Panagiotis Tsirigotis
- Hematology Division, 2nd Department of Internal Medicine, Propaedeutic, ATTIKON General University Hospital, National and Kapodistrian University of Athens, Greece
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Ow KV, Brant JM. Non-Hodgkin Lymphoma: Examining Mycosis Fungoides and Sézary Syndrome in the Context of Oncology Nursing. Clin J Oncol Nurs 2021; 25:555-562. [PMID: 34533520 DOI: 10.1188/21.cjon.555-562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mycosis fungoides and Sézary syndrome are the most common non-Hodgkin lymphomas that manifest primarily in the skin. Although early-stage disease has an excellent long-term survival rate, advanced disease carries a poor survival rate. Given the lengthy and complex clinical course, nurses are at the forefront of education and supportive care management for patients and caregivers. OBJECTIVES This article aims to provide an overview of mycosis fungoides and Sézary syndrome and to highlight practice considerations for optimal nursing care. METHODS Clinical presentation, diagnosis, management, and nursing consideration are discussed. FINDINGS Oncology nurses have a vital role in educating patients and their caregivers about the side effects of cancer treatment, appropriate skin care, and infection risk.
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Affiliation(s)
- Karla V Ow
- University of Texas MD Anderson Cancer Center
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45
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Jonak C, Tittes J, Brunner PM, Guenova E. Mycosis fungoides und Sézary-Syndrom. J Dtsch Dermatol Ges 2021; 19:1307-1335. [PMID: 34541808 DOI: 10.1111/ddg.14610_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Constanze Jonak
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Julia Tittes
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Emmanuella Guenova
- Universitätsklinik für Dermatologie, Fakultät für Biologie und Medizin, Universität Lausanne, Lausanne, Schweiz
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Jonak C, Tittes J, Brunner PM, Guenova E. Mycosis fungoides and Sézary syndrome. J Dtsch Dermatol Ges 2021; 19:1307-1334. [PMID: 34541796 PMCID: PMC9293091 DOI: 10.1111/ddg.14610] [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: 06/03/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are primary cutaneous T-cell lymphomas (CTCL) with not yet fully understood etiology and pathogenesis. Conceptually, MF and SS are classified as distinct entities arising from different T helper cell subsets. MF is the most common CTCL entity, while SS is very rare. MF presents clinically with patch, plaque and/or tumor stages, but can also evolve as erythroderma, which in turn is pathognomonic for SS. SS is characterized by a detectable tumor-cell burden (Sézary cells) in the peripheral blood consistent with advanced-stage disease and a poor prognosis. In early-stage disease of MF, which is the predominant form, the prognosis is generally favorable. However, in up to 30 % of patients, there is progression of skin lesions, which can ultimately lead to visceral involvement. The histological manifestation of MF can be subtle in early-stage disease and therefore a careful clinicopathological correlation is paramount. The treatment of MF/SS is dependent on the disease stage. Therapeutic options include both skin-directed and systemic regimens. Apart from allogeneic stem cell transplantation (alloSCT), there is as yet no curative therapy for MF/SS. Accordingly, the treatment approach is symptom oriented and aims to reduce the tumor burden and improve health-related quality of life. However, the therapeutic landscape for CTCL is constantly being expanded by the discovery of novel therapeutic targets.
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Affiliation(s)
- Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Austria
| | - Julia Tittes
- Department of Dermatology, Medical University of Vienna, Austria
| | | | - Emmanuella Guenova
- Department of Dermatology, Faculty of Biology and Medicine, University of Lausanne, Switzerland
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Abstract
Dermatitis is a common condition frequently encountered by dermatologists. The diagnosis of dermatitis can be challenging because this condition is often multifactorial, and many skin diseases that can mimic dermatitis should be considered in the differential diagnosis. It is important to recognize and be familiar with these conditions because some of them can represent signs of systemic disease or malignancies and misdiagnosis can lead to mismanagement and adverse outcomes for the patient.
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Affiliation(s)
- Oksana A Bailiff
- Geisinger Dermatology, 16 Woodbine Lane, Danville, PA 17822, USA
| | - Christen M Mowad
- Geisinger Dermatology, 16 Woodbine Lane, Danville, PA 17822, USA.
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Zhu L, Xie S, Yang C, Hua N, Wu Y, Wang L, Ni W, Tong X, Fei M, Wang S. Current Progress in Investigating Mature T- and NK-Cell Lymphoma Gene Aberrations by Next-Generation Sequencing (NGS). Cancer Manag Res 2021; 13:5275-5286. [PMID: 34239326 PMCID: PMC8259727 DOI: 10.2147/cmar.s299505] [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: 01/04/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Despite efforts to abrogate the severe threat to life posed by the profound malignancy of mature natural killer/T-cell lymphoma (NKTCL), therapeutic advances still require further investigation of its inherent regulatory biochemical processes. Next-generation sequencing (NGS) is an increasingly developing gene detection technique, which has been widely used in lymphoma genetic research in recent years. Targeted therapy based on the above studies has also generated a series of advances, making genetic mutation a new research hotspot in lymphoma. Advances in NKTCL-related gene mutations are reviewed in this paper.
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Affiliation(s)
- Lifen Zhu
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Shufang Xie
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Chen Yang
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
- Department of Clinical Medicine, Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Nanni Hua
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yi Wu
- Phase I clinical research center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Lei Wang
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Wanmao Ni
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiangmin Tong
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Min Fei
- Center of Health Management, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
| | - Shibing Wang
- Molecular diagnosis laboratory, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China
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Troyanova-Slavkova S. Großzellig-anaplastisches T-Zell-Lymphom und Mycosis fungoides unter der Therapie mit Dupilumab. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1402-9645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDupilumab ist das erste zielgerichtete Biologikum, das bei mittelschwerer bis schwerer atopischer Dermatitis angewendet werden kann. Der monoklonale Antikörper hemmt die Interleukin-4- und Interleukin-13-Signalübertragung 1. Dupilumab belegt für die Behandlung von atopischen und allergischen Erkrankungen ein gutes Verträglichkeitsprofil. Gleichwohl sollten Ärzte seine Neuheit und das Potenzial für unerwartete und unerwünschte Arzneimittelwirkungen berücksichtigen. Wir stellen einen Patienten vor, der nach Einleitung von Dupilumab ein großzellig-anaplastisches T-Zell-Lymphom mit Befall des supraklavikulären Lymphknotens und eine Mycosis fungoides entwickelte.
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50
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Breneman DL, Breneman A, Ballman E, Breneman JC. Long-term effects of total skin electron beam therapy for mycosis fungoides on hair and nail loss and regrowth. J DERMATOL TREAT 2021; 33:1975-1978. [PMID: 33755504 DOI: 10.1080/09546634.2021.1906398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To better document the risk of permanent hair and nail loss after total skin electron beam therapy (TSEBT) for mycosis fungoides (MF). METHODS Interviews and evaluations were conducted in 13 patients with MF treated with TSEBT alone and two patients treated with concomitant TSEBT and chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Evaluated parameters included time to hair and nail loss and regrowth, the density of hair regrowth, and quality of hair and nail regrowth. RESULTS Most patients had complete loss of scalp hair during treatment, and new growth appeared about 2 months following treatment completion. After 18 months, most patients felt their hair had regrown to about 70% of baseline thickness without cosmetically obvious alopecia. The patients treated with TSEBT and concomitant chemotherapy had substantially less scalp hair regrowth with persistent cosmetically obvious alopecia. Some lost eyebrows and eyelashes, but complete or near-complete regrowth generally occurred. Most patients lost their nails following TSEBT, with complete regrowth noted by most patients 5 months after treatment. New nails were most often normal, but a few patients developed post-therapy nail dystrophies. CONCLUSION This data can be used to better inform patients of likely long-term changes of hair and nails following TSEBT.
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Affiliation(s)
- Debra L Breneman
- Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alyssa Breneman
- Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Elaine Ballman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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