1
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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; 28:1423-1429. [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] [MESH Headings] [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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2
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Sarkar R, Meena AK, Mendiratta V, Sonker S, Singh S. Primary Cutaneous B-Cell Lymphoma in an Infant: A Rare Entity. Indian J Dermatol 2024; 69:196-197. [PMID: 38841242 PMCID: PMC11149823 DOI: 10.4103/ijd.ijd_1169_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Affiliation(s)
- Rashmi Sarkar
- From the Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Amit K Meena
- From the Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Vibhu Mendiratta
- From the Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Sneha Sonker
- From the Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Smita Singh
- Department of Pathology, Lady Hardinge Medical College, New Delhi, Delhi, India E-mail:
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3
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Marcé D, Canu D, Laurent C, Pottier C, Jullie ML, Kervarrec T, Beylot-Barry M, Samimi M. Subcutaneous panniculitis-like T-cell lymphoma presenting as facial infiltration with long-term response to methotrexate: Two cases. Ann Dermatol Venereol 2023; 150:294-296. [PMID: 37442745 DOI: 10.1016/j.annder.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/30/2022] [Accepted: 04/11/2023] [Indexed: 07/15/2023]
Affiliation(s)
- D Marcé
- Dermatology Department, University Hospital of Tours, 37000 Tours, France
| | - D Canu
- Dermatology Department, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - C Laurent
- Dermatology Department, University Hospital of Rennes, 35000 Rennes, France
| | - C Pottier
- Dermatology Department, University Hospital of Tours, 37000 Tours, France
| | - M-L Jullie
- Pathology Department, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - T Kervarrec
- Pathology Department, University Hospital of Tours, 37000 Tours, France
| | - M Beylot-Barry
- Dermatology Department, University Hospital of Bordeaux, 33000 Bordeaux, France; Univ. Bordeaux, UMR 1312 INSERM, 33000 Bordeaux, France
| | - M Samimi
- Dermatology Department, University Hospital of Tours, 37000 Tours, France.
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4
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D’Onghia M, Cartocci A, Calabrese L, Maio D, Sirchio A, Erasti M, Tognetti L, Rubegni P, Bocchia M, Cencini E, Fabbri A, Cinotti E. Characteristics of Primary Cutaneous Lymphoma in Italy: A Tertiary Care, Single-Center Study. Curr Oncol 2023; 30:9813-9823. [PMID: 37999132 PMCID: PMC10670225 DOI: 10.3390/curroncol30110712] [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: 09/26/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
Data on primary cutaneous lymphomas (PCLs) patients in the Italian population are limited, and, despite the existence of several treatment options, the management of those patients remains challenging. Our study aimed to investigate the clinical and therapeutic features of PCL patients in a referral center in Italy. We conducted a retrospective study on 100 consecutive PCL patients between January 2017 and December 2022. The mean (SD) age of our cohort was 70.33 (14.14) years. Cutaneous T-cell lymphomas (CTCLs) represented 65% of all cases; the majority were mycosis fungoides (42%), followed by cases of Sezary syndrome (10%) and primary cutaneous anaplastic large cell lymphoma (4%). Cutaneous B-cell lymphomas (CBCLs) accounted for 35 % of PCLs, with 15 cases of primary cutaneous follicle center lymphoma, 10 cases of primary cutaneous diffuse large B-cell lymphoma leg type, and 9 cases of marginal zone B-cell lymphoma. A higher frequency of pruritus (p = 0.008) and higher peripheral blood levels of beta-2 microglobulin (p ≤ 0.001) and lactate dehydrogenase (p = 0.025) were found in CTCLs compared to those of CBCLs. Considering all therapeutic lines performed, treatments were extremely heterogeneous and skin-directed therapies represented the most frequently used approach. Our study confirms the distribution of PCL subtypes formerly reported in the literature and highlights the utility of real-life data in treatments to improve the current management of PCL patients.
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Affiliation(s)
- Martina D’Onghia
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Alessandra Cartocci
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Laura Calabrese
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Daniele Maio
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Azzurra Sirchio
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Maria Erasti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Linda Tognetti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
| | - Monica Bocchia
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Emanuele Cencini
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Alberto Fabbri
- Department of Medical, Surgical and Neurological Sciences, Hematology Section, University of Siena, 53100 Siena, Italy; (M.B.); (E.C.); (A.F.)
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, 53100 Siena, Italy; (A.C.); (L.C.); (D.M.); (A.S.); (M.E.); (L.T.); (P.R.); (E.C.)
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5
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Falkenhain-López D, Muniesa C, Estrach MT, Morillo-Andújar M, Peñate Y, Acebo E, Pujol RM, García-Muret MP, Machan S, Medina S, Botella-Estrada R, Fernández de Misa R, Blanes M, Flórez A, Pérez-Paredes G, Izu R, Yanguas I, Silva-Díaz E, Pérez-Ferriols A, Prieto-Torres L, Zayas A, Parera-Amer ME, Pérez A, Aspe L, Román C, Sánchez-Caminero MP, Bassas-Vila J, Domínguez-Auñón JD, Calzado L, Navedo M, Ortiz-Prieto A, Servitje O, Polo-Rodríguez I, Torres I, Hernández-Hernández MN, Mitxelena-Eceiza J, García-Vázquez A, García-Doval I, Ortiz-Romero PL. [Translated article] Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T291-T298. [PMID: 36848951 DOI: 10.1016/j.ad.2022.11.013] [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: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. PATIENTS AND METHODS RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. RESULTS Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+ lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). CONCLUSION The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.
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Affiliation(s)
- D Falkenhain-López
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - C Muniesa
- Departamento de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M T Estrach
- Departamento de Dermatología, Hospital Clínico, IDIBAPS, Universitario de Barcelona, Barcelona, Spain
| | - M Morillo-Andújar
- Departamento de Dermatología, Hospital Virgen del Rocío, Sevilla, Spain
| | - Y Peñate
- Departamento de Dermatología, Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Spain
| | - E Acebo
- Departamento de Dermatología, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain
| | - R M Pujol
- Departamento de Dermatología, Hospital del Mar, Barcelona, Spain
| | - M P García-Muret
- Departamento de Dermatología, Hospital Santa Creu i Sant Pau, UAB Barcelona, Barcelona, Spain
| | - S Machan
- Departamento de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - S Medina
- Departamento de Dermatología, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - R Botella-Estrada
- Departamento de Dermatología, Hospital Universitario La Fe, Valencia, Spain
| | - R Fernández de Misa
- Departamento de Dermatología, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - M Blanes
- Departamento de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
| | - A Flórez
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - G Pérez-Paredes
- Departamento de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander Cantabria, Spain
| | - R Izu
- Departamento de Dermatología, Hospital Universitario de Basurto, Bilbao, Bizkaia, Spain
| | - I Yanguas
- Departamento de Dermatología Complejo Hospitalario de Navarra, Navarra, Spain
| | - E Silva-Díaz
- Departamento de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - A Pérez-Ferriols
- Departamento de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
| | - L Prieto-Torres
- Departamento de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A Zayas
- Departamento de Dermatología, Hospital Universitario Dr. Peset, Valencia, Spain
| | - M E Parera-Amer
- Departamento de Dermatología, Hospital Universitario Son Llàtzer, Palma, Islas Baleares, Spain
| | - A Pérez
- Departamento de Dermatología, Hospital Universitario Nuestra Señora De Valme, Sevilla, Spain
| | - L Aspe
- Departamento de Dermatología, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, Spain
| | - C Román
- Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - M P Sánchez-Caminero
- Departamento de Dermatología, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - J Bassas-Vila
- Departamento de Dermatología, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J D Domínguez-Auñón
- Departamento de Dermatología, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - L Calzado
- Departamento de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - M Navedo
- Departamento de Dermatología, Complejo Asistencial Universitario de León, León, Spain
| | - A Ortiz-Prieto
- Departamento de Dermatología, Hospital Puerta del Mar, Cádiz, Spain
| | - O Servitje
- Departamento de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - I Polo-Rodríguez
- Departamento de Dermatología, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - I Torres
- Departamento de Dermatología, Hospital Universitario La Fe, Valencia, Spain
| | - M N Hernández-Hernández
- Departamento de Dermatología, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - J Mitxelena-Eceiza
- Departamento de Dermatología Complejo Hospitalario de Navarra, Navarra, Spain
| | - A García-Vázquez
- Departamento de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, León, Spain; Departamento de Dermatología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - P L Ortiz-Romero
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
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6
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Goodlad JR, Cerroni L, Swerdlow SH. Recent advances in cutaneous lymphoma-implications for current and future classifications. Virchows Arch 2023; 482:281-298. [PMID: 36278991 PMCID: PMC9852132 DOI: 10.1007/s00428-022-03421-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/27/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
The Revised European-American Classification of mature lymphoid neoplasms published in 1994 and the 2001, 2008 and 2016 WHO classifications that followed, were the product of international collaboration and consensus amongst haematopathologists, geneticists, molecular scientists and clinicians. Primary cutaneous lymphomas were fully incorporated into this process following the publication of the WHO-EORTC classification of cutaneous lymphomas in 2005. The definition, diagnostic criteria and recommended studies for primary cutaneous lymphoma continue to be refined. The 2022 International Consensus Classification represents the most recent update and an overview of all the main entities presenting primarily in the skin, together with the major changes in classification, are summarized herein. Primary cutaneous marginal zone lymphoma is segregated from other extranodal marginal zone lymphomas of mucosa-associated lymphoid tissue (MALT lymphoma) and downgraded to a lymphoproliferative disorder in line with its markedly indolent behaviour. In addition, two subtypes are recognised, based largely but not exclusively on whether they are heavy chain class-switched or IgM positive. Similarly, in keeping with a trend to greater conservatism, primary cutaneous acral CD8 positive T cell lymphoma is now also classified as a lymphoproliferative disorder. In addition, significant new insights into the biology of primary cutaneous lymphoma have also recently been forthcoming and will be presented. These studies have enhanced our knowledge of genetic, epigenetic and transcriptional changes in this group of diseases. They not only identify potential targets for novel therapies, but also raise as yet unanswered questions as to how we categorise cutaneous lymphomas, particularly with respect to relationships with similar lymphomas at extracutaneous sites.
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Affiliation(s)
- JR Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Level 3 Laboratory Medicine Building Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow, G51 4TF UK
| | - L Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - SH Swerdlow
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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7
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Falkenhain-López D, Muniesa C, Estrach MT, Morillo-Andújar M, Peñate Y, Acebo E, Pujol RM, García-Muret MP, Machan S, Medina S, Botella-Estrada R, Fernández de Misa R, Blanes M, Flórez A, Pérez-Paredes G, Izu R, Yanguas I, Silva-Díaz E, Pérez-Ferriols A, Prieto-Torres L, Zayas A, Parera-Amer ME, Pérez A, Aspe L, Román C, Sánchez-Caminero MP, Bassas-Vila J, Domínguez-Auñón JD, Calzado L, Navedo M, Ortiz-Prieto A, Servitje O, Polo-Rodríguez I, Torres I, Hernández-Hernández MN, Mitxelena-Eceiza J, García-Vázquez A, García-Doval I, Ortiz-Romero PL. Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years. ACTAS DERMO-SIFILIOGRAFICAS 2022; 114:291-298. [PMID: 36529273 DOI: 10.1016/j.ad.2022.11.010] [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: 11/02/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. PATIENTS AND METHODS RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. RESULTS Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). CONCLUSION The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.
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Affiliation(s)
- D Falkenhain-López
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - C Muniesa
- Departamento de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - M T Estrach
- Departamento de Dermatología, Hospital Clínico, IDIBAPS, Universitario de Barcelona, Barcelona, España
| | - M Morillo-Andújar
- Departamento de Dermatología, Hospital Virgen del Rocío, Sevilla, España
| | - Y Peñate
- Departamento de Dermatología, Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, España
| | - E Acebo
- Departamento de Dermatología, Hospital Universitario de Cruces, Barakaldo, Bizkaia, España
| | - R M Pujol
- Departamento de Dermatología, Hospital del Mar, Barcelona, España
| | - M P García-Muret
- Departamento de Dermatología, Hospital Santa Creu i Sant Pau, UAB Barcelona, Barcelona, España
| | - S Machan
- Departamento de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - S Medina
- Departamento de Dermatología, Hospital Universitario Príncipe de Asturias, Madrid, España
| | - R Botella-Estrada
- Departamento de Dermatología, Hospital Universitario La Fe, Valencia, España
| | - R Fernández de Misa
- Departamento de Dermatología, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, España
| | - M Blanes
- Departamento de Dermatología, Hospital General Universitario de Alicante, Alicante, España
| | - A Flórez
- Departamento de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - G Pérez-Paredes
- Departamento de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander Cantabria, España
| | - R Izu
- Departamento de Dermatología, Hospital Universitario de Basurto, Bilbao, Bizkaia, España
| | - I Yanguas
- Departamento de Dermatología Complejo Hospitalario de Navarra, Navarra, España
| | - E Silva-Díaz
- Departamento de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Pérez-Ferriols
- Departamento de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - L Prieto-Torres
- Departamento de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A Zayas
- Departamento de Dermatología, Hospital Universitario Dr. Peset, Valencia, España
| | - M E Parera-Amer
- Departamento de Dermatología, Hospital Universitario Son Llàtzer, Palma, Islas Baleares, España
| | - A Pérez
- Departamento de Dermatología, Hospital Universitario Nuestra Señora De Valme, Sevilla, España
| | - L Aspe
- Departamento de Dermatología, Hospital Universitario de Araba, Vitoria-Gasteiz, Álava, España
| | - C Román
- Departamento de Dermatología, Hospital Universitario de Salamanca, Salamanca, España
| | - M P Sánchez-Caminero
- Departamento de Dermatología, Hospital General de Ciudad Real, Ciudad Real, España
| | - J Bassas-Vila
- Departamento de Dermatología, Hospital Germans Trias i Pujol, Barcelona, España
| | - J D Domínguez-Auñón
- Departamento de Dermatología, Hospital Universitario del Henares, Coslada, Madrid, España
| | - L Calzado
- Departamento de Dermatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - M Navedo
- Departamento de Dermatología, Complejo Asistencial Universitario de León, León, España
| | - A Ortiz-Prieto
- Departamento de Dermatología, Hospital Puerta del Mar, Cádiz, España
| | - O Servitje
- Departamento de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - I Polo-Rodríguez
- Departamento de Dermatología, Hospital Universitario Príncipe de Asturias, Madrid, España
| | - I Torres
- Departamento de Dermatología, Hospital Universitario La Fe, Valencia, España
| | - M N Hernández-Hernández
- Departamento de Dermatología, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, España
| | - J Mitxelena-Eceiza
- Departamento de Dermatología Complejo Hospitalario de Navarra, Navarra, España
| | - A García-Vázquez
- Departamento de Dermatología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - I García-Doval
- Unidad de Investigación, Fundación Piel Sana AEDV, León, España; Departamento de Dermatología, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - P L Ortiz-Romero
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
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8
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Assaf C, Waser N, Bagot M, He M, Li T, Dalal M, Gavini F, Trinchese F, Zomas A, Little M, Pimpinelli N, Ortiz-Romero PL, Illidge TM. Contemporary Treatment Patterns and Response in Relapsed/Refractory Cutaneous T-Cell Lymphoma (CTCL) across Five European Countries. Cancers (Basel) 2021; 14:cancers14010145. [PMID: 35008309 PMCID: PMC8750476 DOI: 10.3390/cancers14010145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
The treatment pattern of cutaneous T-cell lymphoma (CTCL) remains diverse and patient-tailored. The objective of this study was to describe the treatment patterns and outcomes in CTCL patients who were refractory or had relapsed (R/R) after a systemic therapy. A retrospective chart review study was conducted at 27 sites in France, Germany, Italy, Spain and the United Kingdom (UK) of patients who received a first course of systemic therapy and relapsed or were refractory. Data were collected longitudinally from diagnosis to first-, second- and third-line therapy. The study included 157 patients, with a median follow-up of 3.2 years. In total, 151 proceeded to second-line and 90 to third-line therapy. In the first line (n = 147), patients were treated with diverse therapies, including single- and multi-agent chemotherapy in 67 (46%), retinoids in 39 (27%), interferon in 31 (21%), ECP in 4 (3%), corticosteroids in 3 (2%) and new biological agents in 3 (2%). In the second line, the use of chemotherapy and retinoids remained similar to the first line, while the use of new biologics increased slightly. In sharp contrast to the first line, combination chemotherapy was extremely diverse. In the third line, the use of chemotherapy remained high and diverse as in the second line. From the time of first R/R, the median PFS was 1.2 years and the median OS was 11.5 years. The presented real-world data on the current treatments used in the management of R/R CTCL in Europe demonstrate the significant heterogeneity of systemic therapies and combination therapies, as expected from the European guidelines.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology, HELIOS Klinikum Krefeld, Academic Teaching Hospital of the University of Aachen, 47805 Krefeld, Germany
- Department of Dermatology, Charité-Universitätsmedizin, 10117 Berlin, Germany
- Correspondence: or
| | - Nathalie Waser
- ICON Plc, 450-688 West Hastings St., Vancouver, BC V6B 1P1, Canada; (N.W.); (M.H.); (T.L.)
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France;
| | - Mary He
- ICON Plc, 450-688 West Hastings St., Vancouver, BC V6B 1P1, Canada; (N.W.); (M.H.); (T.L.)
| | - Tina Li
- ICON Plc, 450-688 West Hastings St., Vancouver, BC V6B 1P1, Canada; (N.W.); (M.H.); (T.L.)
| | - Mehul Dalal
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA 02139, USA; (M.D.); (F.G.); (M.L.)
| | - Francois Gavini
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA 02139, USA; (M.D.); (F.G.); (M.L.)
| | - Fabrizio Trinchese
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (F.T.); (A.Z.)
| | - Athanasios Zomas
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (F.T.); (A.Z.)
| | - Meredith Little
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA 02139, USA; (M.D.); (F.G.); (M.L.)
| | - Nicola Pimpinelli
- Department of Health Sciences, Dermatology Unit, University of Florence, 50121 Florence, Italy;
| | - Pablo L. Ortiz-Romero
- Institute I+12, Medical School, Hospital Universitario 12 de Octubre, University Complutense, 28040 Madrid, Spain;
| | - Timothy M. Illidge
- Manchester NIHR Biomedical Research Centre, Christie Hospital, University of Manchester, Manchester M20 4BX, UK;
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9
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Button PM, Child F, Mootien M, Saglam S, Magsino J, Dhanoia H. Service improvement in a nurse-led clinic for extracorporeal photopheresis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S10-S14. [PMID: 34605267 DOI: 10.12968/bjon.2021.30.17.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The skin tumour unit at one London hospital has been providing extracorporeal photopheresis (ECP) treatment since 2012, using an online fully integrated system. This report summarises 9 years of continuous process improvement, which has enabled the team to meet the growing demand for ECP treatments for cutaneous T-cell lymphoma (CTCL) and graft-versus-host disease (GvHD) patients. The unit formed a partnership with a lean-management company to go through the process of evaluation of capacity constraints, design layout and patient scheduling. METHODS Increased capacity year-on-year and over the 9-year period was calculated based on data collected from records. The authors reviewed the nurse staffing resources allocated for ECP treatments over the same period, and financial value created by the continuous improvement (additional number of treatments multiplied by the national tariff for ECP treatments). RESULTS In 2012 the average number of ECP treatments per nurse per week was 11. With the implementation of the new planning tool, and improved working practices, the average number of treatments per nurse per week has more than doubled to 23. Nurse staffing was maintained at 4 nurses per shift to deliver ECP treatments. The unit recorded additional revenue of approximately £3.2 million in 2020 compared with 2012. CONCLUSIONS The team has successfully increased the capacity of the service to deliver treatments without incurring any additional nursing costs, resulting in more patients with CTCL and GvHD being able to access ECP treatment and a cost benefit for the Trust. The service continues in its mission to grow and provide a superior patient experience.
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Affiliation(s)
| | - Fiona Child
- Consultant Dermatologist, Guy's and St Thomas' NHS Foundation Trust, London
| | - Manda Mootien
- Matron, Guy's and St Thomas' NHS Foundation Trust, London
| | - Sukran Saglam
- Clinical Nurse Speciaiist, Guy's and St Thomas' NHS Foundation Trust, London
| | - Joanne Magsino
- Clinical Nurse Speciaiist, Guy's and St Thomas' NHS Foundation Trust, London
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10
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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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11
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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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12
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Diagnosis of Early Mycosis Fungoides. Diagnostics (Basel) 2021; 11:diagnostics11091721. [PMID: 34574062 PMCID: PMC8465146 DOI: 10.3390/diagnostics11091721] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022] Open
Abstract
Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphomas, generally has a favorable clinical course. Early MF typically presents erythematous patches and/or plaques and lasts for many years without affecting the life expectancy. Only limited cases progress to develop skin tumors, with subsequent lymph nodes and rarely visceral organ involvement. One of the clinical problems in early MF is the difficulty in differentiating the disease from benign inflammatory disorders (BIDs), such as atopic dermatitis, chronic eczema, and psoriasis. In some MF cases, clinical and pathological findings are similar to those of BIDs. However, the accurate diagnosis of early MF is quite important, as inappropriate treatment including immunosuppressants can cause unfavorable or even fatal outcomes. This article focuses on general methods and novel tools for diagnosis of early MF.
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13
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Rigas K, Monti P, Di Palma S, Verganti S. Sézary syndrome with CD3
+
CD4
+
CD8
−
immunophenotype in a Bichon Frise. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Paola Monti
- Clinical pathology Dick White Referrals Six Mile Bottom UK
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14
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Papadavid E, Kapniari E, Pappa V, Nikolaou V, Iliakis T, Dalamaga M, Jonak C, Porkert S, Engelina S, Quaglino P, Ortiz-Romero PL, Vico C, Cozzio A, Dimitriou F, Guiron R, Guenova E, Hodak E, Bagot M, Scarisbrick J. Multicentric EORTC retrospective study shows efficacy of brentuximab vedotin in patients who have mycosis fungoides and Sézary syndrome with variable CD30 positivity. Br J Dermatol 2021; 185:1035-1044. [PMID: 34137025 DOI: 10.1111/bjd.20588] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Brentuximab vedotin (BV) was approved as a therapy for mycosis fungoides (MF) based on the ALCANZA trial. Little real-world data, however, are available. OBJECTIVES To evaluate the efficacy and safety of BV in patients with MF/Sézary Syndrome (SS) with variable CD30 positivity in a real-world cohort and to explore potential predictors of response. METHODS Data from 72 patients with MF/SS across nine EORTC (European Organization for Research and Treatment of Cancer) centres were included. The primary endpoint was to evaluate the proportion of patients with: overall response (ORR), ORR lasting over 4 months (ORR4), time to response (TTR), response duration (RD), progression-free survival (PFS) and time to next treatment (TTNT). Secondary aims included a safety evaluation and the association of clinicopathological features with ORR, RD and TTNT. RESULTS All 72 patients had received at least one systemic treatment. ORR was achieved in 45 of 67; ORR4 in 28 of 67 with a median TTR of 8 weeks [interquartile range (IQR) 5·5-14] and with a median RD of 9 months (IQR 3·4-14). Median PFS was 7 months (IQR 2-12) and median TTNT was 30 days (6-157·5). Patient response, RD, PFS and TTNT were not associated with any clinicopathological characteristics. In the MF group, patients with stage IIB/III vs. IV achieved longer PFS and had a higher percentage of ORR4. There was a statistically significant association between large-cell transformation and skin ORR (P = 0·03). ORR4 was more frequently achieved in patients without lymph node involvement (P = 0·04). CONCLUSIONS BV is an effective option for patients with MF/SS, including those with variable CD30 positivity, large-cell transformation, SS, longer disease duration and who have been treated previously with several therapies.
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Affiliation(s)
- E Papadavid
- 1st and 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - E Kapniari
- 1st and 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Pappa
- 1st and 2nd Propaedeutic Department, Hematology Units, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - V Nikolaou
- 1st and 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - T Iliakis
- 1st and 2nd Propaedeutic Department, Hematology Units, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - M Dalamaga
- 1st Department of Biological Chemistry, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Porkert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - S Engelina
- Division of Dermatology, Tel Aviv University, Israel
| | - P Quaglino
- Division of Dermatology, Tel Aviv University, Israel
| | - P L Ortiz-Romero
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - C Vico
- Department of Dermatology, 12 de Octubre Hospital, Medical School, University Compultense, Madrid, Spain
| | - A Cozzio
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - F Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - R Guiron
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Tel Aviv University, Israel
| | - E Guenova
- Department of Dermatology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - E Hodak
- Division of Dermatology, Tel Aviv University, Israel
| | - M Bagot
- Dermatology Department, APHP, Saint-Louis Hospital, Université de Paris, Paris, France.,Inserm U976, Paris, France
| | - J Scarisbrick
- Department of Dermatology, Centre for Rare Diseases, University Hospital Birmingham, Birmingham, UK
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15
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Sarfraz H, Gentille C, Ensor J, Wang L, Wong S, Ketcham MS, Joshi J, Pingali SRK. Primary cutaneous anaplastic large-cell lymphoma: a review of the SEER database from 2005 to 2016. Clin Exp Dermatol 2021; 46:1420-1426. [PMID: 34081802 DOI: 10.1111/ced.14777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/27/2021] [Accepted: 06/01/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Primary cutaneous anaplastic large-cell lymphoma (PC-ALCL) is a rare T-cell lymphoma. A prior analysis of the Surveillance, Epidemiology, and End Results (SEER) database reported only 157 cases of localized primary cutaneous CD30+ T-cell lymphoproliferative disorders (PC-ALCL and lymphomatoid papulosis) from 1973 to 2004. Our analysis of the SEER database since 2004 is the largest to date and our results improve our understanding of this disease and their potential prognostic factors. METHODS We used the SEER database to retrospectively identify patients. Survival was analysed using the Kaplan-Meier method, and log-rank tests were used to compare survival distributions. RESULTS There were 501 cases of PC-ALCL recorded from 2005 to 2016. Overall survival rates at 5 and 10 years were found to be 80.6% (95% CI 76.3%-84.3%) and 61.5% (95% CI 54.1%-68.1%) respectively. Age ≥ 60 years [hazard ratio (HR) = 1.09, P = 0.001 and use of chemotherapy (HR = 1.86, P = 0.01)] were associated with lower overall survival. In contrast to the 1973-2004 cohort, the head and neck site was not significantly associated with prognosis on multivariate analysis. CONCLUSION PC-ALCL has been increasingly recognized over the past decade. Age > 60 years and use of chemotherapy are associated with a worse outcome. Contrary to prior studies, location was not associated with poor survival.
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Affiliation(s)
- H Sarfraz
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - C Gentille
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX, USA
| | - J Ensor
- Houston Methodist Research Institute, Houston, TX, USA
| | - L Wang
- Houston Methodist Research Institute, Houston, TX, USA
| | - S Wong
- Houston Methodist Research Institute, Houston, TX, USA
| | - M S Ketcham
- Department of Pathology and Genomic Medicine, Houston Methodist Hospita, Houston, TX, USA
| | - J Joshi
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX, USA
| | - S R K Pingali
- Department of Oncology, Houston Methodist Cancer Center, Houston, TX, USA
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16
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Subcutaneous Panniculitis-like T-Cell Lymphoma With Hemophagocytic Lymphohistiocytosis Syndrome in Children and Its Essential Role of HAVCR2 Gene Mutation Analysis. J Pediatr Hematol Oncol 2021; 43:e80-e84. [PMID: 33003142 DOI: 10.1097/mph.0000000000001954] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We identified 3 adolescents with alpha-beta subtype subcutaneous panniculitis-like T-cell lymphoma. CASE PRESENTATION Three patients presented with prolonged fever, abnormal skin lesions, and cytopenia described in the context. All had the same disease entity, which showed the prolonged duration of B systemic symptoms till diagnosis, difficulty to distinguish from autoimmune diseases, presence of hemophagocytic lymphohistiocytosis syndrome, good response, and remained on long-term remission with nonchemotherapy treatment, which included oral corticosteroid and cyclosporin. CONCLUSIONS Although diagnosis can only be "highly suspected" with pathologic review, some cases may need multiple serial skin biopsy to clarify diagnosis because of the discrete distribution of specific histology. T-cell receptor gene rearrangement, which demonstrates a monoclonal pattern of alpha and beta chain gene, is the essential requirement for specific diagnosis. The role of molecular analysis by identification of germline hepatitis A virus cellular receptor 2 (HAVCR2) gene mutation can be much valuable in classifying susceptible patients.
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17
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Cutaneous Lymphomas — Part I: Mycosis Fungoides, Sézary Syndrome, and CD30+ Cutaneous Lymphoproliferative Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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Pujol R, Gallardo F. Linfomas cutáneos. Parte I: micosis fungoide, síndrome de Sézary y proliferaciones linfoides cutáneas CD30 positivas. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:14-23. [DOI: 10.1016/j.ad.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022] Open
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19
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Şahin M, Miskioğlu M, İnanır I, Akar H, Neşe N, Temiz P, Aydoğdu İ. Cutaneous Anaplastic Large-Cell Lymphoma with Dramatic Response to Brentuximab Vedotin. Turk J Haematol 2020; 38:85-87. [PMID: 33504137 PMCID: PMC7927435 DOI: 10.4274/tjh.galenos.2020.2020.0512] [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] [Indexed: 12/01/2022] Open
Affiliation(s)
- Mustafa Şahin
- Celal Bayar University Faculty of Medicine, Department of Internal Medicine, Manisa, Turkey
| | - Mine Miskioğlu
- Celal Bayar University Faculty of Medicine, Department of Hematology, Manisa, Turkey
| | - Işıl İnanır
- Celal Bayar University Faculty of Medicine, Department of Dermatology, Manisa, Turkey
| | - Hikmet Akar
- Celal Bayar University Faculty of Medicine, Department of Internal Medicine, Manisa, Turkey
| | - Nalan Neşe
- Celal Bayar University Faculty of Medicine, Department of Patology, Manisa, Turkey
| | - Peyker Temiz
- Celal Bayar University Faculty of Medicine, Department of Patology, Manisa, Turkey
| | - İsmet Aydoğdu
- Celal Bayar University Faculty of Medicine, Department of Hematology, Manisa, Turkey
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20
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Stainthorpe A, Fleeman N, Houten R, Chaplin M, Boland A, Beale S, Dundar Y, McEntee J, Syndikus I. Brentuximab Vedotin for Treating Relapsed or Refractory CD30-Positive Cutaneous T-Cell Lymphoma: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. PHARMACOECONOMICS - OPEN 2020; 4:563-574. [PMID: 32207075 PMCID: PMC7688836 DOI: 10.1007/s41669-020-00203-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
As part of the single technology appraisal process, the National Institute for Health and Care Excellence invited Takeda UK Ltd to submit clinical- and cost-effectiveness evidence for brentuximab vedotin (BV) for treating relapsed or refractory CD30-positive (CD30+) cutaneous T-cell lymphoma (CTCL). The Liverpool Reviews and Implementation Group at the University of Liverpool was commissioned to act as the evidence review group (ERG). This article summarises the ERG's review of the company's submission for BV and the appraisal committee (AC) decision. The principal clinical evidence was derived from a subgroup of patients with advanced-stage CD30+ mycosis fungoides (MF) or primary cutaneous anaplastic large-cell lymphoma (pcALCL) in the phase III ALCANZA randomised controlled trial (RCT). This trial compared BV versus physician's choice (PC) of methotrexate or bexarotene. Evidence from three observational studies was also presented, which included patients with other CTCL subtypes. The ERG's main concerns with the clinical evidence were the lack of RCT evidence for CTCL subtypes other than MF or pcALCL, lack of robust overall survival data (data were immature and confounded by subsequent treatment and treatment crossover on disease progression) and lack of conclusive results from analyses of health-related quality-of-life data. The ERG noted that many areas of uncertainty in the cost-effectiveness analysis were related to the clinical data, arising from the rarity of the condition and its subtypes and the complexity of the treatment pathway. The ERG highlighted that the inclusion of allogeneic stem-cell transplant (alloSCT) as an option in the treatment pathway was based on weak evidence and generated more uncertainty in a disease area that, because of its rarity and diversity, was already highly uncertain. The ERG also lacked confidence in the company's modelling of the post-progression pathway and was concerned that it may not produce reliable results. Results from the company's base-case comparison (including a simple discount patient access scheme [PAS] for BV) showed that treatment with BV dominated PC. The ERG's revisions and scenario analyses highlighted the high level of uncertainty around the company base-case cost-effectiveness results, ranging from BV dominating PC to an incremental cost-effectiveness ratio per quality-adjusted life-year gained of £494,981. The AC concluded that it was appropriate to include alloSCT in the treatment pathway even though data were limited. The AC recommended BV as an option for treating CD30+ CTCL after at least one systemic therapy in adults if they have MF, stage IIB or higher pcALCL or Sézary syndrome and if the company provides BV according to the commercial arrangement (i.e. simple discount PAS).
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Affiliation(s)
- Angela Stainthorpe
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Nigel Fleeman
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.
| | - Rachel Houten
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Marty Chaplin
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Sophie Beale
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Joanne McEntee
- North West Medicines Information Centre, Liverpool, L69 3GF, UK
| | - Isabel Syndikus
- Faculty of Health and Life Sciences, University of Liverpool, Thompson Yates Building, Liverpool, L69 3GB, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, CH63 4JY, UK
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21
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Melhoranse Gouveia B, Wells J, Kim J, Collgros H, Guitera P, Longo C, Fernandez-Penas P. Reflectance confocal microscopy role in mycosis fungoides follow-up. Skin Res Technol 2020; 27:414-421. [PMID: 33098224 DOI: 10.1111/srt.12967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is a useful tool for many skin cancers, allowing non-invasive evaluation over time and identifying areas of active disease. Its role to follow-up mycosis fungoides (MF) patients has not yet been evaluated. OBJECTIVE To assess the level of agreement between RCM and histopathology and to develop a RCM checklist that could help monitoring MF patients. METHOD Prospective study in a cutaneous lymphoma clinic of a tertiary hospital in Australia. RCM and biopsies were performed on the same area at baseline, before commencing or changing treatment, and at 6 months after starting treatment. Normal skin sites were also analysed and acted as controls. RCM features and histopathological findings were blindly evaluated by the confocalist and pathologist. Correlation between RCM and histology was measured by overall per cent of agreement (OPA), kappa and ROC curves. Additionally, RCM images before and after treatment were assessed blinded from clinical information and correlated to clinical assessment. RESULTS Thirty-eight MF lesions were included. Nineteen of these 38 were re-assessed by RCM 6 months later. Fifty biopsies were performed (38 at baseline and 12 after 6 months). The combination of four RCM features corresponding to Pautrier's microabscess, epidermal and junctional lymphocytes and interface dermatitis formed the RCM checklist for MF that predicted the severity of disease with AUC of 0.95 (P = .003). CONCLUSION Reflectance confocal microscopy can assess activity within a lesion and over time and assist in the clinical management of patients with MF.
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Affiliation(s)
- Bruna Melhoranse Gouveia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Jillian Wells
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia
| | - Jennifer Kim
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW, Australia
| | - Helena Collgros
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Pascale Guitera
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Italy
| | - Pablo Fernandez-Penas
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, Westmead Hospital, Sydney, NSW, Australia
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22
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Shekhar A, Sinha CP, Sinha DK, Yadav SK, Baxla T. Intragluteal Cleft Ulcer: a Rare Presentation of Primary Cutaneous Non-Hodgkin's Lymphoma. Indian J Surg Oncol 2020; 11:24-26. [PMID: 33088123 DOI: 10.1007/s13193-019-01012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/12/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Abhinav Shekhar
- Department of General Surgery, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand India
| | | | | | | | - Tarak Baxla
- Mahatma Gandhi Memorial Medical College, Jharkhand, Jamshedpur, 831020 India
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23
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Clinical, Histologic, and Molecular Characteristics of Anaplastic Lymphoma Kinase-positive Primary Cutaneous Anaplastic Large Cell Lymphoma. Am J Surg Pathol 2020; 44:776-781. [PMID: 32412717 DOI: 10.1097/pas.0000000000001449] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Unlike systemic anaplastic large cell lymphoma, the vast majority of primary cutaneous anaplastic large cell lymphomas (C-ALCL) do not carry translocations involving the ALK gene and do not express ALK. Expression of ALK protein therefore strongly suggests secondary cutaneous involvement of a systemic anaplastic large cell lymphoma. Recent studies described a small subgroup of ALK-positive C-ALCL, but information on frequency, prognosis, and translocation partners is virtually lacking. A total of 6/309 (2%) C-ALCL patients included in the Dutch registry for cutaneous lymphomas between 1993 and 2019 showed immunohistochemical ALK expression. Clinical and histopathologic characteristics, immunophenotype and disease course were evaluated. Underlying ALK translocations were analyzed with anchored multiplex polymerase chain reaction-based targeted next-generation sequencing. Median age at diagnosis was 39 years (range: 16 to 53 y). All patients presented with a solitary lesion. Treatment with radiotherapy (n=5) or anthracycline-based chemotherapy (n=1) resulted in complete responses in all 6 patients. Three patients developed a relapse, of whom 2 extracutaneous. After a median follow-up of 41 months, 5 patients were alive without disease and 1 patient died of lymphoma. Immunohistochemically, 3 cases (50%) showed combined nuclear and cytoplasmic ALK expression with underlying NPM1-ALK fusions, while 3 cases (50%) showed solely cytoplasmic ALK expression with variant ALK fusion partners (TRAF1, ATIC, TPM3). ALK-positive C-ALCL is extremely uncommon, has a comparable favorable prognosis to ALK-negative C-ALCL, and should be treated in the same way with radiotherapy as first-line treatment.
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24
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Stranzenbach R. How do we treat cutaneous T-cell lymphoma? Ital J Dermatol Venerol 2020; 156:534-544. [PMID: 32938164 DOI: 10.23736/s2784-8671.20.06606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cutaneous T-cell lymphomas are a heterogeneous group of non-Hodgkin lymphomas which are based on the malignant proliferation of skin-related T lymphocytes. The clinical appearance, as well as the course and the associated therapeutic approach, are sometimes very different between the different subtypes. Since allogeneic stem cell transplantation is currently the only curative option, and the morbidity and mortality are not insignificant, a therapy concept should be developed that considers its often rather indolent but chronic course. This concept should enable a good disease control with as few side effects as possible and preserve or improve the quality of life. In the early stages of the disease, skin-oriented therapies are generally used first before systemic and increasingly aggressive therapeutic agents are used as the disease progresses. Considering the current guidelines, literature and subjective experience, we summarize in this review how we treat cutaneous T-cell lymphomas.
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Affiliation(s)
- René Stranzenbach
- Department of Dermatology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany -
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25
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Tawa M, Kopp E, McCann S, Cantrell W. Cutaneous T-Cell Lymphoma: Optimizing Care in Patients Receiving Anti-CCR4 Monoclonal Antibody Mogamulizumab. Clin J Oncol Nurs 2020; 23:E73-E80. [PMID: 31322628 DOI: 10.1188/19.cjon.e73-e80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL), including subtypes mycosis fungoides (MF) and Sézary syndrome (SS), represents a rare group of non-Hodgkin lymphomas. Mogamulizumab is a first-in-class monoclonal antibody that selectively binds to C-C chemokine receptor 4, which is overexpressed on the surface of tumor cells in T-cell malignancies, including MF/SS-type CTCL. OBJECTIVES This review identifies common diagnostic features of MF/SS, the efficacy and side effect profile of mogamulizumab, and practical management strategies for optimizing the nursing care of patients with MF/SS-type CTCL. METHODS Case studies are used to describe the role of mogamulizumab in CTCL and to review practical considerations when administering mogamulizumab to patients. FINDINGS Mogamulizumab is an effective treatment for adult patients with relapsed or refractory MF/SS-type CTCL who have received at least one prior systemic therapy. Infusion reactions and drug eruptions require prompt diagnosis and treatment.
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Affiliation(s)
| | - Erin Kopp
- City of Hope Comprehensive Cancer Center
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26
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Elsayad K, Stadler R, Steinbrink K, Eich HT. Kombination von Ganzhautbestrahlung und Immuncheckpoint‐Inhibitoren: Eine vielversprechende Therapieoption bei Mycosis fungoides und Sézary‐Syndrom. J Dtsch Dermatol Ges 2020; 18:193-198. [PMID: 32130771 DOI: 10.1111/ddg.14044_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Khaled Elsayad
- Klinik für Strahlentherapie, Universitätsklinikum Münster
| | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling-Klinikum Minden
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27
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Elsayad K, Stadler R, Steinbrink K, Eich HT. Combined total skin radiotherapy and immune checkpoint inhibitors: A promising potential treatment for mycosis fungoides and Sezary syndrome. J Dtsch Dermatol Ges 2020; 18:193-197. [DOI: 10.1111/ddg.14044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Khaled Elsayad
- Department of Radiation OncologyUniversity Hospital Muenster Muenster Germany
| | - Rudolf Stadler
- Department of DermatologyJohannes Wesling Klinikum Minden Minden Germany
| | | | - Hans Theodor Eich
- Department of Radiation OncologyUniversity Hospital Muenster Muenster Germany
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28
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Melhoranse Gouveia B, Wells J, Kim J, Consuegra G, Longo C, Fernandez-Penas P. Systematic review and proposal of an in vivo reflectance confocal microscopy assessment tool for cutaneous lymphoma. J Cutan Pathol 2019; 47:295-304. [PMID: 31618473 DOI: 10.1111/cup.13598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is a non-invasive imaging technique that provides dynamic information and allows in vivo monitoring, with excellent histologic correlation. In the last decade, the use of RCM for cutaneous T-cell lymphomas (CTCL) has been reported. CTCL may require multiple biopsies for diagnosis due to its equivocal clinical presentation. RCM was described as a possible tool to help determine the best site for skin biopsy. This study aims to systematically review all RCM features reported in literature for CTCL. METHOD A systematic literature search concerning CTCL evaluated by RCM was performed in eight electronic databases until May 2019 following PRISMA-DTA quality assessment. RESULTS Eighteen RCM features were described in patients with CTCL. The most frequent were: interface dermatitis (89%), epidermal lymphocytes (82%), epidermal architectural disarray (81%), and vesicle-like structure (Pautrier microabscess) (51%). CONCLUSION In order to establish comparable parameters among the studies identified, we proposed descriptors for CTCL features and a grading system to quantify them. This will facilitate to define the role of RCM in the diagnosis and monitoring of CTCL patients.
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Affiliation(s)
| | - Jillian Wells
- Department of Dermatology, Westmead Hospital, Sydney, Australia
| | - Jennifer Kim
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
| | | | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
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29
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Pallazola VA, Deib G, Abha S, Geha RM, Kobayashi K. An Elusive Case of Mycosis Fungoides: Case Report and Review of the Literature. J Gen Intern Med 2019; 34:2669-2674. [PMID: 31388911 PMCID: PMC6848709 DOI: 10.1007/s11606-019-05231-z] [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: 10/19/2018] [Revised: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Abstract
Erythroderma refers to a spectrum of skin diseases resulting in diffuse erythema and scaling encompassing ≥ 90% of the body surface area. The differential diagnosis ranges from primary dermatologic diseases such as atopic dermatitis and psoriasis to potentially deadly causes such as staphylococcal toxic shock syndrome, toxic epidermal necrolysis, and malignancy. Cutaneous T cell lymphoma (CTCL) is an uncommon but highly morbid cause of erythroderma. This non-Hodgkin lymphoma remains a diagnostic challenge due to its variable clinical presentation and varied histologic features. Mycosis fungoides (MF) is the most common form of CTCL. Making a timely diagnosis is challenging as it may mimic inflammatory diseases of the skin including eczema, psoriasis, lichen planus, and cutaneous lupus. We present a case of a 58-year-old man who presented with 5 years of cutaneous symptoms and several months of fevers and night sweats, ultimately diagnosed as MF. Owing to diffuse CD30 positivity, he was a candidate for brentuximab vedotin, an antibody-drug conjugate medication that selectively targets the CD30 antigen. This resulted in an excellent therapeutic response.
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Affiliation(s)
- Vincent A Pallazola
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
| | - Gerard Deib
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Soni Abha
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rabih M Geha
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kimiyoshi Kobayashi
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
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30
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Mandava A, Koppula V, Wortsman X, Catalano O, Alfageme F. The clinical value of imaging in primary cutaneous lymphomas: Role of high resolution ultrasound and PET-CT. Br J Radiol 2019; 92:20180904. [PMID: 30608186 PMCID: PMC6540868 DOI: 10.1259/bjr.20180904] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/01/2018] [Accepted: 12/19/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND: Primary cutaneous lymphoma is a rare extranodal non-Hodgkin's lymphoma confined to the skin. The data on the imaging findings of primary cutaneous lymphomas are largely lacking and the current diagnosis is based on clinical and histopathological examination. With the advances in dermatological ultrasound and molecular imaging, newer perspectives in the evaluation of cutaneous lymphomas are available. OBJECTIVE: To review and describe the imaging findings in patient's with the diagnosis of primary cutaneous lymphoma. METHODS: A multicentric, retrospective observational study was undertaken in four countries to review the high resolution ultrasonography (HRUS) and fluorine 18-fludeoxyglucose positron emission tomography-computed tomography (PET-CT) imaging findings. RESULTS: We had 41 patients, Female:Male 1:4.1; mean age, 57 years; range, 13-94 years. High resolution ultrasonography of the primary cutaneous lesions revealed thickening of the dermis in all the cases and the lesions were hypoechoic without any calcifications or central necrosis. The sonographic appearances of the lesions were categorised into focal infiltrative, nodular, pseudonodular, and diffusely infiltrative patterns. Nodular and pseudonodular lesions were predominant in B cell lymphomas, while diffusely infiltrative lesions were more common in T-cell lymphomas. On colour Doppler imaging, the lesions were hypervascular. Whole body 18F-fludeoxyglucose PET-CT imaging of the patients revealed increased uptake of the metabolite in the lesions. CONCLUSION: Sonographic patterns based on high resolution ultrasonography provide early clues to the non-invasive diagnosis of primary cutaneous lymphomas and PET-CT is the recommended modality of imaging for staging and follow-up. ADVANCES IN KNOWLEDGE: High resolution ultrasound with colour Doppler and PET-CT imaging are complimentary to the clinical diagnosis of primary cutaneous lymphomas.
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Affiliation(s)
- Anitha Mandava
- Department of Radiodiagnosis, Basavatarakam Indo-American Cancer Institute and Research Centre, Hyderabad, India
| | - Veeraiah Koppula
- Department of Radiodiagnosis, Basavatarakam Indo-American Cancer Institute and Research Centre, Hyderabad, India
| | - Ximena Wortsman
- Departments of Dermatology, Faculties of Medicine, University of Chile and Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Fernando Alfageme
- Dermatology Service, Hospital Universitario, Puerta de Hierro, Majadahonda, Madrid, Spain
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31
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32
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Van Der Weyden C, Dickinson M, Whisstock J, Prince HM. Brentuximab vedotin in T-cell lymphoma. Expert Rev Hematol 2018; 12:5-19. [DOI: 10.1080/17474086.2019.1558399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - James Whisstock
- ARC Centre of Excellence in Advanced Molecular Imaging, Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Melbourne, Australia
| | - H. Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Richmond, Australia
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33
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Hematopoietic stem cell transplantation for subcutaneous panniculitis-like T-cell lymphoma: single center experience in an Asian population. Int J Hematol 2018; 109:187-196. [PMID: 30547418 DOI: 10.1007/s12185-018-02568-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare form of cytotoxic T-cell lymphoma. It is believed that SPTL in patients without hemophagocytic syndrome (HPS) follows an indolent course; in contrast, SPTL in patients with HPS has been associated with unfavorable survival. To provide more clinical data on SPTL in Asian populations and to identify optimal therapeutic strategies for SPTL, we assessed the clinicopathological features and long-term follow-up data of 10 Taiwanese SPTL patients diagnosed at a single center. Our study demonstrates a group of patients with high incidence of HPS (50%), rather aggressive courses, and early progression. A total of eight patients underwent hematopoietic stem cell transplant (HSCT), including one autologous HSCT and seven allogeneic HSCT. Seven of eight patients receiving HSCT achieved durable remission and maintained in remission for over 30 months (range 30-132 months). There was no difference in 3-year survival of patients with HPS (80%) compared with patients without HPS (80%). Of long-term survivors in the HPS group, three of four received HSCT (autologous HSCT, n = 1; allogeneic HSCT, n = 2). Our study indicated that HSCT is a curative option for eligible SPTL patients with HPS.
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34
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Wolf S, Goiriz R, Dhairyawan R, Paige D, Rizvi H, Haroon A, Montoto S. Brentuximab vedotin in multifocal cutaneous anaplastic large cell lymphoma in a patient with human immunodeficiency virus following Hodgkin lymphoma. Clin Exp Dermatol 2018; 44:562-564. [PMID: 30430604 DOI: 10.1111/ced.13824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2018] [Indexed: 01/10/2023]
Affiliation(s)
- S Wolf
- Department of Haemato-Oncology, Barts Health NHS Trust, London, UK
| | - R Goiriz
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - R Dhairyawan
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - D Paige
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - H Rizvi
- Department of Pathology, Barts Health NHS Trust, London, UK
| | - A Haroon
- Department of Imaging, Barts Health NHS Trust, London, UK
| | - S Montoto
- Department of Haemato-Oncology, Barts Health NHS Trust, London, UK
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35
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The First Year of the AEVD Primary Cutaneous Lymphoma Registry. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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36
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Registro de linfomas cutáneos primarios de la AEDV: primer año de funcionamiento. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:610-616. [DOI: 10.1016/j.ad.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/19/2018] [Accepted: 03/20/2018] [Indexed: 02/06/2023] Open
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Seto AG, Beatty X, Lynch JM, Hermreck M, Tetzlaff M, Duvic M, Jackson AL. Cobomarsen, an oligonucleotide inhibitor of miR-155, co-ordinately regulates multiple survival pathways to reduce cellular proliferation and survival in cutaneous T-cell lymphoma. Br J Haematol 2018; 183:428-444. [PMID: 30125933 DOI: 10.1111/bjh.15547] [Citation(s) in RCA: 182] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/19/2018] [Indexed: 12/15/2022]
Abstract
miR-155, a microRNA associated with poor prognosis in lymphoma and leukaemia, has been implicated in the progression of mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma (CTCL). In this study, we developed and tested cobomarsen (MRG-106), a locked nucleic acid-modified oligonucleotide inhibitor of miR-155. In MF and human lymphotropic virus type 1 (HTLV-1+) CTCL cell lines in vitro, inhibition of miR-155 with cobomarsen de-repressed direct miR-155 targets, decreased expression of multiple gene pathways associated with cell survival, reduced survival signalling, decreased cell proliferation and activated apoptosis. We identified a set of genes that are significantly regulated by cobomarsen, including direct and downstream targets of miR-155. Using clinical biopsies from MF patients, we demonstrated that expression of these pharmacodynamic biomarkers is dysregulated in MF and associated with miR-155 expression level and MF lesion severity. Further, we demonstrated that miR-155 simultaneously regulates multiple parallel survival pathways (including JAK/STAT, MAPK/ERK and PI3K/AKT) previously associated with the pathogenesis of MF, and that these survival pathways are inhibited by cobomarsen in vitro. A first-in-human phase 1 clinical trial of cobomarsen in patients with CTCL is currently underway, in which the panel of proposed biomarkers will be leveraged to assess pharmacodynamic response to cobomarsen therapy.
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Affiliation(s)
| | - Xuan Beatty
- miRagen Therapeutics, Inc., Boulder, CO, USA
| | | | | | - Michael Tetzlaff
- Section of Dermatopathology, Department of Pathology, Department of Translational and Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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38
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Amitay-Laish I, Reiter O, Prag-Naveh H, Kershenovich R, Hodak E. Retinoic acid receptor agonist as monotherapy for early-stage mycosis fungoides: does it work? J DERMATOL TREAT 2018; 30:258-263. [PMID: 29889596 DOI: 10.1080/09546634.2018.1487525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Retinoids exert their biologic effects by binding to intracellular retinoic-acid receptors (RARs) and/or retinoid X receptors (RXRs). Early-stage mycosis fungoides (MF) has been effectively treated with bexarotene, an RXR-agonist, with overall response (OR) rates 54-67% and complete response (CR) rates 7-27%. Data on RAR-agonist monotherapy are limited. OBJECTIVE To analyze the effectiveness of RAR-agonist monotherapy for early-stage MF. METHODS Data on patients with early-stage MF treated with acitretin/isotretinoin monotherapy at a tertiary cutaneous lymphoma clinic in 2010-2017 were collected retrospectively from the medical files. RESULTS Thirty-five patients (26 males) of median age 50 years (range 8-83) with early-stage MF (IA 9, IB 26) underwent 37 treatment events: 25 acitretin and 12 isotretinoin at a median dosages of 0.3 mg/kg (range 0.2-0.9) and 0.2 mg/kg (range 0.1-0.7), respectively. Median time to maximal response was 6 months for both (range 1-10 for acitretin, 3-16 for isotretinoin); median treatment duration was 10 months (range 3-46) for acitretin, and 9 months (range 3-55) for isotretinoin. OR was 64% for acitretin and 80% for isotretinoin, and CR, 4% and 8%, respectively. Side-effect profiles were as previously reported for retinoids. CONCLUSIONS Early-stage MF patients may benefit from low dose RAR-agonist monotherapy, although the CR rate is low.
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Affiliation(s)
- Iris Amitay-Laish
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ofer Reiter
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Hadas Prag-Naveh
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel
| | - Ruben Kershenovich
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel
| | - Emmilia Hodak
- a Department of Dermatology , Rabin Medical Center, Beilinson Hospital , Petach Tikva, Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Nair R, Kakroo A, Bapna A, Gogia A, Vora A, Pathak A, Korula A, Chakrapani A, Doval D, Prakash G, Biswas G, Menon H, Bhattacharya M, Chandy M, Parihar M, Vamshi Krishna M, Arora N, Gadhyalpatil N, Malhotra P, Narayanan P, Nair R, Basu R, Shah S, Bhave S, Bondarde S, Bhartiya S, Nityanand S, Gujral S, Tilak TVS, Radhakrishnan V. Management of Lymphomas: Consensus Document 2018 by an Indian Expert Group. Indian J Hematol Blood Transfus 2018; 34:398-421. [PMID: 30127547 PMCID: PMC6081314 DOI: 10.1007/s12288-018-0991-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/20/2022] Open
Abstract
The clinical course of lymphoma depends on the indolent or aggressive nature of the disease. Hence, the optimal management of lymphoma needs a correct diagnosis and classification as B cell, T-cell or natural killer (NK)/T-cell as well as indolent or high-grade type lymphoma. The current consensus statement, developed by experts in the field across India, is intended to help healthcare professionals manage lymphomas in adults over 18 years of age. However, it should be noted that the information provided may not be appropriate to all patients and individual patient circumstances may dictate alternative approaches. The consensus statement discusses the diagnosis, staging and prognosis applicable to all subtypes of lymphoma, and detailed treatment regimens for specific entities of lymphoma including diffuse large B-cell lymphoma, Hodgkin's lymphoma, follicular lymphoma, T-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Burkitt's lymphoma, and anaplastic large cell lymphoma.
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Affiliation(s)
- Reena Nair
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Ajay Bapna
- Bhagwan Mahavir Cancer Hospital Research Center (BMCHRC), Jaipur, India
| | - Ajay Gogia
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Anu Korula
- Christian Medical College (CMC), Vellore, India
| | | | - Dinesh Doval
- Rajiv Gandhi Cancer Institute and Research Centre (RGCI), New Delhi, Delhi India
| | - Gaurav Prakash
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ghanashyam Biswas
- Sparsh Hospital American Oncology Institute (AOI), Bhubaneswar, India
| | - Hari Menon
- Cytecare Cancer Hospitals, Bangalore, India
| | | | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Mayur Parihar
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Neeraj Arora
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | - Pankaj Malhotra
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rekha Nair
- Regional Cancer Centre (RCC), Thiruvananthapuram, India
| | - Rimpa Basu
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | - Sandip Shah
- Vedant Institute of Medical Sciences, Ahmedabad, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
| | | | | | - Soniya Nityanand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
| | | | | | - Vivek Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center (TMC), New Town, Rajarhat, Kolkata, West Bengal 700 160 India
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Wickenden K, Graham-Brown MPM, Veitch D, Dormer J, Bamford M, Graham-Brown RAC, Warwick G, Wagner S, Burton JO. Sézary Syndrome Presenting With Renal Involvement. Am J Kidney Dis 2018; 72:890-894. [PMID: 29941220 DOI: 10.1053/j.ajkd.2018.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 04/14/2018] [Indexed: 11/11/2022]
Abstract
Sézary syndrome is a rare aggressive leukemic variant of primary cutaneous T-cell lymphoma, typically presenting with erythroderma, lymphadenopathy, and an atypical clonal T-cell population. Though it often involves the spleen and liver, we report a case of Sézary syndrome with renal involvement that was treated successfully. Visceral involvement confers a poor prognosis requiring systemic treatment. The patient we describe was a 66-year-old man who was referred from Dermatology services for deteriorating kidney function. Polymerase chain reaction of genomic DNA from skin and kidney biopsies confirmed a clonal T-cell population matching a population isolated in peripheral blood. The patient was treated initially with alemtuzumab, which led to a significant improvement in kidney function, and he has subsequently received a successful allogeneic stem cell transplant. This case represents a rare cause of decreased kidney function and highlights the role of biopsy in patients with suspected Sézary syndrome.
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Affiliation(s)
- Katie Wickenden
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Matthew P M Graham-Brown
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom.
| | - David Veitch
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - John Dormer
- Department of Histopathology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mark Bamford
- Department of Dermatology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Robin A C Graham-Brown
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Graham Warwick
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Simon Wagner
- Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - James O Burton
- John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
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Melchers R, Willemze R, Bekkenk M, de Haas E, Horvath B, van Rossum M, Sanders C, Veraart J, Vermeer M, Quint K. Evaluation of treatment results in multifocal primary cutaneous anaplastic large cell lymphoma: report of the Dutch Cutaneous Lymphoma Group. Br J Dermatol 2018; 179:724-731. [DOI: 10.1111/bjd.16501] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- R.C. Melchers
- Department of Dermatology; Leiden University Medical Center; the Netherlands
| | - R. Willemze
- Department of Dermatology; Leiden University Medical Center; the Netherlands
| | - M.W. Bekkenk
- Department of Dermatology; Academic Medical Center and Vrije University Medical Center; Amsterdam the Netherlands
| | - E.R.M. de Haas
- Department of Dermatology; Erasmus Medical Center; Rotterdam the Netherlands
| | - B. Horvath
- Department of Dermatology; University Medical Center of Groningen; the Netherlands
| | - M.M. van Rossum
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
| | - C.J.G. Sanders
- Department of Dermatology; University Medical Center Utrecht; the Netherlands
| | - J.C.J.M. Veraart
- Department of Dermatology; Maastricht University Medical Center; the Netherlands
| | - M.H. Vermeer
- Department of Dermatology; Leiden University Medical Center; the Netherlands
| | - K.D. Quint
- Department of Dermatology; Leiden University Medical Center; the Netherlands
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Estrach T, Servitje O, Ortiz-Romero PL. AEDV Primary Cutaneous Lymphoma Registry. ACTAS DERMO-SIFILIOGRAFICAS 2018; 108:181-183. [PMID: 28347423 DOI: 10.1016/j.ad.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Indexed: 01/30/2023] Open
Affiliation(s)
- T Estrach
- Servicio de Dermatologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - O Servitje
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat España
| | - P L Ortiz-Romero
- Servicio de Dermatologia, Hospital 12 de Octubre, Instituto i+12, Facultad de Medicina, Universidad Complutense, Madrid, España
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Primary cutaneous non-Hodgkin lymphoma: results of a retrospective analysis in the light of the recent ILROG guidelines. TUMORI JOURNAL 2018; 104:394-400. [PMID: 28218382 DOI: 10.5301/tj.5000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE: To analyze clinical outcome, local response, survival and toxicity in patients with primary cutaneous lymphoma (PCL) treated with radiotherapy. METHODS: From 1995 to 2014, 112 patients were treated. B-cell lymphomas (CBCLs; n = 86) and T-cell lymphomas (CTCLs; n = 23) were analyzed separately. Clinical and therapeutic characteristics (age, sex, histology, primary treatment and radiotherapy modality) were related to response to treatment, survival and toxicity. RESULTS: CBCLs were divided into 4 subgroups: marginal-zone lymphoma (n = 20), follicle center lymphoma (n = 32), diffuse large-cell lymphoma (DLBCL; n = 22) and DLBCL-leg type (n = 12). No significant correlation was found between doses and systemic treatments, extent of biopsy and number of lesions. DLBCL-leg type patients were older (p = 0.05), had disseminated disease (p = 0.034), and more frequently had local (p = 0.01) or systemic recurrence (p = 0.05). CTCLs were divided into 4 subgroups: α/β CTCL (n = 3), nasal type CTCL (n = 0), γ/δ CTCL (n = 10) and mycosis fungoides (n = 10). Longer disease-free survival was observed in patients obtaining complete remission (p<0.001). CONCLUSIONS: Radiotherapy is feasible, safe and effective for localized PCLs. The choice of dose is related to histological subgroups and the related prognoses. Survival results are very good also in relapsing disease. In advanced cutaneous lymphoma radiotherapy alone has mainly a role in symptom palliation.
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Maminakis C, Whitman AC, Islam N. Bexarotene-Induced Hypertriglyceridemia: A Case Report. Case Rep Oncol 2018; 11:234-238. [PMID: 29805374 PMCID: PMC5968235 DOI: 10.1159/000488447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022] Open
Abstract
We present a case of a patient with cutaneous T-cell lymphoma started on bexarotene 300 mg/m2 due to progressing disease. The patient experienced good clinical response, but unfortunately, she developed rapid and profound hypertriglyceridemia. Although hypertriglyceridemia occurs in high incidence with bexarotene therapy, management recommendations are scarce. Due to the rise in triglycerides, atorvastatin 10 mg daily was initiated in combination with fenofibrate 120 mg daily. Triglycerides continued to increase, so the patient was instructed to take atorvastatin 40 mg, fenofibrate 120 mg, and to hold bexarotene for 2 weeks. After the 2-week break, bexarotene was restarted at 150 mg/m2.
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Affiliation(s)
- Chris Maminakis
- College of Pharmacy and Health Sciences, Western New England University, Springfield, Massachusetts, USA
| | - Arin C Whitman
- Oncology Clinic, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Nahida Islam
- Oncology Clinic, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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Abstract
PURPOSE OF REVIEW Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma. Globally, the most common subtypes of CTCL are mycosis fungoides and Sézary syndrome. CTCL can confer significant morbidity and even mortality in advanced disease. Here we review the current and potential future treatments for advanced-stage CTCL. RECENT FINDINGS Heterogeneity of treatment choice has been demonstrated both in US and non-US centers. Systemic treatment choice is currently guided by prognostic features, incorporating stage, immunophenotypic and molecular findings, and patient-specific factors such as age and comorbidities. Randomized controlled studies are uncommon, and the literature is composed predominantly of retrospective, cohort, and early-phase studies. International consensus guidelines are available; however, the lack of comparative trials means that there is no clear algorithmic approach to treatment. This review article reports on the systemic treatment options in current use for advanced CTCL, and on the possible future therapies, acknowledging that an algorithmic approach is not yet forthcoming to guide treatment prioritization.
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Ruiz R, Morante Z, Mantilla R, Mas L, Casanova L, Gomez HL. Primary cutaneous T-cell lymphoma: experience from the Peruvian National Cancer Institute. An Bras Dermatol 2018; 92:649-654. [PMID: 29166501 PMCID: PMC5674697 DOI: 10.1590/abd1806-4841.20176825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/04/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Primary cutaneous T-cell lymphomas constitute a heterogeneous and rare group of diseases with regional particularities in Latin America. OBJECTIVE To determine the clinicopathological features, relative frequency and survival among patients from a Peruvian institution. METHODS Primary cutaneous T-cell lymphomas were defined based on the absence of extracutaneous disease at diagnosis. Classification was performed following the 2008 World Health Organization Classification of Neoplasms of the Hematopoietic and Lymphoid tissues. Risk groups were established according to the 2005 World Health Organization-EORTC classification for cutaneous lymphomas. Data of patients admitted between January 2008 and December 2012 were analyzed. RESULTS 74 patients were included. Mean age was 49.5 years. In order of frequency, diagnoses were: mycosis fungoides (40.5%), peripheral T-cell lymphoma not otherwise specified (22.95%), adult T-cell lymphoma/leukemia (18.9%), CD30+ lymphoproliferative disorders (6.8%), hydroa vacciniforme-like lymphoma (5.4%), extranodal NK/T-cell lymphoma (4.1%) and Sézary syndrome (1.4%). Predominant clinical patterns were observed across different entities. Mycosis fungoides appeared mainly as plaques (93%). Peripheral T-cell lymphoma not otherwise specified and adult T-cell lymphoma/leukemia presentation was polymorphic. All patients with hydroa vacciniforme-like lymphoma presented with facial edema. All cases of extranodal NK/T-cell lymphoma appeared as ulcerated nodules/tumors. Disseminated cutaneous involvement was found in 71.6% cases. Forty-six percent of patients were alive at 5 years. Five-year overall survival was 76.4% and 19.2%, for indolent and high-risk lymphomas, respectively (p<0.05). High risk group (HR: 4.6 [2.08-10.18]) and increased DHL level (HR: 3.2 [1.57-6.46]) emerged as prognostic factors for survival. STUDY LIMITATIONS Small series. CONCLUSION Primary cutaneous T-cell lymphomas other than mycosis fungoides or CD30+ lymphoproliferative disorders are aggressive entities with a poor prognosis.
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Affiliation(s)
- Rosana Ruiz
- Medical Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN) - Surquillo, Peru
| | - Zaida Morante
- Medical Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN) - Surquillo, Peru
| | - Raul Mantilla
- Education Department, Instituto Nacional de Enfermedades Neoplásicas (INEN) - Surquillo, Peru
| | - Luis Mas
- Medical Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN) - Surquillo, Peru
| | - Luis Casanova
- Medical Oncology Service, Instituto Oncológico Miraflores - Miraflores, Peru
| | - Henry L Gomez
- Medical Oncology Service, Instituto Nacional de Enfermedades Neoplásicas (INEN) - Surquillo, Peru
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Allogeneic hematopoietic stem cell transplantation in Primary Cutaneous T Cell Lymphoma. Ann Hematol 2018; 97:1041-1048. [PMID: 29442161 DOI: 10.1007/s00277-018-3275-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/02/2018] [Indexed: 11/12/2022]
Abstract
In our retrospective study, 16 patients affected by advanced cutaneous T cell lymphoma (CTCL) underwent allogeneic hematopoietic stem cell transplantation (HSCT). Two patients (12.5%) were in complete remission (CR), nine (56.3%) in partial remission (PR), and five (31.2%) with active disease. The patients were transplanted from an HLA-identical (n = 7) from a mismatched (n = 1) or haploidentical (n = 1) sibling, from matched unrelated donor (n = 5), or from a single cord blood unit (n = 2). Conditioning regimen was standard myeloablative in 6 patients and at reduced intensity in 10. Seven patients died from non relapse mortality (NRM) and four patients relapsed or progressed, three of them achieved a second CR after donor lymphocyte infusion (DLI) or chemotherapy plus DLI. To date, with a median follow-up of 76 months (range 6-130), nine patients are alive, eight in CR, and one with active disease. Overall survival (OS) and disease-free survival (DFS) at 1 and 10 years are 61% (95% CI 40-91%) and 54% (95% CI 33-86%), 40% (95% CI 22-74%), and 34% (95% CI 16-68%), respectively. The time from diagnosis to transplant seems to influence negatively both OS (log-rank p < 0.04) and DFS (log-rank p < 0.05). Our results confirm on a long follow-up that CTCL appears particularly susceptible to the graft versus lymphoma (GVL) effect, so that allogeneic HSCT represents a possibility of cure for advanced CTCL. The timing of HSCT in the clinical course of disease remains an open issue.
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Transformation of primary cutaneous follicle centre lymphoma into primary cutaneous diffuse large B-cell lymphoma of other type. Postepy Dermatol Alergol 2018; 34:625-628. [PMID: 29422831 PMCID: PMC5799751 DOI: 10.5114/pdia.2017.66625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022] Open
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Polańska A, Dańczak-Pazdrowska A, Olek-Hrab K, Osmola-Mańkowska A, Bowszyc-Dmochowska M, Żaba R, Adamski Z. High-frequency ultrasonography-New non-invasive method in assessment of skin lymphomas. Skin Res Technol 2018; 24:517-521. [PMID: 29383760 DOI: 10.1111/srt.12450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Mycosis fingoides (MF) is the most common subtype of primary cutaneous T-cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5-year long monitoring of response to therapy in MF patients. MATERIALS AND METHODS The 5-years long follow-up based on 19 skin USG images of patients diagnosed as early stages of MF was studied. The assessed USG parameter was the mean diameter of subepidermal low echogenic band (SLEB). RESULTS In every MF patient during exacerbation within lesional skin we could observe SLEB, which thinning or complete disappearance was detected after finishing the therapy. Lack of complete absence of SLEB was related to the lack of complete remission assessed by mSWAT. CONCLUSION We present for the first time the possibility of monitoring patients' clinical state on the base of non-invasive USG imaging. We recommend additional use of 20 MHz USG to reduce intra-observer variability and to assess residual disease. USG imaging can complement evaluation of skin lesions in MF and can support clinical judgement.
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Affiliation(s)
- A Polańska
- Department of Dermatology and Venereology, University of Medical Sciences, Poznań, Poland
| | | | - K Olek-Hrab
- Department of Dermatology, University of Medical Sciences, Poznań, Poland
| | - A Osmola-Mańkowska
- Department of Dermatology, University of Medical Sciences, Poznań, Poland
| | | | - R Żaba
- Department of Dermatology and Venereology, University of Medical Sciences, Poznań, Poland
| | - Z Adamski
- Department of Dermatology, University of Medical Sciences, Poznań, Poland
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Purnak S, Azar J, Mark LA. Etoposide as a single agent in the treatment of mycosis fungoides: A retrospective analysis. Dermatol Ther 2018; 31:e12586. [DOI: 10.1111/dth.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Seda Purnak
- Department of DermatologyIndiana University School of MedicineIndianapolis Indiana
- Deparment of DermatologyUniversity of Health Sciences, Ankara Numune Training and Research HospitalAnkara Turkey
| | - Jose Azar
- Department of Hematology and OncologyIndiana University School of MedicineIndianapolis Indiana
| | - Lawrence Aaron Mark
- Department of DermatologyIndiana University School of MedicineIndianapolis Indiana
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