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Ndou L, Chambuso R, Valley-Omar Z, Rebello G, Algar U, Goldberg P, Boutall A, Ramesar R. Human Leukocyte Antigen-Allelic Variations May Influence the Age at Cancer Diagnosis in Lynch Syndrome. J Pers Med 2024; 14:575. [PMID: 38929796 PMCID: PMC11204704 DOI: 10.3390/jpm14060575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Lynch syndrome (LS) is an inherited cancer predisposition disorder associated with an elevated risk of developing various solid cancers, but mostly colorectal cancer (CRC). Despite having the same germline pathogenic variant (PV) in one of the mis-match repair genes or the EPCAM gene, Lynch syndrome variant heterozygotes (LSVH) exhibit a remarkable phenotypic variability in the risk of developing cancer. The role of human leukocyte antigen (HLA) in modifying cancer development risk prompted our hypothesis into whether HLA variations act as potential genetic modifiers influencing the age at cancer diagnosis in LSVH. To investigate this, we studied a unique cohort of 426 LSVH carrying the same germline PV in the hMLH1 gene (MLH1:c.1528C > T) in South Africa. We intuitively selected 100 LSVH with the greatest diversity in age at cancer diagnosis (N = 80) and the oldest cancer unaffected LSVH (N = 20) for a high-throughput HLA genotyping of 11 HLA class I and class II loci using the shotgun next-generation sequencing (NGS) technique on the Illumina MiSeq platform. Statistical analyses employed Kaplan-Meier survival analyses with log-rank tests, and Cox proportional hazards using binned HLA data to minimize type I error. Significant associations were observed between young age at cancer diagnosis and HLA-DPB1*04:02 (mean age: 37 y (25-50); hazard ratio (HR) = 3.37; corrected p-value (q) = 0.043) as well as HLA-DPB1 binned alleles (including HLA-DPB1*09:01, HLA-DPB1*10:01, HLA-DPB1*106:01, HLA-DPB1*18:01, HLA-DPB1*20:01, HLA-DPB1*26:01, HLA-DPB1*28:01, HLA-DPB1*296:01, and HLA-DPB1*55:01) (mean age: 37 y (17-63); HR = 2.30, q = 0.045). The involvement of HLA-DPB1 alleles in the age at cancer diagnosis may highlight the potential role of HLA class II in the immune response against cancer development in LSVH. When validated in a larger cohort, these high-risk HLA-DPB1 alleles could be factored into cancer risk prediction models for personalized cancer screening in LSVH.
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Affiliation(s)
- Lutricia Ndou
- UCT/MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, The University of Cape Town, Affiliated Hospitals, Cape Town 7704, South Africa
| | - Ramadhani Chambuso
- UCT/MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, The University of Cape Town, Affiliated Hospitals, Cape Town 7704, South Africa
| | - Ziyaad Valley-Omar
- Medical Virology, National Health Laboratory Service, Groote Schuur Hospital, The University of Cape Town, Cape Town 7925, South Africa
| | - George Rebello
- UCT/MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, The University of Cape Town, Affiliated Hospitals, Cape Town 7704, South Africa
| | - Ursula Algar
- The Colorectal Unit of the Department of Surgery, Groote Schuur Hospital, The University of Cape Town, Cape Town 7925, South Africa
| | - Paul Goldberg
- The Colorectal Unit of the Department of Surgery, Groote Schuur Hospital, The University of Cape Town, Cape Town 7925, South Africa
| | - Adam Boutall
- The Colorectal Unit of the Department of Surgery, Groote Schuur Hospital, The University of Cape Town, Cape Town 7925, South Africa
| | - Raj Ramesar
- UCT/MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine, The University of Cape Town, Affiliated Hospitals, Cape Town 7704, South Africa
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Almaani N, Farhan F, Bani Hamad S, Abuhawileh EA, Koubaitary L, Ahram M, Aladily TN. Genetic predisposition to early mycosis fungoides: investigating genetic polymorphisms in tissue-resident memory T-cell genes. J Int Med Res 2024; 52:3000605241239034. [PMID: 38546260 PMCID: PMC10981233 DOI: 10.1177/03000605241239034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/26/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVES Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma; it arises from tissue-resident memory T-cells (TRM). In the present study, we investigated potential functional genetic variations that may predispose MF development. METHODS A case-control study was conducted using whole-exome sequencing, with a focus on genes that are essential to TRM function. RESULTS We included 21 patients and 19 healthy subjects in the study. Single nucleotide polymorphisms in the following genes were significantly more common in patients than in healthy subjects: GZMB, HLA-DRB1, CD103, and NOTCH1. Moreover, the number of patients carrying single nucleotide polymorphisms in LAG3, NR4A2, and CD26L was significantly greater in the patient group than in the control group. CONCLUSIONS The presence of genetic variations in one or more TRM functional gene may predispose patients to develop MF. Further studies involving a larger patient population and a comparative analysis of protein expression will be necessary to validate these findings.
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Affiliation(s)
- Nour Almaani
- Department of Dermatology, The University of Jordan, Amman, Jordan
| | - Fatima Farhan
- Department of Health Data Analysis, Electronic Health Solution, Amman, Jordan
| | | | | | - Lana Koubaitary
- Department of Pathology, The University of Jordan, Amman, Jordan
| | - Mamoun Ahram
- Department of Physiology and Biochemistry, The University of Jordan, Amman, Jordan
| | - Tariq N Aladily
- Department of Pathology, The University of Jordan, Amman, Jordan
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Tizu M, Calenic B, Maruntelu I, Caragea AM, Talangescu A, Ursu L, Rotarescu C, Surugiu M, Constantinescu AE, Constantinescu I. Immunogenetic Background of Chronic Lymphoproliferative Disorders in Romanian Patients-Case Control Study. Med Sci (Basel) 2024; 12:14. [PMID: 38535155 PMCID: PMC10972167 DOI: 10.3390/medsci12010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The implications of the genetic component in the initiation and development of chronic lymphoproliferative disorders have been the subject of intense research efforts. Some of the most important genes involved in the occurrence and evolution of these pathologies are the HLA genes. The aim of this study is to analyze, for the first time, possible associations between chronic lymphoproliferative diseases and certain HLA alleles in the Romanian population. MATERIALS AND METHODS This study included 38 patients with chronic lymphoproliferative disorders, diagnosed between 2021 and 2022 at Fundeni Clinical Institute, Bucharest, Romania, and 50 healthy controls. HLA class I and class II genes (HLA-A/B/C, HLA-DQB1/DPB1/DRB1) were investigated by doing high resolution genotyping using sequence specific primers (SSP). RESULTS Several HLA alleles were strongly associated with chronic lymphoproliferative disorders. The most important finding was that the HLA-C*02:02 (p = 0.002, OR = 1.101), and HLA-C*12:02 (p = 0.002, OR = 1.101) have a predisposing role in the development of chronic lymphoproliferative disorders. Moreover, we identified that HLA-A*11:01 (p = 0.01, OR = 0.16), HLA-B*35:02 (p = 0.037, OR = 0.94), HLA-B*81:01 (p = 0.037, OR = 0.94), HLA-C*07:02 (p = 0.036, OR = 0.34), HLA-DRB1*11:01 (p = 0.021, OR = 0.19), and HLA-DRB1*13:02 (p = 0.037, OR = 0.94), alleles have protective roles. CONCLUSIONS Our study indicates that HLA-C*02:02 and HLA-C*12:02 are positively associated with chronic lymphoproliferative disorders for our Romanian patients while HLA-DRB1*11:01, HLA-DRB1*13:02, and HLA-B*35:02 alleles have a protective role against these diseases.
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Affiliation(s)
- Maria Tizu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 258 Fundeni Avenue, 022328 Bucharest, Romania (A.T.)
| | - Bogdan Calenic
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
| | - Ion Maruntelu
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 258 Fundeni Avenue, 022328 Bucharest, Romania (A.T.)
| | - Andreea Mirela Caragea
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 258 Fundeni Avenue, 022328 Bucharest, Romania (A.T.)
| | - Adriana Talangescu
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 258 Fundeni Avenue, 022328 Bucharest, Romania (A.T.)
| | - Larisa Ursu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
| | - Corina Rotarescu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
| | - Mariana Surugiu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
| | - Alexandra Elena Constantinescu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
| | - Ileana Constantinescu
- Immunology and Transplant Immunology, Carol Davila University of Medicine and Pharmacy, 258 Fundeni Avenue, 022328 Bucharest, Romania; (B.C.); (C.R.)
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 258 Fundeni Avenue, 022328 Bucharest, Romania (A.T.)
- Academy of Romanian Scientists (AOSR), 3 Ilfov Street, Sector 5, 022328 Bucharest, Romania
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Saghir SA, Ansari RA. HLA gene variations and mycotoxin toxicity: Four case reports. Mycotoxin Res 2024; 40:159-173. [PMID: 38198040 DOI: 10.1007/s12550-023-00517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
Mycotoxins are produced by certain molds that can cause many health effects. We present four human cases of prolonged consistent mycotoxins exposure linked to genetic variations in human leukocyte antigen (HLA) alleles. The HLA-DR/DQ isotype alleles are linked to mycotoxins susceptibility due to the lack of proper immune response; individuals with these alleles are poor eliminators of mycotoxins from their system. Four subjects with variations in their HLA-DR alleles were exposed to mycotoxins from living in mold-infested houses and experienced persistent mold-related symptoms long after moving out from the mold-infested houses and only exposed to the levels of molds found in the ambient air. From one of the subjects, two urine samples were collected ~ 18 months apart after the cessation of exposure. Urinary elimination rate was extremely slow for two of the mycotoxins (ochratoxin A [OTA] and mycophenolic acid [MPA]) detected in both samples. In 18 months, decline in OTA level was only ~ 3-fold (estimated t½ of ~ 311 days) and decline in MPA level was ~ 11-fold (estimated t½ of ~ 160 days), which was ~ 10- and ~ 213-fold slower than expected in individuals without HLA-DR alleles, respectively. We estimated that ~ 4.3 and ~ 2.2 years will be required for OTA and MPA to reach < LLQ in urine, respectively. Three other subjects with variations in HLA-DR alleles were members of a family who lived in a mold-infested house for 4 years. They kept experiencing mold-related issues >2 years after moving to a non-mold-infested house. Consistent exposure was confirmed by the presence of several mycotoxins in urine >2 years after the secession of higher than background (from outdoor ambient air) exposure. This was consistent with the extremely slow elimination of mycotoxins from their system. Variations in HLA-DR alleles can, consequently, make even short periods of exposure to chronic exposure scenarios with related adverse health effects. It is, therefore, important to determine genetic predisposition as a reason for prolonged/lingering mold-related symptoms long after the cessation of higher than background exposure. Increased human exposure to mycotoxins is expected from increased mold infestation that is anticipated due to rising CO2, temperature, and humidity from the climate change with possibly increased adverse health effects, especially in individuals with genetic susceptibility to mold toxicity.
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Affiliation(s)
- Shakil Ahmed Saghir
- ToxInternational Inc, Hilliard, OH, USA.
- Mold Law Group, Atlanta, GA, USA.
- Department of Biological & Biomedical Sciences, Aga Khan Univ, Karachi, Pakistan.
- Institute of Environmental Science and Meteorology, College of Science, University of the Philippines-Diliman, Quezon City, Philippines.
| | - Rais Ahmed Ansari
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Health Professions Division, Nova Southeastern University, Fort Lauderdale, FL, USA
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Blanco G, López‐Aventín D, Pujol RM, Gómez‐Llonín A, Puiggros A, López‐Sánchez M, Estrach T, García‐Muret MP, López‐Lerma I, Servitje O, Bellosillo B, Muro M, Espinet B, Rabionet R, Gallardo F. High-throughput RNA sequencing of the T cell receptor alpha and beta chains for simultaneous clonality and biological analyses in Sezary syndrome. J Clin Lab Anal 2023; 37:e24982. [PMID: 38115685 PMCID: PMC10756948 DOI: 10.1002/jcla.24982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Previous investigations pointed out a role for antigen stimulation in Sezary syndrome (SS). High-throughput sequencing of the T cell receptor (TR) offers several applications beyond diagnostic purposes, including the study of T cell pathogenesis. METHODS We performed high-throughput RNA sequencing of the TR alpha (TRA) and beta (TRB) genes focusing on the complementarity-determining region 3 (CDR3) in 11 SS and one erythrodermic mycosis fungoides (MF) patients. Five psoriasis patients were employed as controls. Peripheral blood CD4+ cells were isolated and RNA sequenced (HiSeq2500). High-resolution HLA typing was performed in neoplastic patients. RESULTS Highly expanded predominant TRA and TRB CDR3 were only found in SS patients (median frequency: 94.4% and 93.7%). No remarkable CDR3 expansions were observed in psoriasis patients (median frequency of predominant TRA and TRB CDR3: 0.87% and 0.69%, p < 0.001 compared to SS). CDR3 almost identical to the predominant were identified within each SS patient and were exponentially correlated with frequencies of the predominant CDR3 (R2 = 0.918, p < 0.001). Forty-six different CDR3 were shared between SS patients displaying HLA similarities, including predominant TRA and TRB CDR3 in one patient that were found in other three patients. Additionally, 351 antigen matches were detected (Cytomegalovirus, Epstein-Barr, Influenza virus, and self-antigens), and the predominant CDR3 of two different SS patients matched CDR3 with specificity for Influenza and Epstein-Barr viruses. CONCLUSIONS Besides detecting clonality, these findings shed light on the nature of SS-related antigens, pointing to RNA sequencing as a useful tool for simultaneous clonality and biological analysis in SS.
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Affiliation(s)
- Gonzalo Blanco
- Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
- Laboratori de Citogenètica Molecular, Servei de PatologiaHospital del MarBarcelonaSpain
- Karches Center for Oncology ResearchThe Feinstein Institutes for Medical Research, Northwell HealthManhassetNew YorkUSA
| | - Daniel López‐Aventín
- Servei de DermatologiaHospital del MarBarcelonaSpain
- Programa de Doctorat en Medicina, Departament de MedicinaUniversitat Autònoma de Barcelona (UAB)BarcelonaSpain
| | - Ramon M. Pujol
- Servei de DermatologiaHospital del MarBarcelonaSpain
- Grup de Recerca en Malalties Inflamatòries i Neoplàsiques Dermatològiques, Inflammation and Cardiovascular Disorders Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
| | - Andrea Gómez‐Llonín
- Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
- Laboratori de Citogenètica Molecular, Servei de PatologiaHospital del MarBarcelonaSpain
- Laboratori de Recerca Translacional en Microambient TumoralCancer Research ProgrammeBarcelonaSpain
| | - Anna Puiggros
- Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
- Laboratori de Citogenètica Molecular, Servei de PatologiaHospital del MarBarcelonaSpain
| | - Manuela López‐Sánchez
- Servicio de InmunologíaHospital Clínico Universitario Virgen de la Arrixaca‐IMIBMurciaSpain
| | - Teresa Estrach
- Servei de Dermatologia, Hospital Clínic, IDIBAPSUniversitat de BarcelonaBarcelonaSpain
| | | | | | | | - Beatriz Bellosillo
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Cancer Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
- Laboratori de Biologia Molecular, Servei de PatologiaHospital del MarBarcelonaSpain
| | - Manuel Muro
- Servicio de InmunologíaHospital Clínico Universitario Virgen de la Arrixaca‐IMIBMurciaSpain
| | - Blanca Espinet
- Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
- Laboratori de Citogenètica Molecular, Servei de PatologiaHospital del MarBarcelonaSpain
| | - Raquel Rabionet
- Departament de Genètica, Microbiologia i EstadísticaUniversitat de BarcelonaBarcelonaSpain
- Institut de Recerca Sant Joan de DéuHospital Sant Joan de DéuBarcelonaSpain
- Institut de Biomedicina (IBUB)Universitat de BarcelonaBarcelonaSpain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER)Instituto de Salud Carlos III (ISCIII)MadridSpain
| | - Fernando Gallardo
- Grup de Recerca Translacional en Neoplàsies Hematològiques, Cancer Research ProgrammeIMIM‐Hospital del MarBarcelonaSpain
- Servei de DermatologiaHospital del MarBarcelonaSpain
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Lee H. Mycosis fungoides and Sézary syndrome. Blood Res 2023; 58:66-82. [PMID: 37105561 PMCID: PMC10133849 DOI: 10.5045/br.2023.2023023] [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: 01/26/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are a distinct disease entity of cutaneous T-cell lymphoma with heterogenous clinical features and prognosis. MF mainly involves skin and usually shows an indolent and favorable clinical course. In patients with advanced-stage disease, extracutaneous involvement including lymph nodes, viscera, and blood, or large cell transformation may be observed. SS is a leukemic form of advanced-stage MF, characterized by generalized erythroderma. Early-stage MF can be treated with skin-directed therapy. However, patients with refractory or advanced-stage disease are associated with severe symptoms or poor prognosis, requiring systemic therapy. Recent progress in understanding the pathogenesis of MF/SS has contributed to advances in the management of these rare diseases. This review aims to describe the clinical manifestations, diagnosis, risk stratification, and treatment strategy of MF/SS, focusing on the recent updates in the management of these diseases.
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Affiliation(s)
- Hyewon Lee
- Division of Hemato-Oncology, Department of Internal Medicine, and Center for Hematologic Malignancy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Atilla PA, Atilla E. Are we there yet? cellular therapies for cutaneous T cell lymphoma. Curr Res Transl Med 2023; 71:103390. [PMID: 37062252 DOI: 10.1016/j.retram.2023.103390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
Cutaneous T cell lymphomas (CTCLs) are a heterogenous group of skin-involved T-cell non-Hodgkin lymphoma which Mycosis Fungoides and Sezary Syndrome are the most common variants. Despite considerable progress in distinguishing the pathophysiology, the treatment options are still limited for advanced-stage disease. Recent approval of novel agents such as vorinostat, brentuximab vedotin and mogamulizumab paved a way. Allogeneic hematopoietic stem cell transplantation has been shown to be a feasible option in selected advanced-stage CTCL patients. Chimeric antigen receptor (CAR) T cells have been promising for the treatment of B-cell tumors and have been approved for second-line treatment in non-Hodgkin's lymphoma. Although several obstacles still need to be addressed, CAR T cell treatment for CTCLs seems not far off. This review discusses new discoveries in pathophysiology, the state of cellular therapies in current practice, challenges for cellular treatment in advanced CTCL, and how to overcome these challenges.
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Affiliation(s)
- Pinar Ataca Atilla
- Ankara University Stem Cell Institute, Ankara, Turkey; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | - Erden Atilla
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA; Genyo Centre for Genomics and Oncological Research, Genomic Medicine Department, Pfizer/University of Gradana/Andalusian Regional Government, Health Sciences Technnology Park, Granada, Spain.
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Schaefer L, Comfere N, Sokumbi O. Development of Cutaneous T-Cell Lymphoma Following Biologic Treatment: A Systematic Review. Am J Clin Dermatol 2023; 24:153-164. [PMID: 36627479 DOI: 10.1007/s40257-022-00749-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphoma following biologic therapy is extremely rare. OBJECTIVE The aim of this systematic review was to investigate the development of cutaneous T-cell lymphoma (CTCL) following treatment with a biologic agent. METHODS A systematic literature review was performed for patients who developed CTCL after exposure to biologic therapy. Works were limited to English language and excluded animal studies, guidelines, and protocols. Potentially eligible titles were identified using controlled vocabulary in tandem with key words. The search strategy was peer-reviewed prior to execution. RESULTS Twenty-eight total studies revealed sixty-two patients who developed CTCL following exposure to a biologic agent. Of these, 44% were Caucasian, and the median age at diagnosis was 56 years. Seventy-six percent of patients received biologic therapy for a primary inflammatory skin condition. Dupilumab was the most reported (42%) agent amongst the cohort. The median time from initiation of the biologic agent to diagnosis of CTCL in these cases was 4 months (range: 0-84). Mycosis fungoides (65%) and Sézary syndrome (10%) were the most common subtypes of CTCL diagnosed. Twenty-one (34%) patients were reported to be alive with disease, outcome was not reported in 21 patients (34%), ten patients (16%) were alive and in complete remission, eight patients (13%) died of disease and two patients (3%) died due to other causes. CONCLUSION While biologic agents may have a role in the development of CTCL, in order to definitively elucidate their role, more methodologically robust studies (such as those that utilize population databases) would need to occur.
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Affiliation(s)
| | - Nneka Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, USA. .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA.
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Joshi TP, Black TA, Fernandez B, Friske S, Stafford H, Strouphauer E, Duvic M. Comorbidities associated with mycosis fungoides: A case-control study in the All of Us database. J Am Acad Dermatol 2023; 88:686-688. [PMID: 35817334 DOI: 10.1016/j.jaad.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/03/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Tejas P Joshi
- School of Medicine, Baylor College of Medicine, Houston, Texas.
| | - T Austin Black
- McGovern Medical School, University of Texas, Houston, Texas
| | | | - Sarah Friske
- School of Medicine, Baylor College of Medicine, Houston, Texas
| | | | | | - Madeleine Duvic
- Department of Dermatology, University of Texas, MD Anderson Cancer Center, Houston, Texas
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Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas: 2023 update on diagnosis, risk-stratification, and management. Am J Hematol 2023; 98:193-209. [PMID: 36226409 PMCID: PMC9772153 DOI: 10.1002/ajh.26760] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 02/04/2023]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or the blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and Dermatology, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109-2800
| | - Trilokraj Tejasvi
- Department of Dermatology, 1910 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Ryan A. Wilcox
- Correspondence to: Ryan Wilcox, MD, PhD, Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, 1500 E. Medical Center Drive, Room 4310 CC, Ann Arbor, MI 48109-5948, Phone: (734) 615-9799, Fax: (734) 936-7376,
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11
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Dehner CA, Ruff WE, Greiling T, Pereira MS, Redanz S, McNiff J, Girardi M, Kriegel MA. Malignant T Cell Activation by a Bacillus Species Isolated from Cutaneous T-Cell Lymphoma Lesions. JID INNOVATIONS 2022; 2:100084. [PMID: 35199089 PMCID: PMC8844718 DOI: 10.1016/j.xjidi.2021.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 01/04/2023] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a life-debilitating malignancy of lymphocytes homing to the skin. Although CTCL is thought to arise from a combination of genetic, epigenetic, and environmental factors, specific triggers are unclear. The skin is colonized by a unique microbiota and is heavily influenced by its interactions. We hypothesized that adaptive immune responses to skin commensals lead to clonal T-cell proliferation and transformation in the appropriate genetic background. We therefore collected lesional and nonlesional skin microbiota from patients with CTCL to study T cell interactions using skin T cell explants and peripheral, skin-homing CD4+ T cells. By various methods, we identified Bacillus safensis in CTCL lesions, a rare human commensal in healthy skin, and showed that it can induce malignant T cell activation and cytokine secretion. Taken together, our data suggest microbial triggers in the skin microbiota of patients with CTCL as potential instigators of tumorigenesis.
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Affiliation(s)
- Carina A. Dehner
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - William E. Ruff
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Teri Greiling
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Márcia S. Pereira
- Department of Translational Rheumatology and Immunology, Institute of Musculoskeletal Medicine, University of Münster, Münster, Germany
| | - Sylvio Redanz
- Department of Translational Rheumatology and Immunology, Institute of Musculoskeletal Medicine, University of Münster, Münster, Germany
| | - Jennifer McNiff
- Department of Dermatopathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael Girardi
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martin A. Kriegel
- Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Translational Rheumatology and Immunology, Institute of Musculoskeletal Medicine, University of Münster, Münster, Germany
- Section of Rheumatology and Clinical Immunology, Department of Medicine, University Hospital Münster, Münster, Germany
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12
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Karamova AE, Vorontsova AA, Zhilova MB, Znamenskaya LF, Saytburkhanov RR, Aulova KM. Melanoma in patients with mycosis fungoides. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The development of both malignant neoplasms mycosis fungoides and cutaneous malignant melanoma is a rare condition; nevertheless, the literature describes both cases of the development of mycosis fungoides in patients with a primary diagnosis of melanoma and the detection of cutaneous malignant melanoma in patients with T-cell lymphomas of the skin. The question of the effect of previous therapy for mycosis fungoides on the risk of cutaneous malignant melanoma remains controversial. Currently, the world community is considering a possible pathogenetic relationship between these two oncopathologies. The clinical observations of the development of cutaneous malignant melanoma in 2 patients with mycosis fungoides presented in the article emphasize the importance of a thorough clinical and dermatoscopic examination of all pigmented formations for the timely detection of malignant melanocytic neoplasms, the presence of which radically affects the further choice of treatment tactics for patients.
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13
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Hristov AC, Tejasvi T, Wilcox RA. Cutaneous T-cell lymphomas: 2021 update on diagnosis, risk-stratification, and management. Am J Hematol 2021; 96:1313-1328. [PMID: 34297414 PMCID: PMC8486344 DOI: 10.1002/ajh.26299] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies, including biologic-response modifiers, histone deacetylase inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and Dermatology, North Campus Research Complex, Ann Arbor, Michigan, USA
| | - Trilokraj Tejasvi
- Director Cutaneous Lymphoma program, Department of Dermatology, A. Alfred Taubman Health Care Center, Ann Arbor, Michigan, USA
| | - Ryan A. Wilcox
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
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14
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Bobrowicz M, Fassnacht C, Ignatova D, Chang YT, Dimitriou F, Guenova E. Pathogenesis and Therapy of Primary Cutaneous T-Cell Lymphoma: Collegium Internationale Allergologicum (CIA) Update 2020. Int Arch Allergy Immunol 2020; 181:733-745. [PMID: 32690848 DOI: 10.1159/000509281] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a heterogeneous disease group of unknown etiology with a complex immunological background. As CTCL arises from T cells that have a vital role in the antitumor response, their therapy is largely aimed at reversing the immunological mechanisms leading to or manifesting during this malignancy. Early disease stages can be controlled with skin-directed therapy in most CTCL cases. Still, advanced CTCL has a dismal prognosis and warrants systemic therapy. Despite considerable progress in understanding the pathophysiology of the disease and the numerous systemic treatment options available, long-term remission rates with conventional treatments alone are still low. Allogeneic hematopoietic stem cell transplantation is currently the only curative option for advanced CTCL, including mycosis fungoides and Sézary syndrome. The aims of this review is to summarize the recent findings on the immunology of this heterogeneous disease and to present the advances in its clinical management.
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Affiliation(s)
| | - Christina Fassnacht
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Desislava Ignatova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Florentia Dimitriou
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland, .,Faculty of Medicine, University of Zurich, Zurich, Switzerland, .,Department of Dermatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland, .,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,
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15
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Bhat TS, Rosman IS, Cornelius LA, Musiek AC. Mycosis fungoides associated with recurrence of malignant melanoma. JAAD Case Rep 2020; 6:793-795. [PMID: 32775589 PMCID: PMC7394829 DOI: 10.1016/j.jdcr.2020.06.029] [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: 11/18/2022] Open
Affiliation(s)
- Trisha S. Bhat
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
- Correspondence to: Trisha S. Bhat, BA, Division of Dermatology, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8123, St Louis, MO 63110.
| | - Ilana S. Rosman
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
- Department of Pathology & Immunology, Washington University School of Medicine, St Louis, Missouri
| | - Lynn A. Cornelius
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Amy C. Musiek
- Division of Dermatology, Washington University School of Medicine, St Louis, Missouri
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16
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Fiore D, Cappelli LV, Broccoli A, Zinzani PL, Chan WC, Inghirami G. Peripheral T cell lymphomas: from the bench to the clinic. Nat Rev Cancer 2020; 20:323-342. [PMID: 32249838 DOI: 10.1038/s41568-020-0247-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
Peripheral T cell lymphomas (PTCLs) are a heterogeneous group of orphan neoplasms. Despite the introduction of anthracycline-based chemotherapy protocols, with or without autologous haematopoietic transplantation and a plethora of new agents, the progression-free survival of patients with PTCLs needs to be improved. The rarity of these neoplasms, the limited knowledge of their driving defects and the lack of experimental models have impaired clinical successes. This scenario is now rapidly changing with the discovery of a spectrum of genomic defects that hijack essential signalling pathways and foster T cell transformation. This knowledge has led to new genomic-based stratifications, which are being used to establish objective diagnostic criteria, more effective risk assessment and target-based interventions. The integration of genomic and functional data has provided the basis for targeted therapies and immunological approaches that underlie individual tumour vulnerabilities. Fortunately, novel therapeutic strategies can now be rapidly tested in preclinical models and effectively translated to the clinic by means of well-designed clinical trials. We believe that by combining new targeted agents with immune regulators and chimeric antigen receptor-expressing natural killer and T cells, the overall survival of patients with PTCLs will dramatically increase.
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MESH Headings
- Epigenesis, Genetic/genetics
- Epigenesis, Genetic/physiology
- Humans
- Immunotherapy
- Lymphoma, T-Cell, Peripheral/drug therapy
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/metabolism
- Molecular Targeted Therapy
- Mutation
- Signal Transduction/genetics
- Signal Transduction/physiology
- T-Lymphocytes/physiology
- Transcription Factors/genetics
- Transcription Factors/physiology
- Tumor Microenvironment/genetics
- Tumor Microenvironment/immunology
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Affiliation(s)
- Danilo Fiore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Luca Vincenzo Cappelli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Alessandro Broccoli
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy.
| | - Wing C Chan
- Department of Pathology, City of Hope Medical Center, Duarte, CA, USA.
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
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17
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Phyo ZH, Shanbhag S, Rozati S. Update on Biology of Cutaneous T-Cell Lymphoma. Front Oncol 2020; 10:765. [PMID: 32477957 PMCID: PMC7235328 DOI: 10.3389/fonc.2020.00765] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Cutaneous T cell lymphomas (CTCL) comprise of a heterogeneous group of non-Hodgkin lymphomas derived from skin-homing T cells. Variation in clinical presentation and lack of definitive molecular markers make diagnosis especially challenging. The biology of CTCL remains elusive and clear links between genetic aberrations and epigenetic modifications that would result in clonal T cell expansion have not yet been identified. Nevertheless, in recent years, next generation sequencing (NGS) has enabled a much deeper understanding of the genomic landscape of CTCL by uncovering aberrant genetic pathways and epigenetic dysregulations. Additionally, single cell profiling is rapidly advancing our understanding of patients-specific tumor landscape and its interaction with the surrounding microenvironment. These studies have paved the road for future investigations that will explore the functional relevance of genetic alterations in the progression of disease. The ultimate goal of elucidating the pathogenesis of CTCL is to establish effective therapeutic targets with more durable clinical response and treat relapsing and refractory CTCL.
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Affiliation(s)
- Zaw H Phyo
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Satish Shanbhag
- Departments of Oncology and Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sima Rozati
- Department of Dermatology, Johns Hopkins University, Baltimore, MD, United States
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18
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Lewis DJ. Cutaneous microbiota in the pathogenesis of cutaneous T‐cell lymphoma and the role of antibiotic therapy. Int J Dermatol 2020; 59:e223-e224. [DOI: 10.1111/ijd.14798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel J. Lewis
- Department of Dermatology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA USA
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19
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Cao S, Wu Y, Qian X, Ma H. Genetic variants in HLA-DP/DQ contribute to risk of acute myeloid leukemia: A case-control study in Chinese. Pathol Res Pract 2020; 216:152829. [PMID: 32008865 DOI: 10.1016/j.prp.2020.152829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/19/2019] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
Human leukocyte antigens (HLA) are heterodimeric cell surface molecules that bind short peptides derived from non-self and self proteins. Accumulative evidence showed that specific alleles of HLA class II were associated with the susceptibility to malignant tumors including acute leukemia. In this study, we investigated the association between four single nucleotide polymorphisms (SNPs) at HLA-DP/DQ and acute myeloid leukemia (AML) risk. We genotyped four SNPs in HLA-DP (rs3077 G > A and rs9277535 G > A) and HLA-DQ (rs2856718 A > G and rs7453920 G > A) in a case-control study of 545 AML cases and 1034 cancer-free controls using Taqman allelic discrimination assay. The associations between these SNPs and AML risk were estimated by computing the odds ratios (ORs) and their 95% confidence intervals (CIs) from multivariate logistic regression analysis. We found significant associations of the variant alleles in HLA-DP (rs3077 and rs9277535) and HLA-DQ rs7453920 with increased AML risk (adjusted OR = 1.29, 95%CI = 1.10-1.51for rs3077 in additive model; adjusted OR = 1.29, 95%CI = 1.11-1.51 for rs9277535 in additive model; adjusted OR = 3.18, 95%CI = 1.86-5.46 for rs7453920 in recessive model). When combining the effects of rs3077, rs9277535 and rs7453920, we found that AML risk was significantly increased with the increasing number of variant alleles of the three SNPs in a dose-dependent manner (P for trend < 0.001). Besides, we found multiplicative interaction between rs3077 and age (≤45 years old and > 45 years old; P = 0.046). In conclusion, HLA-DP and HLA-DQ loci are candidate susceptibility regions for AML in Han Chinese.
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Affiliation(s)
- Songyu Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Yifei Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Xifeng Qian
- Department of Hematology, Wuxi Peoples' Hospital Affiliated to Nanjing Medical University, No. 299 Qingyang Road, Wuxi, China
| | - Hongxia Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China.
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20
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Vahedi SM, Nikbakht G, Jamshidi S, Lankarani L, Alimi N, Esmailnejad A. Association between DLA-DRB1.2 allelic diversity and development of mammary gland tumors in dogs. Acta Vet Scand 2019; 61:55. [PMID: 31727096 PMCID: PMC6857217 DOI: 10.1186/s13028-019-0491-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/04/2019] [Indexed: 01/12/2023] Open
Abstract
Background The major histocompatibility complex (MHC) is the best-characterized genetic region related to resistance/susceptibility to a wide range of infectious and immune-mediated diseases. Evidences suggest that MHC class II genes may play an important role in developing different types of tumors including breast cancer. Canine mammary gland tumors (CMTs) are the most common neoplasms in female dogs. In the current study, the association of canine MHC class II DLA-DRB1.2 genotypes with development of mammary gland tumor profiles in dogs was investigated. DLA-DRB1.2 allelic diversity was determined in 40 dogs (18 CMT cases and 22 controls) using HRM technique and DNA sequencing. Association of the DLA-DRB1.2 genotypes with CMT profiles was expressed as odds ratio (OR). Results Based on the histopathological typing of tumors, CMT cases were categorized into 4 groups: simple carcinoma, complex carcinoma, carcinoma arising in a benign tumor and special types of carcinoma. A total of eight HRM profiles (A to H) were identified in dogs sampled. The association study revealed a significant correlation between DLA-DRB1.2 genotypes with different CMT profiles. The E genotype was significantly associated with increased risk of carcinoma arising in a benign tumor, and the B genotype represented a positive correlation with complex carcinoma. Significant association was also observed between the heterozygosity of DLA-DRB1.2 genotypes and decreased risk of developing tumor in dogs. Conclusions These results provide additional support for the association between DLA-DRB1 genes and development of mammary gland tumors in dogs and could potentially be used for early diagnosis of neoplasia and identifying susceptible dogs.
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21
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Martinez XU, Di Raimondo C, Abdulla FR, Zain J, Rosen ST, Querfeld C. Leukaemic variants of cutaneous T-cell lymphoma: Erythrodermic mycosis fungoides and Sézary syndrome. Best Pract Res Clin Haematol 2019; 32:239-252. [PMID: 31585624 PMCID: PMC9056079 DOI: 10.1016/j.beha.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/05/2019] [Indexed: 01/22/2023]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common types of cutaneous lymphoma, accounting for approximately 60% of cutaneous T-cell lymphomas. Diagnosis requires correlation of clinical, histologic, and molecular features. A multitude of factors have been linked to the aetiopathogenesis, however, none have been definitively proven. Erythrodermic MF (E-MF) and SS share overlapping clinical features, such as erythroderma, but are differentiated on the degree of malignant blood involvement. While related, they are considered to be two distinct entities originating from different memory T cell subsets. Differential expression of PD-1 and KIR3DL2 may represent a tool for distinguishing MF and SS, as well as a means of monitoring treatment response. Treatment of E-MF/SS is guided by disease burden, patients' ages and comorbidities, and effect on quality of life. Current treatment options include biologic, targeted, immunologic, and investigational therapies that can provide long term response with minimal side effects. Currently, allogeneic stem cell transplantation is the only potential curative treatment.
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Affiliation(s)
| | - Cosimo Di Raimondo
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Farah R Abdulla
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Jasmine Zain
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA.
| | - Steven T Rosen
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, United States.
| | - Christiane Querfeld
- City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA; Beckman Research Institute, 1500 E. Duarte Road, Duarte, CA, 91010, United States.
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22
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Hristov AC, Tejasvi T, Wilcox RA. Mycosis fungoides and Sézary syndrome: 2019 update on diagnosis, risk-stratification, and management. Am J Hematol 2019; 94:1027-1041. [PMID: 31313347 DOI: 10.1002/ajh.25577] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 01/04/2023]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of T-cell neoplasms involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, skin-directed therapies are preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with systemic therapies. These include biologic-response modifiers, histone deacetylase (HDAC) inhibitors, or antibody-based strategies, in an escalating fashion. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Alexandra C. Hristov
- Departments of Pathology and DermatologyUniversity of Michigan Ann Arbor Michigan
| | | | - Ryan A. Wilcox
- Division of Hematology/Oncology, Department of Internal MedicineUniversity of Michigan Rogel Cancer Center Ann Arbor Michigan
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23
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Zhong C, Cozen W, Bolanos R, Song J, Wang SS. The role of HLA variation in lymphoma aetiology and survival. J Intern Med 2019; 286:154-180. [PMID: 31155783 DOI: 10.1111/joim.12911] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Epidemiologic and laboratory evidence has consistently supported a strong inflammatory and immune component for lymphoma aetiology. These studies have consistently implicated variation in the immune gene, human leucocyte antigen (HLA), to be associated with lymphoma risk. In this review, we summarize the historical and recent evidence of HLA in both lymphoma aetiology and survival. The recent momentum in uncovering HLA associations has been propelled by the conduct of genome-wide association studies (GWAS), which has permitted the evaluation of imputed HLA alleles in much larger sample sizes than historically feasible with allelotyping studies. Based on the culmination of smaller HLA typing studies and larger GWAS, we now recognize several HLA associations with Hodgkin (HL) and non-Hodgkin lymphomas (NHLs) and their subtypes. Although other genetic variants have also been implicated with lymphoma risk, it is notable that HLA associations have been reported in every NHL and HL subtype evaluated to date. Both HLA class I and class II alleles have been linked with NHL and HL risk. It is notable that the associations identified are largely specific to each lymphoma subtype. However, pleiotropic HLA associations have also been observed. For example, rs10484561, which is in linkage disequilibrium with HLA-DRB1*01:01˜DQA1*01:01˜DQB1*05:01, has been implicated in increased FL and DLBCL risk. Opposing HLA associations across subtypes have also been reported, such as for HLA-A*01:01 which is associated with increased risk of EBV-positive cHL but decreased risk of EBV-negative cHL and chronic lymphocytic leukaemia/small cell lymphoma. Due to extensive linkage disequilibrium and allele/haplotypic variation across race/ethnicities, identification of causal alleles/haplotypes remains challenging. Follow-up functional studies are needed to identify the specific immunological pathways responsible in the multifactorial aetiology of HL and NHL. Correlative studies linking HLA alleles with known molecular subtypes and HLA expression in the tumours are also needed. Finally, additional association studies investigating HLA diversity and lymphoma survival are also required to replicate initial associations reported to date.
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Affiliation(s)
- C Zhong
- Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute and Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
| | - W Cozen
- Genetic Epidemiology Center, Department of Preventive Medicine, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - R Bolanos
- Genetic Epidemiology Center, Department of Preventive Medicine, Keck School of Medicine of USC, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - J Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - S S Wang
- Division of Health Analytics, Department of Computational and Quantitative Medicine, Beckman Research Institute and Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
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24
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Chen CC, Chang YT, Liu HN, Chen YJ. Cancer risk in patients with alopecia areata: a nationwide population-based matched cohort study. Cancer Med 2018; 7:2153-2159. [PMID: 29577672 PMCID: PMC5943418 DOI: 10.1002/cam4.1448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/20/2022] Open
Abstract
Alopecia areata (AA) is an organ-specific autoimmune disorder. Defective immune system related disorders are prone to increase the risk of cancer formation. However, the association among AA and variety of cancer types had never been studied. A nationwide population-based matched cohort study was conducted to evaluate the cancer risk in patients with AA. Records from Taiwan National Health Insurance Research Database were analyzed. Cases of AA from 1997 to 2013 and cancers registered in the catastrophic illness profile from the same time period were collected. The standard incidence ratio (SIR) of each cancer was calculated. In total, 2099 cancers among 162,499 patients with AA and without prior cancers were identified. The overall cancer risks in AA patients were slightly decreased, especially among male subjects (SIR: 0.89). Refer to individual cancer, the cancer risk of nonmelanoma skin cancer (NMSC) (SIR: 0.59), upper GI cancer (SIR: 0.70), liver cancer (SIR: 0.82), uterine, and cervix cancer (SIR: 0.84) were significantly lower in patients with AA. In contrast, AA patients were inclined to have lymphoma, breast cancer, kidney, and urinary bladder cancer with the SIR of 1.55, 2.93, and 2.95, respectively. Age stratified analyses revealed female AA patients younger than 50 years old have even higher risk of breast cancer (SIR: 3.37). Further sensitivity analysis showed similar results after excluding major autoimmune disorders. Cancer risk in AA patients is organ specific, and it is not associated with the underlying autoimmune disorders in patients with AA.
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Affiliation(s)
- Chih-Chiang Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Nan Liu
- Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Ju Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan.,Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
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25
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Wilcox RA. Cutaneous T-cell lymphoma: 2017 update on diagnosis, risk-stratification, and management. Am J Hematol 2017; 92:1085-1102. [PMID: 28872191 DOI: 10.1002/ajh.24876] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multi-disciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Comprehensive Cancer Center; Ann Arbor Michigan 48109-5948
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26
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Abstract
T-cell lymphoma, a collection of subtypes of Non-Hodgkin lymphoma, is a rare malignancy. The low prevalence of this disease has made it challenging to identify subtype-specific risk factors. Potential risk factors could enable us to identify high-risk patients and predict patient outcomes. Here, we report on the current epidemiologic and prognostic factors data associated with the individual subtypes both of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) found in large cohort and case studies. Additionally, with recent findings, as well as updates in the new World Health Organization (WHO) classification of lymphoid neoplasms, we consider what this could do to change our approach to this group of diseases.
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27
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Pediatric mycosis fungoides: a study of the human leukocyte antigen system among Israeli Jewish patients. Arch Dermatol Res 2017; 309:851-856. [DOI: 10.1007/s00403-017-1783-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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28
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Odum N, Lindahl LM, Wod M, Krejsgaard T, Skytthe A, Woetmann A, Iversen L, Christensen K. Investigating heredity in cutaneous T-cell lymphoma in a unique cohort of Danish twins. Blood Cancer J 2017; 7:e517. [PMID: 28106877 PMCID: PMC5301035 DOI: 10.1038/bcj.2016.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- N Odum
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - L M Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - M Wod
- The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - T Krejsgaard
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - A Skytthe
- The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - A Woetmann
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - K Christensen
- The Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark
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29
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Ehsani AH, Azizpour A, Noormohammadpoor P, Seirafi H, Farnaghi F, Kamyab-Hesari K, Sharifi M, Nasimi M. Folliculotropic Mycosis Fungoides: Clinical and Histologic Features in Five Patients. Indian J Dermatol 2016; 61:554-8. [PMID: 27688448 PMCID: PMC5029244 DOI: 10.4103/0019-5154.190124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Alopecia can be a manifestation of mycosis fungoides (MF); however, the prevalence is unknown. AIMS We sought to describe the clinicopathologic presentation of alopecia in patients with diagnosis of MF. METHODS A retrospective analysis of patients with biopsy-proven MF, who were evaluated at our cancer center from 2002 to 2012, was performed to identify patients with alopecia. RESULTS Five patients with alopecia were identified from reviewing of 157 patients with MF. The male:female ratio was 3:2, and the mean age of patients was 42.8 years. Two of these patients showed patchy hair loss on scalp which was clinically identical to alopecia areata. In remaining three patients, hair loss was seen in areas of MF lesions, and epidermal changes consisted of patch- and plaque-type lesions of MF, tumors, and follicular lesions (follicular MF) were also present. In two of these patients, lymphadenopathy without any visceral involvement was detected. CONCLUSIONS Alopecia was observed in 5 (3.18%) patients with MF, which makes it a rare finding, which included alopecia areata-like patchy loss in 2 and alopecia within MF lesions in 3.
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Affiliation(s)
- Amir Hooshang Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arghavan Azizpour
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Noormohammadpoor
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Seirafi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farnaghi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Kamyab-Hesari
- Department of Dermatopatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Sharifi
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Moling O, Piccin A, Tauber M, Marinello P, Canova M, Casini M, Negri G, Raffeiner B, Binazzi R, Gandini L, Vecchiato C, Rimenti G, Billio A. Intravascular large B-cell lymphoma associated with silicone breast implant, HLA-DRB1*11:01, and HLA-DQB1*03:01 manifesting as macrophage activation syndrome and with severe neurological symptoms: a case report. J Med Case Rep 2016; 10:254. [PMID: 27634631 PMCID: PMC5025582 DOI: 10.1186/s13256-016-0993-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Silicone implants have been successfully used for breast augmentation and reconstruction in millions of women worldwide. The reaction to the silicone implant is highly variable; it can lead to local inflammatory symptoms, and sometimes to systemic symptoms and disease. Over 80 cases of anaplastic lymphoma kinase-negative anaplastic large cell lymphoma have been reported in patients with silicone breast implants and have been accepted as a new clinical entity. To the best of our knowledge, an intravascular large B-cell lymphoma associated with a silicone breast implant has not been reported previously. CASE PRESENTATION A 48-year-old Caucasian woman who presented with high fever was found to have splenomegaly on physical examination. A laboratory diagnosis revealed pancytopenia, hypertriglyceridemia, and hyperferritinemia. She developed signs of altered sensorium, hemiparesis, aphasia, and cauda equina syndrome. On further evaluation, she fulfilled the necessary five out of eight criteria for diagnosis of macrophage activation syndrome/hemophagocytic lymphohistiocytosis. Dexamethasone administration was followed by prompt improvement; however, 3 days later she again manifested high fever, which persisted despite administration of immunoglobulin and cyclosporine A. Her silicone breast implant was considered a possible contributor to her macrophage activation syndrome and was therefore removed. A histological examination of the capsule tissue showed an extensive lymphohistiocytic/giant cell foreign body reaction suggestive of autoimmune/inflammatory syndrome induced by adjuvants. However, the histological examination unexpectedly also revealed an intravascular large B-cell lymphoma. CONCLUSIONS The genetic background of our patient with silicone breast implants might have predisposed her to three rare and difficult to diagnose syndromes/diseases: macrophage activation syndrome/hemophagocytic lymphohistiocytosis, autoimmune/inflammatory syndrome induced by adjuvants, and intravascular large B-cell lymphoma. The simultaneous manifestation of all three syndromes suggests causal interrelationships. Human leukocyte antigen testing in all women who undergo silicon breast implantation could in the future enable us to better evaluate the risk of potential side effects.
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Affiliation(s)
- Oswald Moling
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy.
| | - Andrea Piccin
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| | - Martina Tauber
- Department of Pathology, Ospedale Generale, 39100, Bolzano, Italy
| | - Peter Marinello
- Department of General Surgery, Ospedale Generale, 39100, Bolzano, Italy
| | - Mariagrazia Canova
- Rheumatology Unit, Department of Medicine, Ospedale Generale, 39100, Bolzano, Italy
| | - Marco Casini
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
| | - Giovanni Negri
- Department of Pathology, Ospedale Generale, 39100, Bolzano, Italy
| | - Bernd Raffeiner
- Rheumatology Unit, Department of Medicine, Ospedale Generale, 39100, Bolzano, Italy
| | - Raffaella Binazzi
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Latha Gandini
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Cinzia Vecchiato
- Laboratory of Immunogenetics, Transfusion Medicine Service, Ospedale Generale, 39100, Bolzano, Italy
| | - Giovanni Rimenti
- Division of Infectious Diseases, Ospedale Generale, 39100, Bolzano, Italy
| | - Atto Billio
- Department of Hematology, Ospedale Generale, 39100, Bolzano, Italy
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Abstract
PURPOSE OF REVIEW Mycosis fungoides and Sézary syndrome arise from malignant T cells that reside in skin, and subsequently are capable of circulating between skin, lymph nodes, and blood. The pathophysiologic mechanisms that cause and result in different behaviors of the skin-homing-malignant T cells in different stages of cutaneous T-cell lymphoma (CTCL) are still unknown. It is hypothesized that the skin microenvironment which is composed by various immune cell subsets as well as their spatial distribution and T-cell interaction through different chemokines and cytokines have an important role in the development and pathogenesis of CTCL and will be addressed in this chapter. RECENT FINDINGS Recent studies have discovered that malignant T cells in Sézary syndrome are of the central memory T-cell subset, whereas those in mycosis fungoides are nonrecirculating skin-resident effector memory T cells, and have shown a protumorigenic role of mast cells and macrophages in CTCL. In addition, it has been observed that malignant T cells may exhibit features of one of these three distinct phenotypes (forkhead box P3 + regulatory T-cell phenotype, Th2 phenotype, and Th17 phenotype) and are functionally exhausted through an increased expression of certain coinhibitory molecules, such as programmed death-1. SUMMARY All these new findings could assist in the development of novel targeted therapies for CTCL.
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32
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Hodak E, Friedman E. Familial mycosis fungoides: model of genetic susceptibility. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 10 Suppl 2:S67-9. [PMID: 20826400 DOI: 10.3816/clml.2010.s.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Emmila Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel Tel Aviv University, Tel-Aviv, Israel
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33
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Wilcox RA. Cutaneous T-cell lymphoma: 2016 update on diagnosis, risk-stratification, and management. Am J Hematol 2016; 91:151-65. [PMID: 26607183 PMCID: PMC4715621 DOI: 10.1002/ajh.24233] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 12/11/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors before escalating therapy to include systemic, single-agent chemotherapy. In highly-selected patients, allogeneic stem-cell transplantation may be considered, as this may be curative in some patients.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology, University of Michigan Cancer Center, 1500 E. Medical Center Drive, Room 4310 CC, Ann Arbor, MI 48109-5948
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34
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Abstract
Mycosis fungoides (MF) is the most common type of cutaneous lymphoma, accounting for almost 50% of all primary cutaneous lymphomas. When initially described, it was believed to be a distinct clinical entity with a pathognomonic histopathologic picture. Through the years we have come to know that, like syphilis, MF is a great masquerader and can present clinically and histopathologically in many ways. This review is an attempt to cover the many faces of MF that have evolved through the years.
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Brazzelli V, Rivetti N, Badulli C, Carugno A, Cananzi R, De Silvestri A, Martinetti M, Borroni G. Mycosis fungoides: association of KIR ligands and HLA-DQB1*05 with bad prognosis of the disease. J Eur Acad Dermatol Venereol 2015; 30:266-9. [DOI: 10.1111/jdv.13083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/27/2015] [Indexed: 11/27/2022]
Affiliation(s)
- V. Brazzelli
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - N. Rivetti
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - C. Badulli
- Immunogenetic Laboratory; Immunohematology Service and Trasfusional Medicine; Pavia Italy
| | - A. Carugno
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - R. Cananzi
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - A. De Silvestri
- Biometry and Statistics; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - M. Martinetti
- Immunogenetic Laboratory; Immunohematology Service and Trasfusional Medicine; Pavia Italy
| | - G. Borroni
- Department of Clinical-Surgical, Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
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36
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Litvinov IV, Tetzlaff MT, Rahme E, Habel Y, Risser DR, Gangar P, Jennings MA, Pehr K, Prieto VG, Sasseville D, Duvic M. Identification of geographic clustering and regions spared by cutaneous T-cell lymphoma in Texas using 2 distinct cancer registries. Cancer 2015; 121:1993-2003. [PMID: 25728286 DOI: 10.1002/cncr.29301] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/07/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCLs) (mycosis fungoides and its leukemic variant, Sezary syndrome) are rare malignancies. Reports of the occurrence of mycosis fungoides in married couples and families raise the possibility of an environmental trigger for this cancer. Although it has been suggested that CTCL arises from inappropriate T-cell stimulation, to the authors' knowledge no preventable trigger has been identified to date. METHODS Using region, zip code, age, sex, and ethnicity, the authors analyzed the demographic data of 1047 patients from Texas who were seen in a CTCL clinic at The University of Texas MD Anderson Cancer Center during 2000 through 2012 (the MDACC database) and 1990 patients who were recorded in the population-based Texas Cancer Registry between 1996 and 2010. Subsequently, data from both databases were cross-analyzed and compared. RESULTS The current study findings, based on the MDACC database, documented geographic clustering of patients in 3 communities within the Houston metropolitan area, in which CTCL incidence rates were 5 to 20 times higher than the expected population rate. Analysis of the Texas Cancer Registry database defined the CTCL population rate for the state to be 5.8 cases per million individuals per year (95% confidence interval, 5.5-6.0 per million individuals per year), thus confirming the observations from the MDACC database and further highlighting additional areas of geographic clustering and regions spared from CTCL in Texas. CONCLUSIONS The current study documented geographic clustering of CTCL cases in Texas and argued for the existence of yet unknown external causes/triggers for this rare malignancy.
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Affiliation(s)
- Ivan V Litvinov
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael T Tetzlaff
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elham Rahme
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Youssef Habel
- Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - David R Risser
- Cancer Epidemiology and Surveillance Branch, Texas Cancer Registry, Department of State Health Services, Austin, Texas
| | - Pamela Gangar
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michelle A Jennings
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin Pehr
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Victor G Prieto
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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37
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Hodak E, Amitay-Laish I. Response to: "Tumor stage mycosis fungoides in nonblood-related family members". J Am Acad Dermatol 2014; 71:1002-3. [PMID: 25437961 DOI: 10.1016/j.jaad.2014.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Emmilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Iris Amitay-Laish
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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38
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Vitamin D Deficiency in Mycosis Fungoides and Sézary Syndrome Patients Is Similar to Other Cancer Patients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:518-24. [DOI: 10.1016/j.clml.2014.06.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/14/2014] [Accepted: 06/17/2014] [Indexed: 11/23/2022]
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39
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Wilcox RA. Cutaneous T-cell lymphoma: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol 2014; 89:837-51. [PMID: 25042790 DOI: 10.1002/ajh.23756] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY TNMB (tumor, node, metastasis, and blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy (e.g., CHOP) may be employed for those patients with extensive visceral involvement requiring rapid disease control. In highly selected patients, allogeneic stem-cell transplantation may be considered.
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Affiliation(s)
- Ryan A. Wilcox
- Division of Hematology/Oncology; University of Michigan Cancer Center; Ann Arbor Michigan
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40
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Brazzelli V, Rivetti N, Badulli C, Carugno A, Grasso V, De Silvestri A, Martinetti M, Borroni G. Immunogenetic factors in mycosis fungoides: can the HLA system influence the susceptibility and prognosis of the disease? Long-term follow-up study of 46 patients. J Eur Acad Dermatol Venereol 2014; 28:1732-7. [DOI: 10.1111/jdv.12391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/10/2014] [Indexed: 12/20/2022]
Affiliation(s)
- V. Brazzelli
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - N. Rivetti
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - C. Badulli
- Immunohematology Service and Trasfusional Medicine; Immunogenetic Laboratory; Pavia Italy
| | - A. Carugno
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - V. Grasso
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
| | - A. De Silvestri
- Biometry and Statistics; Fondazione IRCCS Policlinico San Matteo; University of Pavia; Pavia Italy
| | - M. Martinetti
- Immunohematology Service and Trasfusional Medicine; Immunogenetic Laboratory; Pavia Italy
| | - G. Borroni
- Department of Clinical-Surgical; Diagnostic and Pediatric Science; Institute of Dermatology; Pavia Italy
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41
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Jawed SI, Myskowski PL, Horwitz S, Moskowitz A, Querfeld C. Primary cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome). J Am Acad Dermatol 2014; 70:205.e1-16; quiz 221-2. [DOI: 10.1016/j.jaad.2013.07.049] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 02/08/2023]
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42
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Willerslev-Olsen A, Krejsgaard T, Lindahl LM, Bonefeld CM, A. Wasik M, B. Koralov S, Geisler C, Kilian M, Iversen L, Woetmann A, Odum N. Bacterial toxins fuel disease progression in cutaneous T-cell lymphoma. Toxins (Basel) 2013; 5:1402-21. [PMID: 23949004 PMCID: PMC3760043 DOI: 10.3390/toxins5081402] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/02/2013] [Accepted: 08/06/2013] [Indexed: 01/02/2023] Open
Abstract
In patients with cutaneous T-cell lymphoma (CTCL) bacterial infections constitute a major clinical problem caused by compromised skin barrier and a progressive immunodeficiency. Indeed, the majority of patients with advanced disease die from infections with bacteria, e.g., Staphylococcus aureus. Bacterial toxins such as staphylococcal enterotoxins (SE) have long been suspected to be involved in the pathogenesis in CTCL. Here, we review links between bacterial infections and CTCL with focus on earlier studies addressing a direct role of SE on malignant T cells and recent data indicating novel indirect mechanisms involving SE- and cytokine-driven cross-talk between malignant- and non-malignant T cells.
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Affiliation(s)
- Andreas Willerslev-Olsen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Thorbjørn Krejsgaard
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Lise M. Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus 8000, Denmark; E-Mails: (L.M.L.); (L.I.)
| | - Charlotte Menne Bonefeld
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Mariusz A. Wasik
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; E-Mail:
| | - Sergei B. Koralov
- Department of Pathology, NYU Langone Medical Center, New York, NY 10016, USA; E-Mail:
| | - Carsten Geisler
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Mogens Kilian
- Department of Biomedicine, Aarhus University, Aarhus 8000, Denmark; E-Mail:
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus 8000, Denmark; E-Mails: (L.M.L.); (L.I.)
| | - Anders Woetmann
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
| | - Niels Odum
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen 2200, Denmark; E-Mails: (A.W.-O.); (T.K.); (C.M.B.); (C.G.); (A.W.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +45-3532-7879
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Kim S, Jahan-Tigh R, Duvic M. Papuloerythroderma of Ofuji associated with an indolent CD3(−), CD4(+), TCR(−) peripheral T-cell lymphoma. Leuk Lymphoma 2013; 54:2059-61. [DOI: 10.3109/10428194.2012.762976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jahan-Tigh RR, Huen AO, Lee GL, Pozadzides JV, Liu P, Duvic M. Hydrochlorothiazide and cutaneous T cell lymphoma: prospective analysis and case series. Cancer 2012; 119:825-31. [PMID: 22952039 DOI: 10.1002/cncr.27740] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) and leukemic Sézary syndrome (SS) are the most common cutaneous T cell lymphomas (CTCL), but their etiology remains unknown. After patients were observed with hydrochlorothiazide (HCTZ)-associated CTCL, HCTZ was examined as a putative chronic antigen in a cohort of prospectively staged patients. METHODS Demographic and drug exposure data was examined from 1443 confirmed MF and SS patients. Hypertensive CTCL patients were divided into HCTZ users or nonusers for statistical analysis by chi-square and t tests. Causality in a case series was rated by the Naranjo Adverse Drug Reaction Probability Scale. RESULTS A total of 815 of 1443 MF and SS patients (56.5%) were hypertensive; 205 (25.2%) were taking HCTZ at initial staging. Comparing stage of patients who were using or not using HCTZ, the most significant difference was between stage I and stage IV (odds ratio of 0.45; 95% confidence interval of 0.25-0.78, P = .003), demonstrating reduced likelihood of being stage IV in patients who were on HCTZ. Seventy-seven percent of the MF patients on HCTZ were stage I. A total of 125 patients of 196 (63.8%) started HCTZ prior to developing CTCL lesions, and 35 of 121 (28.0%) started within 1 year of first skin rash. Thirty-six of 125 patients (28.8%) experienced complete or partial remissions after discontinuing HCTZ. A monoclonal T cell receptor rearrangement was detected more frequently in the hypertensive stage I patients not taking HCTZ as compared with those who were (55.3% vs 69.1%, P = .032). Three patients were rechallenged and developed MF lesions that resolved or improved with discontinuation. CONCLUSIONS HCTZ is commonly prescribed and may be a putative antigen in a small subset of early MF patients. Careful drug histories and a trial off medication are warranted.
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Affiliation(s)
- Richard R Jahan-Tigh
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
Epigenetic modification by small-molecule histone deacetylase inhibitors (HDAC-Is) has been a promising new antineoplastic approach for various solid and hematological malignancies, particularly for cutaneous T-cell lymphoma (CTCL). Vorinostat, a pan-HDAC-I and, most recently, romidepsin, a bicyclic pan-HDAC-I, have been US FDA approved for treatment of relapsed or refractory CTCL. However, because many patients do not reach the 50% partial response mark and response is not always sustainable, overcoming HDAC-I resistance by adding other agents or finding more selective molecules is an important clinical problem in realizing the full clinical potential of HDAC-Is. In this review, we discuss the molecular basis for HDAC-I function in cancer, the clinical response and side-effect profile experienced by CTCL patients, and the progress made in attempting to identify biomarkers of response and resistance, as well as synergistic combination therapies.
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Orouji E, Tavakkol Afshari J, Badiee Z, Shirdel A, Alipour A. Association between HLA-DQB1 gene and patients with acute lymphoblastic leukemia (ALL). Int J Hematol 2012; 95:551-5. [PMID: 22434102 DOI: 10.1007/s12185-012-1051-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 01/22/2023]
Abstract
Acute lymphoblastic leukemia (ALL) affects both children and adults. Survival in ALL has improved in recent decades due to recognition of its biological heterogeneity. Although children have higher remission and cure rates than adults, both populations have benefited from these improvements. Our aim in this study is to determine the association between HLA-DQB1 genes with childhood and adult ALL patients. To define this association, we compared HLA-DQB1 allele frequencies and allele carrier frequencies in a cohort of 135 adults and children with ALL with 150 controls, using polymerase chain reaction with sequence-specific primers. Allele carrier frequencies in childhood ALL show a deficiency in DQ2 (*0201) (P 0.049 and RR 0.75), but an increase in DQ5 (*0501-*0504) and DQ7 (*0301, *0304) compared to the control group (P 0.001 RR 1.89, P 0.003 RR 1.48, respectively). Allele carrier frequencies in adult ALL indicated an increase in DQ5 (*0501-*0504) (P0.045 RR 2.28). Allelic frequencies in childhood ALL revealed the same increase in DQ5 and DQ7, and a decrease in DQ2. In adult ALL it shows a decrease in DQ7. Therefore, our results in adult ALL were similar to childhood ALL addressing DQ5 allele carriers, which showed an increase in both age groups. We suggest that DQ5 could be more strongly considered as an ALL susceptibility allele, and that this allele may underlie a pathogenic phenotype with a major role in the immunologic process involved in both adults and children with ALL.
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Affiliation(s)
- Elias Orouji
- Department of Immunogenetics, BuAli Research Institute, Mashhad University of Medical Sciences (MUMS), BuAli Square, Mashhad, Iran.
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Wilcox RA. Cutaneous T-cell lymphoma: 2011 update on diagnosis, risk-stratification, and management. Am J Hematol 2011; 86:928-48. [PMID: 21990092 DOI: 10.1002/ajh.22139] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
DISEASE OVERVIEW Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS). DIAGNOSIS The diagnosis of MF or SS requires the integration of clinical and histopathologic data. RISK-ADAPTED THERAPY Tumor, node, metastasis, and blood (TNMB) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic-response modifiers, denileukin diftitox, and histone deacetylase inhibitors before escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy may be used for those patients with extensive visceral involvement requiring rapid disease control. In highly-selected patients with disease refractory to standard treatments, allogeneic stem-cell transplantation may be considered.
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Affiliation(s)
- Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Cancer Center, Ann Arbor, 48109-5948, USA. rywilcox@med. umich.edu
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Wong HK, Mishra A, Hake T, Porcu P. Evolving insights in the pathogenesis and therapy of cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome). Br J Haematol 2011; 155:150-66. [PMID: 21883142 DOI: 10.1111/j.1365-2141.2011.08852.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of malignancies derived from skin-homing T cells. The most common forms of CTCL are Mycosis Fungoides (MF) and Sezary Syndrome (SS). Accurate diagnosis remains a challenge due to the heterogeneity of presentation and the lack of highly characteristic immunophenotypical and genetic markers. Over the past decade molecular studies have improved our understanding of the biology of CTCL. The identification of gene expression differences between normal and malignant T-cells has led to promising new diagnostic and prognostic biomarkers that now need validation to be incorporated into clinical practice. These biomarkers may also provide insight into the mechanism of development of CTCL. Additionally, treatment options have expanded with the approval of new agents, such as histone deacetylase inhibitors. A better understanding of the cell biology, immunology and genetics underlying the development and progression of CTCL will allow the design of more rational treatment strategies for these malignancies. This review summarizes the clinical epidemiology, staging and natural history of MF and SS; discusses the immunopathogenesis of MF and the functional role of the malignant T-cells; and reviews the latest advances in MF and SS treatment.
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Affiliation(s)
- Henry K Wong
- Division of Dermatology, The Ohio State University, Columbus, OH 43221, USA.
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Xin YN, Lin ZH, Jiang XJ, Zhan SH, Dong QJ, Wang Q, Xuan SY. Specific HLA-DQB1 alleles associated with risk for development of hepatocellular carcinoma: A meta-analysis. World J Gastroenterol 2011; 17:2248-54. [PMID: 21633537 PMCID: PMC3092879 DOI: 10.3748/wjg.v17.i17.2248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 12/09/2010] [Accepted: 12/16/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the association of human leukocyte antigen (HLA)-DQB1 alleles with hepatocellular carcinoma (HCC) through meta-analysis of published data.
METHODS: Case-control studies on HLA-DQB1 allele association with HCC published up to January 2010 were included in the analyses. The odds ratios (ORs) of HLA-DQB1 allele distributions in HCC patients were analyzed and compared with healthy controls. The meta-analysis software REVMAN 5.0 was applied for investigating heterogeneity among individual studies and for summarizing all the studies. A meta-analysis was performed using fixed-effect or random-effect methods, depending on the absence or presence of significant heterogeneity. Seven case-control studies containing 398 cases and 594 controls were included in the final analysis.
RESULTS: Among the five family alleles, two (DQB1*02 and DQB1*03) were found to be significantly associated with the risk of HCC. The combined OR for the association of DQB1*02 and DQB1*03 allele with the risk for HCC was 1.78 (95% CI: 1.05-3.03, P = 0.03) and 0.65 (95% CI: 0.48-0.89, P = 0.007), respectively. Among the 13 specific alleles, two (DQB1*0502 and DQB1*0602) were significantly associated with risk of HCC. The combined OR for the association of DQB1*0502 and DQB1*0602 allele with the risk for HCC was 1.82 (95% CI: 1.14-2.92, P = 0.01) and 0.58 (95% CI: 0.36-0.95, P = 0.03), respectively. No significant association was established for other HLA-DQB1 family alleles and specific alleles.
CONCLUSION: Our results support the hypothesis that specific HLA-DQB1 allele families and alleles might influence the susceptibility or resistance to HCC, although it needs further investigations.
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Abstract
Mycosis fungoides is the most common type of primary cutaneous lymphomas. The phenotype of the tumor cell corresponds to an effector/memory-type of helper T cell which, given its repertoire of homing receptors, is specialized for recirculation through the skin. In recent years genetic analyses have uncovered various chromosomal aberrations in the tumour cells of mycosis fungoides. Their relevance to the pathogenesis and clinical appearance are discussed in the following.
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Affiliation(s)
- Marc Beyer
- Department of Dermatology, Venereology and Allergology, Charité- Universitätsmedizin Berlin, Germany.
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