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De Masson A, Lazaridou I, Moins-Teisserenc H, Ram-Wolff C, Giustiniani J, Bagot M, Battistella M, Bensussan A. Pathophysiology of cutaneous T-cell lymphomas: Perspective from a French referral centre. Immunol Lett 2024; 268:106871. [PMID: 38801999 DOI: 10.1016/j.imlet.2024.106871] [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: 02/29/2024] [Revised: 05/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a diverse group of malignant blood disorders characterized by initial skin infiltration, and sometimes, tumor spreading to lymph nodes, blood, and viscera. Mycosis fungoides is the most common form. Sézary syndrome is a distinctive form of CTCL marked by a significant presence of circulating tumor cells in peripheral blood. These diseases are characterized by the plasticity and heterogeneity of the tumor cells in the different tissue compartments, and a difficulty in identifying these tumor cells for diagnostic purposes and therapeutic monitoring. Progress has been made in the understanding of the pathophysiology of these diseases in recent years, and we provide here a review of these advancements.
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Affiliation(s)
- Adèle De Masson
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Centre coordinateur national du réseau de cancers rares INCa Lymphomes Cutanés, France; INSERM U976, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France.
| | | | - Hélène Moins-Teisserenc
- Université Paris Cité, Paris, France; INSERM U1160, Institut de Recherche Saint-Louis, Paris, France; Laboratoire d'Hématologie Biologique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Caroline Ram-Wolff
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Centre coordinateur national du réseau de cancers rares INCa Lymphomes Cutanés, France
| | | | - Martine Bagot
- Service de Dermatologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Centre coordinateur national du réseau de cancers rares INCa Lymphomes Cutanés, France; INSERM U976, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Maxime Battistella
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France; Laboratoire de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, France
| | - Armand Bensussan
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France; Mohammed VI Polytechnic University, Benguerir, Morocco
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2
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Bozonnat A, Beylot-Barry M, Dereure O, D’Incan M, Quereux G, Guenova E, Perier-Muzet M, Dalle S, Grange F, Viguier MA, Ram-Wolff C, Feldmeyer L, Beltraminelli H, Bonnet N, Amatore F, Maubec E, Franck N, Machet L, Chasset F, Brunet-Possenti F, Bouaziz JD, Battistella M, Donzel M, Pham-Ledard A, Bejar C, Moins-Teisserenc H, Mourah S, Saiag P, Hainaut E, Michel C, Bens G, Adamski H, Aubin F, Boulinguez S, Joly P, Tedbirt B, Templier I, Troin L, Montaudié H, Ingen-Housz-Oro S, Faiz S, Mortier L, Dobos G, Bagot M, Resche-Rigon M, Montlahuc C, Serret-Larmande A, de Masson A. Real-life efficacy of immunotherapy for Sézary syndrome: a multicenter observational cohort study. EClinicalMedicine 2024; 73:102679. [PMID: 39007062 PMCID: PMC11245986 DOI: 10.1016/j.eclinm.2024.102679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 07/16/2024] Open
Abstract
Background Sézary syndrome is an extremely rare and fatal cutaneous T-cell lymphoma (CTCL). Mogamulizumab, an anti-CCR4 monoclonal antibody, has recently been associated with increased progression-free survival in a randomized clinical trial in CTCL. We aimed to evaluate OS and prognostic factors in Sézary syndrome, including treatment with mogamulizumab, in a real-life setting. Methods Data from patients with Sézary (ISCL/EORTC stage IV) and pre-Sézary (stage IIIB) syndrome diagnosed from 2000 to 2020 were obtained from 24 centers in Europe. Age, disease stage, plasma lactate dehydrogenases levels, blood eosinophilia at diagnosis, large-cell transformation and treatment received were analyzed in a multivariable Cox proportional hazard ratio model. This study has been registered in ClinicalTrials (SURPASSe01 study: NCT05206045). Findings Three hundred and thirty-nine patients were included (58% men, median age at diagnosis of 70 years, Q1-Q3, 61-79): 33 pre-Sézary (9.7% of 339), 296 Sézary syndrome (87.3%), of whom 10 (2.9%) had large-cell transformation. One hundred and ten patients received mogamulizumab. Median follow-up was 58 months (95% confidence interval [CI], 53-68). OS was 46.5% (95% CI, 40.6%-53.3%) at 5 years. Multivariable analysis showed that age ≥ 80 versus <50 (HR: 4.9, 95% CI, 2.1-11.2, p = 0.001), and large-cell transformation (HR: 2.8, 95% CI, 1.6-5.1, p = 0.001) were independent and significant factors associated with reduced OS. Mogamulizumab treatment was significantly associated with decreased mortality (HR: 0.34, 95% CI, 0.15-0.80, p = 0.013). Interpretation Treatment with mogamulizumab was significantly and independently associated with decreased mortality in Sézary syndrome. Funding French Society of Dermatology, Swiss National Science Foundation (IZLIZ3_200253/1) and SKINTEGRITY.CH collaborative research program.
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Affiliation(s)
- Alizée Bozonnat
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | - Marie Beylot-Barry
- Department of Dermatology, CHU de Bordeaux, BoRdeaux Institute of Oncology, BRIC INSERM U1312, INSERM BoRdeaux Institute of Oncology, Team 5, Université de Bordeaux, Bordeaux, France
| | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Michel D’Incan
- Department of Dermatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaëlle Quereux
- Department of Dermatology, Nantes University Hospital, CIC 1413, Inserm UMR 1302/EMR6001 INCIT, F-44000 Nantes, France
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Stephane Dalle
- Department of Dermatology, Hospices Civils de Lyon, Lyon, France
| | | | - Manuelle-Anne Viguier
- Department of Dermatology, Université Reims-Champagne Ardenne, EA7509-IRMAIC, Reims, France
| | | | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helmut Beltraminelli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nathalie Bonnet
- Department of Dermatology, CHU de Marseille, Marseille, France
| | - Florent Amatore
- Department of Dermatology, CHU de Marseille, Marseille, France
| | - Eve Maubec
- Department of Dermatology, Avicenne Hospital, AP-HP, Bobigny, France
| | | | | | - François Chasset
- Department of Dermatology, CHU Tenon, Faculty of Medicine, Sorbonne University, Paris, France
| | | | - Jean-David Bouaziz
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | - Maxime Battistella
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
- Pathology Laboratory, Saint-Louis Hospital, AP-HP, Paris, France
| | - Marie Donzel
- Pathology Laboratory, Hospices Civils de Lyon, Lyon, France
| | - Anne Pham-Ledard
- Department of Dermatology, CHU de Bordeaux, BoRdeaux Institute of Oncology, BRIC INSERM U1312, INSERM BoRdeaux Institute of Oncology, Team 5, Université de Bordeaux, Bordeaux, France
| | - Claudia Bejar
- Department of Dermatology, Avicenne Hospital, AP-HP, Bobigny, France
| | - Hélène Moins-Teisserenc
- Université Paris Cité, Paris, France
- Hematology Laboratory, Saint-Louis Hospital, AP-HP, Paris, France
| | - Samia Mourah
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
- Department of Pharmacogenomics and Oncogenetics, Saint-Louis Hospital, AP-HP, Paris, France
| | - Philippe Saiag
- Department of Dermatology, Ambroise-Paré Hospital, AP-HP, & EA 4340 “Biomarkers in Cancerology and Hemato-Oncology”, UVSQ, Université Paris-Saclay, 92104, Boulogne-Billancourt, France
| | - Ewa Hainaut
- Department of Dermatology, CHU de Poitiers, Poitiers, France
| | - Catherine Michel
- Department of Dermatology, CH Mulhouse, Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Guido Bens
- Department of Dermatology, CHU Orléans, Orléans, France
| | - Henri Adamski
- Department of Dermatology, CHU Pontchaillou, Rennes, France
| | - François Aubin
- Department of Dermatology, CHU de Besançon, Besançon, France
| | | | - Pascal Joly
- Department of Dermatology, CHU de Rouen, Rouen, France
| | | | | | - Laura Troin
- Department of Dermatology, CHU de Nice, Nice, France
| | | | | | - Sarah Faiz
- Department of Dermatology, CHU Lille, Lille, France
| | | | - Gabor Dobos
- Department of Dermatology, Charité Hospital, Berlin, Germany
| | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | - Matthieu Resche-Rigon
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
- Department of Biostatistics, Saint-Louis Hospital, AP-HP, Paris, France
| | - Claire Montlahuc
- Department of Biostatistics, Saint-Louis Hospital, AP-HP, Paris, France
| | - Arnaud Serret-Larmande
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
- Department of Biostatistics, Saint-Louis Hospital, AP-HP, Paris, France
| | - Adèle de Masson
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
| | - Cutaneous Lymphomas French Study Group
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Institut de Recherche Saint-Louis, Paris, France
- Université Paris Cité, Paris, France
- Department of Dermatology, CHU de Bordeaux, BoRdeaux Institute of Oncology, BRIC INSERM U1312, INSERM BoRdeaux Institute of Oncology, Team 5, Université de Bordeaux, Bordeaux, France
- Department of Dermatology, University of Montpellier, Montpellier, France
- Department of Dermatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Department of Dermatology, Nantes University Hospital, CIC 1413, Inserm UMR 1302/EMR6001 INCIT, F-44000 Nantes, France
- Department of Dermatology, University Hospital Lausanne, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Dermatology, Hospices Civils de Lyon, Lyon, France
- Department of Dermatology, CH de Valence, France
- Department of Dermatology, Université Reims-Champagne Ardenne, EA7509-IRMAIC, Reims, France
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Dermatology, CHU de Marseille, Marseille, France
- Department of Dermatology, Avicenne Hospital, AP-HP, Bobigny, France
- Department of Dermatology, CHU Cochin, Paris, France
- Department of Dermatology, CHU de Tours, Tours, France
- Department of Dermatology, CHU Tenon, Faculty of Medicine, Sorbonne University, Paris, France
- Department of Dermatology, CHU Bichat, Paris, France
- Pathology Laboratory, Saint-Louis Hospital, AP-HP, Paris, France
- Pathology Laboratory, Hospices Civils de Lyon, Lyon, France
- Hematology Laboratory, Saint-Louis Hospital, AP-HP, Paris, France
- Department of Pharmacogenomics and Oncogenetics, Saint-Louis Hospital, AP-HP, Paris, France
- Department of Dermatology, Ambroise-Paré Hospital, AP-HP, & EA 4340 “Biomarkers in Cancerology and Hemato-Oncology”, UVSQ, Université Paris-Saclay, 92104, Boulogne-Billancourt, France
- Department of Dermatology, CHU de Poitiers, Poitiers, France
- Department of Dermatology, CH Mulhouse, Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
- Department of Dermatology, CHU Orléans, Orléans, France
- Department of Dermatology, CHU Pontchaillou, Rennes, France
- Department of Dermatology, CHU de Besançon, Besançon, France
- Department of Dermatology, CHU de Toulouse, Toulouse, France
- Department of Dermatology, CHU de Rouen, Rouen, France
- Department of Dermatology, CHU de Grenoble, Grenoble, France
- Department of Dermatology, CHU de Nice, Nice, France
- Department of Dermatology, Henri Mondor Hospital, APHP, Créteil, France
- Department of Dermatology, CHU Lille, Lille, France
- Department of Dermatology, Charité Hospital, Berlin, Germany
- Department of Biostatistics, Saint-Louis Hospital, AP-HP, Paris, France
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Chang YT, Prompsy P, Kimeswenger S, Tsai YC, Ignatova D, Pavlova O, Iselin C, French LE, Levesque MP, Kuonen F, Bobrowicz M, Brunner PM, Pascolo S, Hoetzenecker W, Guenova E. MHC-I upregulation safeguards neoplastic T cells in the skin against NK cell-mediated eradication in mycosis fungoides. Nat Commun 2024; 15:752. [PMID: 38272918 PMCID: PMC10810852 DOI: 10.1038/s41467-024-45083-8] [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: 03/31/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
Cancer-associated immune dysfunction is a major challenge for effective therapies. The emergence of antibodies targeting tumor cell-surface antigens led to advancements in the treatment of hematopoietic malignancies, particularly blood cancers. Yet their impact is constrained against tumors of hematopoietic origin manifesting in the skin. In this study, we employ a clonality-supervised deep learning methodology to dissect key pathological features implicated in mycosis fungoides, the most common cutaneous T-cell lymphoma. Our investigations unveil the prominence of the IL-32β-major histocompatibility complex (MHC)-I axis as a critical determinant in tumor T-cell immune evasion within the skin microenvironment. In patients' skin, we find MHC-I to detrimentally impact the functionality of natural killer (NK) cells, diminishing antibody-dependent cellular cytotoxicity and promoting resistance of tumor skin T-cells to cell-surface targeting therapies. Through murine experiments in female mice, we demonstrate that disruption of the MHC-I interaction with NK cell inhibitory Ly49 receptors restores NK cell anti-tumor activity and targeted T-cell lymphoma elimination in vivo. These findings underscore the significance of attenuating the MHC-I-dependent immunosuppressive networks within skin tumors. Overall, our study introduces a strategy to reinvigorate NK cell-mediated anti-tumor responses to overcome treatment resistance to existing cell-surface targeted therapies for skin lymphoma.
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Affiliation(s)
- Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Pacôme Prompsy
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Susanne Kimeswenger
- Department of Dermatology and Venerology, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Yi-Chien Tsai
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Desislava Ignatova
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Olesya Pavlova
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Christoph Iselin
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Lars E French
- Department of Dermatology and Allergology, Ludwig-Maximilians-University of Munich, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mitchell P Levesque
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - François Kuonen
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Patrick M Brunner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Steve Pascolo
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Wolfram Hoetzenecker
- Department of Dermatology and Venerology, Medical Faculty, Johannes Kepler University, Linz, Austria.
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Department of Dermatology, University Hospital of Zurich and Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Department of Dermatology, Hospital 12 de Octubre, Medical School, University Complutense, Madrid, Spain.
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Biazus Soares G, Guitart J, Yosipovitch G. What's New in Cutaneous T-Cell Lymphoma-Associated Pruritus. Am J Clin Dermatol 2024; 25:67-77. [PMID: 37971624 DOI: 10.1007/s40257-023-00823-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
Cutaneous T-cell lymphomas are a heterogenous group of lymphomas that cause various skin manifestations. Severe pruritus occurs frequently in cutaneous T-cell lymphoma and negatively impacts patients' quality of life. The pathophysiology of cutaneous T-cell lymphoma-associated itch is complex and involves various immune cells, inflammatory cytokines, and neuroimmune interactions. Treating cutaneous T-cell lymphoma pruritus can be challenging, and there have been few randomized controlled studies evaluating the use of antipruritic treatments in these patients. Systemic therapies targeting the disease have also been shown to have some antipruritic effects. Furthermore, although biologic therapy has revolutionized the treatment of other pruritic skin conditions, the use of biologics in cutaneous T-cell lymphoma remains controversial.
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Affiliation(s)
- Georgia Biazus Soares
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA.
- , 5555 Ponce de Leon, Coral Gables, FL, 33146, USA.
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5
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Goyal A, Foss F. Allogeneic transplantation and cellular therapies in cutaneous T-cell lymphoma. Expert Rev Anticancer Ther 2024; 24:41-58. [PMID: 38224371 DOI: 10.1080/14737140.2024.2305356] [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: 07/21/2023] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common types of cutaneous T-cell lymphoma. Although many available treatments offer temporary disease control, allogeneic hematopoietic stem cell transplant (allo-HSCT) is the only curative treatment option for advanced stage MF and SS. CAR T-cell therapy is a promising new avenue for treatment. AREAS COVERED In this review, we discuss the evidence supporting the use of allo-HSCT for the treatment of MF/SS, including disease status at the time of transplant, conditioning regimen, total body irradiation (TBI), and donor lymphocyte infusion (DLI). We also address the potential role for CAR T-cell therapy in CTCL. EXPERT OPINION Allo-HSCT is an effective treatment for patients with advanced MF and SS. However, significant research is required to determine optimal treatment protocols. Data support the use of reduced-intensity conditioning regimens and suggests that the use of TBI for debulking of skin disease may result in more durable remissions. Donor lymphocyte infusions (DLI) appear to be particularly effective in inducing complete remission in MF/SS patients with relapsed or residual disease. Challenges with CAR-T therapies in T-cell lymphoma include T-cell fratricide due to shared antigens on malignant and nonmalignant T-cells, penetrance into the skin compartment, and CAR-T cell persistence.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale School of Medicine, New Haven, Connecticut, USA
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Nogueira M, Lau C, Teixeira MDA, Peixeiro R, Cabral R, Fernandes I. Alemtuzumab as first- and second-line treatment in patients with Sézary syndrome-The experience of a tertiary centre. J Eur Acad Dermatol Venereol 2024; 38:e86-e88. [PMID: 37595960 DOI: 10.1111/jdv.19441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Miguel Nogueira
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Catarina Lau
- Laboratory of Cytometry, Department of Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Maria Dos Anjos Teixeira
- Laboratory of Cytometry, Department of Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rita Peixeiro
- Department of Clinical Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Renata Cabral
- Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Department of Clinical Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Iolanda Fernandes
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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7
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Aires D, Abhyankar S. Early intervention of extracorporeal photopheresis for advancing/progressing cutaneous T-cell lymphoma. Hematol Oncol 2023; 41:809-816. [PMID: 37974524 DOI: 10.1002/hon.3229] [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: 10/06/2022] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Patients with cutaneous T-cell lymphoma with progressive disease typically undergo a series of skin-directed and systemic therapy regimens during cycles of response and relapse. Extracorporeal photopheresis (ECP) is an effective and safe systemic treatment option, often reserved for later stages of disease and typically employed after failure of several other therapies. ECP has benefits in response rate, time to next treatment, and tolerability that may support its use earlier in the treatment cycle for advancing/progressing disease.
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Affiliation(s)
| | - Sunil Abhyankar
- University of Kansas Cancer Center and the University of Kansas Medical Center, Kansas City, Kansas, USA
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8
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Sonego B, Ibatici A, Rivoli G, Angelucci E, Sola S, Massone C. Histopathological Markers for Target Therapies in Primary Cutaneous Lymphomas. Cells 2023; 12:2656. [PMID: 37998391 PMCID: PMC10670482 DOI: 10.3390/cells12222656] [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: 10/04/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023] Open
Abstract
In recent years, targeted (biological) therapies have become available also for primary cutaneous T-cell lymphomas (PCTCLs) including anti-CD30 (brentuximab vedotin) in mycosis fungoides, primary cutaneous anaplastic large T-cell lymphoma, lymphomatoid papulosis; anti-CCR4 (mogamulizumab) in Sezary syndrome; anti-CD123 (tagraxofusp) in blastic plasmocytoid cell neoplasm. Moreover, anti-PD1 (nivolumab), anti-PDL1 (pembrolizumab, atezolizumab), anti-CD52 (alemtuzumab), anti-KIR3DL2-CD158k (lacutamab), and anti-CD70 (cusatuzumab) have been tested or are under investigations in phase II trials. The expression of these epitopes on neoplastic cells in skin biopsies or blood samples plays a central role in the management of PCTCL patients. This narrative review aims to provide readers with an update on the latest advances in the newest therapeutic options for PCTCLs.
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Affiliation(s)
- Benedetta Sonego
- Dermatology Clinic, University of Trieste, 35125 Trieste, Italy;
| | - Adalberto Ibatici
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Giulia Rivoli
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Emanuele Angelucci
- UO Ematologia e Terapie Cellulari, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (A.I.); (G.R.); (E.A.)
| | - Simona Sola
- Surgical Pathology, Galliera Hospital, 16128 Genoa, Italy;
| | - Cesare Massone
- Dermatology Unit & Scientific Directorate, Galliera Hospital, 16128 Genoa, Italy
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9
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Quadri I, Reneau JC, Hanel W, Chung CG. Advancements in the treatment of mycosis fungoides and Sézary syndrome: monoclonal antibodies, immunotherapies, and Janus kinase inhibitors. Front Immunol 2023; 14:1291259. [PMID: 38022633 PMCID: PMC10654973 DOI: 10.3389/fimmu.2023.1291259] [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: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are forms of cutaneous T cell lymphoma (CTCL) that pose significant challenges in their clinical management, particularly in refractory and advanced-stage disease. With the emergence of novel therapeutic modalities however, there are increasing opportunities to exploit the current understanding of pathophysiologic mechanisms of MF/SS for treatment. This review summarizes recent advances in the treatment of MF/SS, with a focus on monoclonal antibodies, immunotherapies, and Janus kinase (JAK) inhibitors, including ongoing clinical trials.
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Affiliation(s)
- Iman Quadri
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - John C. Reneau
- Division of Hematology, The Ohio State University Wexner Medical Center and The James and Solove Research Center and Cancer Hospital, Columbus, OH, United States
| | - Walter Hanel
- Division of Hematology, The Ohio State University Wexner Medical Center and The James and Solove Research Center and Cancer Hospital, Columbus, OH, United States
| | - Catherine G. Chung
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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10
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Pelcovits A, Ollila TA, Olszewski AJ. Advances in Immunotherapy for the Treatment of Cutaneous T-Cell Lymphoma. Cancer Manag Res 2023; 15:989-998. [PMID: 37700809 PMCID: PMC10493109 DOI: 10.2147/cmar.s330908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Cutaneous T-Cell Lymphoma (CTCL) is a heterogenous disease that consists of distinct clinicopathologic entities and presentations requiring a unique and expert approach to management. The most common subtype is mycosis fungoides, in which local disease has an excellent prognosis and is often managed with topical therapy alone. More extensive cutaneous involvement as well as involvement of lymph nodes and the peripheral blood (Sezary syndrome) require systemic therapies. Recent years have brought an expansion of therapeutic options, specifically with immune-based approaches that were developed using the knowledge gained regarding the biology and molecular pathology of CTCL. Previous systemic therapies such as retinoids, histone deacetylase inhibitors, and chemotherapeutic agents come with significant toxicity and only short-term response. Newer agents such as mogamulizumab and brentuximab vedotin use a targeted immune-based approach leading to longer periods of response with less systemic toxicity. While still in its infancy, the use of immune checkpoint inhibitors such as nivolumab and pembrolizumab appears promising, and while their current clinical application is limited, early data suggest possible future areas for research of immune manipulation to treat CTCL. Herein, we review these novel immune-based treatment strategies, their superiority over prior systemic options, and the ongoing need for further research and clinical trial enrollment.
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Affiliation(s)
- Ari Pelcovits
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Thomas A Ollila
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Adam J Olszewski
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA
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11
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Braun T, Schrader A. Education and Empowering Special Forces to Eradicate Secret Defectors: Immune System-Based Treatment Approaches for Mature T- and NK-Cell Malignancies. Cancers (Basel) 2023; 15:cancers15092532. [PMID: 37173999 PMCID: PMC10177197 DOI: 10.3390/cancers15092532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Mature T- and NK-cell leukemia/lymphoma (MTCL/L) constitute a heterogeneous group of, currently, 30 distinct neoplastic entities that are overall rare, and all present with a challenging molecular markup. Thus, so far, the use of first-line cancer treatment modalities, including chemotherapies, achieve only limited clinical responses associated with discouraging prognoses. Recently, cancer immunotherapy has evolved rapidly, allowing us to help patients with, e.g., solid tumors and also relapsed/refractory B-cell malignancies to achieve durable clinical responses. In this review, we systematically unveiled the distinct immunotherapeutic approaches available, emphasizing the special impediments faced when trying to employ immune system defense mechanisms to target 'one of their own-gone mad'. We summarized the preclinical and clinical efforts made to employ the various platforms of cancer immunotherapies including antibody-drug conjugates, monoclonal as well as bispecific antibodies, immune-checkpoint blockades, and CAR T cell therapies. We emphasized the challenges to, but also the goals of, what needs to be done to achieve similar successes as seen for B-cell entities.
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Affiliation(s)
- Till Braun
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases, Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany
| | - Alexandra Schrader
- Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Excellence Cluster for Cellular Stress Response and Aging-Associated Diseases, Center for Molecular Medicine Cologne, University of Cologne, 50937 Cologne, Germany
- Lymphoma Immuno Biology Team, Equipe Labellisée LIGUE 2023, Centre International de Recherche en Infectiologie, INSERM U1111-CNRS UMR5308, Faculté de Médecine Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon I-ENS de Lyon, 69921 Lyon, France
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12
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Single-cell analyses reveal novel molecular signatures and pathogenesis in cutaneous T cell lymphoma. Cell Death Dis 2022; 13:970. [PMID: 36400759 PMCID: PMC9674677 DOI: 10.1038/s41419-022-05323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/19/2022]
Abstract
Sézary syndrome (SS) is a rare and aggressive type of cutaneous T cell lymphoma (CTCL) with a poor prognosis. Intra-tumoral heterogeneity caused by different disease compartments (e.g., skin, blood) and poor understanding of the pathogenesis has created obstacles to the precise diagnosis and targeted treatment of the disease. Here we performed a comprehensive analysis by integrating single-cell transcriptomic data of 40,333 peripheral blood mononuclear cells (PBMCs) and 41,580 skin cells, as well as single-cell chromatin accessibility data of 11,058 PBMCs from an SS patient and matched healthy controls (HCs). Validation and functional investigation were carried out in an independent cohort consisting of SS patients, mycosis fungoides (MF) patients, psoriatic erythroderma patients, and HCs, as well as multiple cell lines. The analysis revealed that skin-derived Sézary cells (SCs) had a shifting trend to more advanced mature phenotypes compared to blood-derived SCs. A series of specific marker genes (TOX, DNM3, KLHL42, PGM2L1, and SESN3) shared in blood- and skin-derived SCs were identified, facilitating the diagnosis and prognosis of MF/SS. Moreover, luciferase reporter assays and gene knockdown assays were used to verify that KLHL42 was transcriptionally activated by GATA3 in SS. Functional assays indicated that KLHL42 silencing significantly inhibited aggressive CTCL cell proliferation and promoted its apoptosis. Therefore, targeting inhibition KLHL42 might serve as a promising therapeutic approach in CTCL.
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13
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Roccuzzo G, Mastorino L, Gallo G, Fava P, Ribero S, Quaglino P. Folliculotropic Mycosis Fungoides: Current Guidance and Experience from Clinical Practice. Clin Cosmet Investig Dermatol 2022; 15:1899-1907. [PMID: 36124283 PMCID: PMC9482435 DOI: 10.2147/ccid.s273063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
Introduction Folliculotropic mycosis fungoides (FMF) is the most frequent variant of mycosis fungoides (MF), with clinical features which differ from the classic form. As for therapeutic options, the latest guidelines on MF agree on a stage-driven strategy, in consideration of clinical presentation, symptom burden and patient’s comorbidities. Materials and Methods A search on MEDLINE, PubMed, Scopus and Cochrane Library was conducted to gather the latest evidence on FMF clinical management. Manuscripts published in the last five years (January 2017–April 2022) were included. Our single-center experience was also described. Results A total of 15 articles were analyzed, with a total of 432 patients (disease stage from IA to IVA2). The most widely-used treatment was psoralen ultra-violet A (PUVA) in monotherapy or in association with other drugs. Oral retinoid-based therapy was also described as a therapeutic option alone or in combination. Other therapy reported were based on Brentuximab Vedotin, Mogamulizumab, Carmustine, topical steroids, tazarotene and excimer laser, interferon, nitrogen mustard, imiquimod, systemic chemotherapy, extracorporeal photopheresis and stem cell transplantation. Discussion FMF is characterized by specific clinical-pathologic features. Advanced forms assume characteristics more similar to classic MF (infiltrated plaques and nodules), whilst early stages can present in a wide range of clinical forms (acneiform lesions, follicular-like keratoses, erythematous patches). As for therapeutic options, in absence of specific guidelines, a high number of treatments are described in clinical practice, with variable results. Phototherapy in all its forms, especially as PUVA, appears to have the greatest initial therapeutic success. Retinoids, although widely used, appear to be poorly effective in monotherapy, particularly acitretin. Combination treatment with phototherapy seems to be advisable. Ionizing treatments, such as radiotherapy and TSEBT, appear effective, at least in the short term. Overall, an integrated approach is mandatory for the inconstant course of the disease and its multidisciplinary nature.
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Affiliation(s)
- Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Luca Mastorino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Giuseppe Gallo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Paolo Fava
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
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14
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[Current therapeutic options in Mycosis fungoides and Sézary syndrome]. Hautarzt 2022; 73:75-85. [PMID: 34988613 DOI: 10.1007/s00105-021-04924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
Driven by the approval of new targeted therapies, significant progress has been made in recent years in the clinical management of cutaneous T‑cell lymphomas. Although there are no curative treatment options for cutaneous T‑cell lymphomas, response rates are often encouraging, in particular when using combination therapies. The decision for the appropriate form of treatment depends on the specific diagnosis, disease stage, and the history of prior therapies. This article provides a comprehensive overview of current treatment options in mycosis fungoides and Sézary syndrome, based on the recently published, revised German S2k guidelines on cutaneous lymphomas (update 2021). In addition, we present promising, yet-to-be-approved therapies that at least in part can be already used off-label in clinical practice today.
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15
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Roccuzzo G, Giordano S, Fava P, Pileri A, Guglielmo A, Tonella L, Sanlorenzo M, Ribero S, Fierro MT, Quaglino P. Immune Check Point Inhibitors in Primary Cutaneous T-Cell Lymphomas: Biologic Rationale, Clinical Results and Future Perspectives. Front Oncol 2021; 11:733770. [PMID: 34485162 PMCID: PMC8415544 DOI: 10.3389/fonc.2021.733770] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/30/2021] [Indexed: 12/14/2022] Open
Abstract
Primary cutaneous T-cell lymphomas (PCTCL) are the most common types of cutaneous lymphomas, with Mycosis fungoides as the most frequent subtype. Besides early stages which usually have a good prognosis, advanced stages remain a great therapeutic challenge with low survival rates. To date, none of the currently available therapeutic options have significantly improved the outcomes of advanced cutaneous lymphomas. Recent studies have demonstrated that immune-checkpoint molecules, such as PD-1 and CTLA-4, play part in the proliferation pathways of neoplastic T-cells, as well as in other tumors. Hence, the potential role of immune-checkpoint-inhibitors in treating cutaneous lymphomas has been investigated in the last years. Herein, we outline the current knowledge regarding the role of immune-checkpoint molecules in PCTCL, their signaling pathways, microenvironment and therapeutic inhibition rationale. Moreover, we review the published data on immunotherapies in PCTCL and summarize the currently ongoing clinical trials in this field.
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Affiliation(s)
- Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Silvia Giordano
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Paolo Fava
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Alessandro Pileri
- Dermatology-IRCCS Policlinico di Sant'Orsola Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alba Guglielmo
- Dermatology-IRCCS Policlinico di Sant'Orsola Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Luca Tonella
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Martina Sanlorenzo
- Department of Medicine, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Maria Teresa Fierro
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
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16
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Mehta-Shah N, Horwitz SM, Ansell S, Ai WZ, Barnes J, Barta SK, Clemens MW, Dogan A, Fisher K, Goodman AM, Goyal G, Guitart J, Halwani A, Haverkos BM, Hoppe RT, Jacobsen E, Jagadeesh D, Lunning MA, Mehta A, Olsen EA, Pro B, Rajguru SA, Shanbhag S, Shaver A, Shustov A, Sokol L, Torka P, Torres-Cabala C, Wilcox R, William BM, Zain J, Dwyer MA, Sundar H, Kim YH. NCCN Guidelines Insights: Primary Cutaneous Lymphomas, Version 2.2020. J Natl Compr Canc Netw 2021; 18:522-536. [PMID: 32380458 DOI: 10.6004/jnccn.2020.0022] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL), and Sézary syndrome (SS) is a rare erythrodermic and leukemic subtype of CTCL characterized by significant blood involvement. Although early-stage disease can be effectively treated predominantly with skin-directed therapies, systemic therapy is often necessary for the treatment of advanced-stage disease. Systemic therapy options have evolved in recent years with the approval of novel agents such as romidepsin, brentuximab vedotin, and mogamulizumab. These NCCN Guidelines Insights discuss the diagnosis and management of MF and SS (with a focus on systemic therapy).
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Affiliation(s)
- Neha Mehta-Shah
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Weiyun Z Ai
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | - Stefan K Barta
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Kristopher Fisher
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | - Joan Guitart
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Deepa Jagadeesh
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Satish Shanbhag
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Andrei Shustov
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | | | | | - Basem M William
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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17
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Sanches JA, Cury-Martins J, Abreu RM, Miyashiro D, Pereira J. Mycosis fungoides and Sézary syndrome: focus on the current treatment scenario. An Bras Dermatol 2021; 96:458-471. [PMID: 34053802 PMCID: PMC8245718 DOI: 10.1016/j.abd.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022] Open
Abstract
Cutaneous T-cell lymphomas are a heterogeneous group of lymphoproliferative disorders, characterized by infiltration of the skin by mature malignant T cells. Mycosis fungoides is the most common form of cutaneous T-cell lymphoma, accounting for more than 60% of cases. Mycosis fungoides in the early-stage is generally an indolent disease, progressing slowly from some patches or plaques to more widespread skin involvement. However, 20% to 25% of patients progress to advanced stages, with the development of skin tumors, extracutaneous spread and poor prognosis. Treatment modalities can be divided into two groups: skin-directed therapies and systemic therapies. Therapies targeting the skin include topical agents, phototherapy and radiotherapy. Systemic therapies include biological response modifiers, immunotherapies and chemotherapeutic agents. For early-stage mycosis fungoides, skin-directed therapies are preferred, to control the disease, improve symptoms and quality of life. When refractory or in advanced-stage disease, systemic treatment is necessary. In this article, the authors present a compilation of current treatment options for mycosis fungoides and Sézary syndrome.
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Affiliation(s)
- José Antonio Sanches
- Dermatology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Jade Cury-Martins
- Dermatology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Denis Miyashiro
- Dermatology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Pereira
- Hematology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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18
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Harrop S, Abeyakoon C, Van Der Weyden C, Prince HM. Targeted Approaches to T-Cell Lymphoma. J Pers Med 2021; 11:481. [PMID: 34072040 PMCID: PMC8229513 DOI: 10.3390/jpm11060481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
The T-cell lymphomas are a rare group of Non-Hodgkin's lymphomas derived from mature T-lymphocytes. They are divided broadly into the Peripheral T-cell lymphomas and the Cutaneous T-cell lymphomas. Clinical outcomes vary widely but are generally unsatisfactory with current treatments. The development of an understanding of the various critical pathways in T-cell lymphogenesis and subsequent identification of therapeutic targets has led to a rapid expansion of the previously underwhelming T-cell lymphoma armament. This review aims to provide an up-to-date overview of the current state of targeted therapies in the T-cell lymphomas, including novel antibody-based treatments, small molecule inhibitors and immune-based therapies.
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Affiliation(s)
- Sean Harrop
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.V.D.W.); (H.M.P.)
| | | | | | - H. Miles Prince
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (C.V.D.W.); (H.M.P.)
- Epworth Healthcare, Melbourne, VIC 3002, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
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19
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Rendón-Serna N, Correa-Londoño LA, Velásquez-Lopera MM, Bermudez-Muñoz M. Cell signaling in cutaneous T-cell lymphoma microenvironment: promising targets for molecular-specific treatment. Int J Dermatol 2021; 60:1462-1480. [PMID: 33835479 DOI: 10.1111/ijd.15451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/31/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) result from the infiltration and proliferation of a population of T cells in the skin, inducing changes in the activity of both T cells and surrounding skin cells. In the CTCL microenvironment, cell interactions mediated by cell signaling pathways are altered. Defining changes in cell signaling enables to understand T-cell deregulations in the CTCL microenvironment and thus the progression of the disease. Moreover, characterizing signaling networks activated in CTCL stages can lead to consider new molecular biomarkers and therapeutic targets. Focusing on mycosis fungoides (MF), the most frequent variant of CTCL, and Sézary syndrome (SS), its leukemic variant, this review highlights recent molecular and genetic findings revealing modifications of key signaling pathways involved in (1) cell proliferation, cell growth, and cell survival such as MAP kinases and PI3K/Akt; (2) immune responses derived from TCR, TLR, JAK/STAT, and NF-kB; and (3) changes in tissue conditions such as extracellular matrix remodeling, hypoxia, and angiogenesis. Alterations in these signaling networks promote malignant T-cell proliferation and survival, T-cell migration, inflammation, and suppression of immune regulation of malignant T cells, making a skin microenvironment that allows disease progression. Targeting key proteins of these signaling pathways, using molecules already available and used in research, in clinical trials, and with other disease indications, can open the way to different therapeutic options in CTCL treatment.
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Affiliation(s)
- Natalia Rendón-Serna
- Instituto de Biología, Universidad de Antioquia, Medellin, Colombia.,Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
| | - Luis A Correa-Londoño
- Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
| | - Margarita M Velásquez-Lopera
- Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
| | - Maria Bermudez-Muñoz
- Instituto de Biología, Universidad de Antioquia, Medellin, Colombia.,Centro de Investigaciones Dermatológicas CIDERM, Facultad de Medicina, Universidad De Antioquia, Medellin, Colombia
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20
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Reneau JC, Wilcox RA. Novel therapies targeting cutaneous T cell lymphomas and their microenvironment. Semin Hematol 2021; 58:103-113. [PMID: 33906720 DOI: 10.1053/j.seminhematol.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/24/2021] [Accepted: 02/01/2021] [Indexed: 01/08/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are rare non-Hodgkin lymphomas with a generally indolent course managed with topical, skin-directed therapies. A small subset, however, will progress to advanced stage disease necessitating systemic therapy for disease control. Currently approved therapies have low response rates and generally short durations of response. Novel therapies, therefore, are urgently needed to address this unmet need. In this review, the mechanisms of CTCL pathogenesis and progression, including the role of the tumor microenvironment and molecular alterations, are summarized. Based on these biologic insights, novel therapies currently under investigation and those with a strong preclinical biologic rationale including T cell and macrophage checkpoint inhibitors, epigenetic regulators, targeted antibodies, tyrosine kinase inhibitors, and apoptosis modulating therapies are discussed.
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Affiliation(s)
- John C Reneau
- The Ohio State University, Division of Hematology, Columbus, OH.
| | - Ryan A Wilcox
- Division of Hematology/Oncology, University of Michigan Cancer Center, Ann Arbor, MI
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21
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Topical and Systemic Formulation Options for Cutaneous T Cell Lymphomas. Pharmaceutics 2021; 13:pharmaceutics13020200. [PMID: 33540765 PMCID: PMC7913115 DOI: 10.3390/pharmaceutics13020200] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
Although various anti-cutaneous T-cell lymphoma (CTCL) therapies are available for clinical use, appropriate chemotherapy lines for the treatment of CTCLs have yet to be established. Therefore, to date, various clinical trials for the treatment of advanced CTCLs are ongoing. In this review, we evaluate the therapeutic options that are available in clinical practice for treatment of early- and advanced-stage CTCLs (targeted therapies, histone deacetylase (HDAC) inhibitors, retinoids, interferons, cytotoxic drugs, etc.). We also examine clinical trials of novel regimens for the treatment of CTCLs.
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22
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Cutaneous Lymphomas — Part I: Mycosis Fungoides, Sézary Syndrome, and CD30+ Cutaneous Lymphoproliferative Disorders. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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23
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Pujol R, Gallardo F. Linfomas cutáneos. Parte I: micosis fungoide, síndrome de Sézary y proliferaciones linfoides cutáneas CD30 positivas. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:14-23. [DOI: 10.1016/j.ad.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/13/2020] [Accepted: 08/22/2020] [Indexed: 12/11/2022] Open
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24
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Ohtsuka M, Hamada T, Miyagaki T, Shimauchi T, Yonekura K, Kiyohara E, Fujita H, Izutsu K, Okuma K, Kawai K, Koga H, Sugaya M. Outlines of the Japanese guidelines for the management of primary cutaneous lymphomas 2020. J Dermatol 2020; 48:e49-e71. [PMID: 33245165 DOI: 10.1111/1346-8138.15707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 01/06/2023]
Abstract
Since the publication of the Japanese "Guidelines for the management of cutaneous lymphomas" in 2011, the World Health Organization (WHO) classification of hematolymphoid neoplasms and the WHO-European Organisation for Research and Treatment of Cancer classification for primary cutaneous lymphomas were updated and a number of novel systemic drugs for cutaneous T-cell lymphoma had been approved in Japan. In 2020, we revised the Japanese guidelines for the management of cutaneous lymphomas with consideration of the recent advances in the understanding of the pathophysiology and classification of cutaneous lymphomas together with the update of treatment strategies reflecting the advent of novel drugs. In addition to a brief explanation of epidemiology, diagnosis, staging system, prognosis and management of each subtype of cutaneous lymphomas, the recommendations for nine clinical questions regarding treatment options that can vary even among experts are also described. A systematic review process and determination of recommendations in answer to each clinical question have been performed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation scheme by a multidisciplinary expert panel consisting of dermatologists, a hematologist and a radiation oncologist. In this article, we present the outlines of the revised Japanese "Guidelines for the management of cutaneous lymphomas".
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Affiliation(s)
- Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Takatoshi Shimauchi
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kentaro Yonekura
- Department of Dermatology, Imamura General Hospital, Kagoshima, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University School of Medicine, Suita, Japan
| | - Hideki Fujita
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Kawai
- Department of Dermatology, Kido Hospital, Niigata, Japan
| | - Hiroshi Koga
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
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25
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Allogeneic Hematopoietic Stem Cell Transplantation in Cutaneous T-Cell Lymphomas. Cancers (Basel) 2020; 12:cancers12102856. [PMID: 33023002 PMCID: PMC7601655 DOI: 10.3390/cancers12102856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Advanced-stage cutaneous T-cell lymphomas are aggressive diseases with frequent disease relapses and a reduced overall survival. Most treatment regimens fail to induce long-term remissions. Allogeneic hematopoietic stem cell transplantation has been associated with treatment-free long-term remissions and holds a potential for cure in this disease but is associated with frequent complications, mostly linked to the development of graft-versus-host disease and infections. Herein, we review the current evidence supporting the use of allogeneic stem cell transplantation in advanced-stage cutaneous T-cell lymphomas. Abstract Cutaneous T-cell lymphomas (CTCLs) are non-Hodgkin lymphomas that develop primarily in the skin. They account for almost 80% of primary cutaneous lymphomas. Epidermotropic CTCLs (mycosis fungoides (MF) and Sézary syndrome (SS)) are the most common form of CTCL. The course of the disease ranges from an indolent clinical behavior in early-stage disease to an aggressive evolution in the advanced stages. Advanced-stage disease is defined by the presence of tumors, erythroderma, or significant blood, nodal or visceral involvement. Advanced-stage disease is characterized by frequent disease relapses, refractory disease, a severely impaired quality of life and reduced overall survival. In the last twenty-five years, allogeneic hematopoietic stem cell transplantation (HSCT) has led to prolonged remissions in advanced CTCL, presumably linked to a graft-versus-lymphoma effect and is thus emerging as a potential cure of the disease. However, the high post-transplant relapse rate and severe morbidity and mortality associated with graft-versus-host disease and infections are important issues. Allogeneic HSCT is thus mostly considered in young patients with no comorbidities and an aggressive, advanced-stage CTCL. Allogeneic HSCT gives the best results in patients with a pre-transplant complete remission of the lymphoma. For this reason, one of the challenges is to define the best time to consider allogeneic HSCT in the disease course. Early identification of patients at high risk for progression is important to identify candidates who may benefit from allogeneic HSCT before their disease becomes treatment-refractory. This review describes the role of allogeneic HSCT in CTCL, summarizes the published data and future perspectives in this area.
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26
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Brumfiel CM, Saardi KM, Ronkainen SD, Shenoy AG. Alemtuzumab as initial therapy for Sézary syndrome: A report of 2 cases. JAAD Case Rep 2020; 6:905-908. [PMID: 32875042 PMCID: PMC7452245 DOI: 10.1016/j.jdcr.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Carpentier C, Verbanck S, Schandené L, Heimann P, Trépant AL, Cogan E, Roufosse F. Eosinophilia Associated With CD3 -CD4 + T Cells: Characterization and Outcome of a Single-Center Cohort of 26 Patients. Front Immunol 2020; 11:1765. [PMID: 32849632 PMCID: PMC7432433 DOI: 10.3389/fimmu.2020.01765] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Lymphocytic variant hypereosinophilic syndrome is characterized by marked over-production of eosinophilopoietic factor(s) by dysregulated T cells leading to eosinophil expansion. In most cases, these T cells are clonal and express a CD3-CD4+ phenotype. As this is a rare disorder, presenting manifestations, disease course, treatment responses, and outcome are not well-characterized. Materials and Methods: In this retrospective single-center observational study, we reviewed medical files of all patients with persistent hypereosinophilia seen between 1994 and 2019 in whom CD3-CD4+ T cells were detected. Data collection included clinical and biological findings at presentation, treatment responses, disease course, and serial CD3-CD4+ T cell counts. Results: Our cohort comprises 26 patients, including 2 with hypereosinophilia of undetermined significance. All 24 symptomatic patients had cutaneous lesions and/or angioedema, and fasciitis was present in several cases. The aberrant T cell subset represented 2% or less total lymphocytes in 11 subjects. TCR gene rearrangement patterns on whole blood were polyclonal in these cases, while they all had serum CCL17/TARC levels above 1,500 pg/ml. Disease manifestations were mild and did not require maintenance therapy in roughly one third of the cohort, while two thirds required long-term oral corticosteroids and/or second-line agents. Among these, interferon-alpha was the most effective treatment option with a response observed in 8/8 patients, one of whom was cured of disease. Treatment had to be interrupted in most cases however due to poor tolerance and/or development of secondary resistance. Anti-interleukin-5 antibodies reduced blood eosinophilia in 5/5 patients, but clinical responses were disappointing. A sub-group of 5 patients had severe treatment-refractory disease, and experienced significant disease- and treatment-related morbidity and mortality, including progression to T cell lymphoma in three. Conclusions: This retrospective longitudinal analysis of the largest monocentric cohort of CD3-CD4+ T cell associated lymphocytic variant hypereosinophilic syndrome published so far provides clinicians confronted with this rare disorder with relevant new data on patient presentation and outcome that should help tailor therapy and follow-up to different levels of disease severity. It highlights the need for novel therapeutic options, especially for the subset of patients with severe treatment-refractory disease. Future research efforts should be made toward understanding CD3-CD4+ T cell biology in order to develop new treatments that target primary pathogenic mechanisms.
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Affiliation(s)
- Caroline Carpentier
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvain Verbanck
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Liliane Schandené
- Laboratory of Immunobiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Heimann
- Department of Medical Genetics, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Laure Trépant
- Department of Pathology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Elie Cogan
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Roufosse
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Institute for Medical Immunology, Université Libre de Bruxelles, Brussels, Belgium
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28
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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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29
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Dangien A, Ram-Wolff C, Brice P, Battistella M, Roelens M, Moins-Teisserenc H, Peffault de Latour R, Mourah S, Bouaziz JD, Lebbé C, Bagot M, de Masson A. Ifosfamide and etoposide in advanced-stage, relapsed or refractory primary cutaneous T-cell lymphomas. Br J Dermatol 2020; 183:961-962. [PMID: 32407544 DOI: 10.1111/bjd.19220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Dangien
- Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
| | - C Ram-Wolff
- Dermatology, Saint-Louis Hospital, AP-HP, Paris, France
| | - P Brice
- Department of, Hematology, Saint-Louis Hospital, AP-HP, Paris, France
| | - M Battistella
- Department of, Pathology, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Paris, France.,Université de Paris, Paris, France
| | - M Roelens
- Université de Paris, Paris, France.,INSERM U1160, Paris, France
| | | | - R Peffault de Latour
- Department of, Hematology and Bone Marrow Transplant, Saint-Louis Hospital, AP-HP, Paris, France.,Université de Paris, Paris, France.,INSERM U1160, Paris, France
| | - S Mourah
- Department of Pharmacogenomics, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Paris, France.,Université de Paris, Paris, France
| | - J-D Bouaziz
- Dermatology, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Paris, France.,Université de Paris, Paris, France
| | - C Lebbé
- Dermatology, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Paris, France.,Université de Paris, Paris, France
| | - M Bagot
- Dermatology, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Paris, France.,Université de Paris, Paris, France
| | - A de Masson
- Dermatology, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976 Human Immunology, Pathophysiology and Immunotherapy, Paris, France.,Université de Paris, Paris, France
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30
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Elsayad K, Stadler R, Steinbrink K, Eich HT. Kombination von Ganzhautbestrahlung und Immuncheckpoint‐Inhibitoren: Eine vielversprechende Therapieoption bei Mycosis fungoides und Sézary‐Syndrom. J Dtsch Dermatol Ges 2020; 18:193-198. [PMID: 32130771 DOI: 10.1111/ddg.14044_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Khaled Elsayad
- Klinik für Strahlentherapie, Universitätsklinikum Münster
| | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling-Klinikum Minden
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31
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Elsayad K, Stadler R, Steinbrink K, Eich HT. Combined total skin radiotherapy and immune checkpoint inhibitors: A promising potential treatment for mycosis fungoides and Sezary syndrome. J Dtsch Dermatol Ges 2020; 18:193-197. [DOI: 10.1111/ddg.14044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/16/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Khaled Elsayad
- Department of Radiation OncologyUniversity Hospital Muenster Muenster Germany
| | - Rudolf Stadler
- Department of DermatologyJohannes Wesling Klinikum Minden Minden Germany
| | | | - Hans Theodor Eich
- Department of Radiation OncologyUniversity Hospital Muenster Muenster Germany
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32
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Peterson E, Weed J, Lo Sicco K, Latkowski JA. Cutaneous T Cell Lymphoma: A Difficult Diagnosis Demystified. Dermatol Clin 2020; 37:455-469. [PMID: 31466586 DOI: 10.1016/j.det.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cutaneous T cell lymphoma (CTCL) represents a heterogeneous group of extranodal non-Hodgkin lymphomas in which monoclonal T lymphocytes infiltrate the skin. The mechanism of CTCL development is not fully understood, but likely involves dysregulation of various genes and signaling pathways. A variety of treatment modalities are available, and although they can induce remission in most patients, the disease may recur after treatment cessation. Owing to relatively low incidence and significant chronicity of disease, and the high morbidity of some therapeutic regimens, further clinical trials are warranted to better define the ideal treatment option for each subtype of CTCL.
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Affiliation(s)
- Erik Peterson
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Jason Weed
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA; New York Harbor VA Healthcare System, Dermatology Residency Training Program.
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33
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Dalal M, Mitchell S, McCloskey C, Zagadailov E, Gautam A. The clinical and humanistic burden of cutaneous T-cell lymphomas and response to conventional and novel therapies: results of a systematic review. Expert Rev Hematol 2020; 13:405-419. [DOI: 10.1080/17474086.2020.1717945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mehul Dalal
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | - Erin Zagadailov
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Ashish Gautam
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
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34
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Wang Y, Bagot M. Updates in cutaneous lymphoma: evidence-based guidelines for the management of cutaneous lymphoma 2018. Br J Dermatol 2019; 180:443-444. [PMID: 30821385 DOI: 10.1111/bjd.17523] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
| | - M Bagot
- Department of Dermatology and Inserm U976, Hopital Saint Louis, Paris 7 University, Paris, France
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35
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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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36
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Hu T, Buus TB, Krejsgaard T, Nansen A, Lundholt BK, Spee P, Fredholm S, Petersen DL, Blümel E, Gluud M, Monteiro MN, Willerslev-Olsen A, Andersen MH, Straten PT, Met Ö, Stolearenco V, Fogh H, Gniadecki R, Nastasi C, Litman T, Woetmann A, Gjerdrum LMR, Ødum N. Expression and function of Kv1.3 channel in malignant T cells in Sézary syndrome. Oncotarget 2019; 10:4894-4906. [PMID: 31448055 PMCID: PMC6690676 DOI: 10.18632/oncotarget.27122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
The voltage-gated potassium channel Kv1.3 (KCNA3) is expressed by a subset of chronically activated memory T cells and plays an important role in their activation and proliferation. Here, we show that primary malignant T cells isolated from patients with Sézary syndrome (SS) express Kv1.3 and are sensitive to potent Kv1.3 inhibitors ShK and Vm24, but not sensitive to a less potent inhibitor [N17A/F32T]-AnTx. Kv1.3 blockade inhibits CD3/CD28-induced proliferation and IL-9 expression by SS cells in a concentration-dependent manner. In parallel, CD3/CD28-mediated CD25 induction is inhibited, whereas Kv1.3 blockade has no effect on apoptosis or cell death as judged by Annexin V and PI staining. In conclusion, we provide the first evidence that malignant T cells in SS express functional Kv1.3 channels and that Kv1.3 blockade inhibits activation-induced proliferation as well as cytokine and cytokine receptor expression in malignant T cells, suggesting that Kv1.3 is a potential target for therapy in SS.
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Affiliation(s)
- Tengpeng Hu
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Terkild Brink Buus
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thorbjørn Krejsgaard
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Anneline Nansen
- Department of Molecular Pharmacology, Zealand Pharma A/S, Glostrup, Denmark
| | | | | | - Simon Fredholm
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - David Leander Petersen
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Edda Blümel
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Maria Gluud
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Madalena N. Monteiro
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Willerslev-Olsen
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Mads Hald Andersen
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark
| | - Per thor Straten
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark
| | - Özcan Met
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Center for Cancer Immune Therapy, Department of Hematology, Copenhagen University Hospital at Herlev, Copenhagen, Denmark
| | - Veronica Stolearenco
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Fogh
- Department of Dermatology, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Robert Gniadecki
- Department of Dermatology, Copenhagen University Hospital at Bispebjerg, Copenhagen, Denmark
| | - Claudia Nastasi
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Litman
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Anders Woetmann
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Niels Ødum
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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37
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Khan S, Sawas A. Antibody-Directed Therapies: Toward a Durable and Tolerable Treatment Platform for CTCL. Front Oncol 2019; 9:645. [PMID: 31417860 PMCID: PMC6683760 DOI: 10.3389/fonc.2019.00645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022] Open
Abstract
Cutaneous T-cell lymphomas (CTCL) are a rare group of heterogeneous disorders characterized by cutaneous involvement of monoclonal T-lymphocytes. Although indolent at early stages, CTCL can confer significant morbidity, and mortality when advanced. There is an unmet need for tolerable and durable treatments with antibodies recently gaining promise. Here we review approved systemic therapies and discuss select antibodies in development.
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Affiliation(s)
- Shaheer Khan
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, The New York Presbyterian Hospital, College of Physician and Surgeons, New York, NY, United States
| | - Ahmed Sawas
- Department of Medicine, Center for Lymphoid Malignancies, Columbia University Medical Center, The New York Presbyterian Hospital, College of Physician and Surgeons, New York, NY, United States
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Van-de-Velde V, Zhou Y. Existing and Emerging Therapies for Cutaneous T-Cell Lymphoma. J Cutan Med Surg 2019; 23:319-327. [DOI: 10.1177/1203475419840629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of non-Hodgkin lymphomas characterized by an infiltration of malignant monoclonal T lymphocytes into the skin. Mycosis fungoides (MF), the most common subtype, and the rarer Sézary syndrome (SS), are considered the classical forms of CTCL, which, because of a varying presentation and lack of genetic and immunophenotypical markers, can often have a delayed diagnosis. With skin-directed topical treatment being the mainstay of therapy in the early stages, there is an absence of long-term curative therapies for advanced disease. Recent insight into the pathogenesis of CTCL has identified new potential therapeutic targets including the monoclonal antibody therapies, brentuximab vedotin and mogamulizumab. Brentuximab vedotin, an anti-CD30 antibody-drug conjugate, received extended approval by the US FDA in 2017 to include primary cutaneous anaplastic large-cell lymphoma and CD30-expressing MF. Mogamulizumab, an anti-CCR4 antibody, received FDA approval in 2018 for relapsed or refractory MF and SS. Further targets and therapies continue to be investigated, including the monoclonal antibody therapy alemtuzumab, an anti-CD52 antibody, and the immune checkpoint blockade therapies, pembrolizumab and nivolumab. These new and emerging targets and therapies may lead to a promising broadening of CTCL treatment options in the future.
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Affiliation(s)
- Vanessa Van-de-Velde
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Youwen Zhou
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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Denis D, Beneton N, Laribi K, Maillard H. Management of mycosis fungoides-type cutaneous T-cell lymphoma (MF-CTCL): focus on chlormethine gel. Cancer Manag Res 2019; 11:2241-2251. [PMID: 30962713 PMCID: PMC6433101 DOI: 10.2147/cmar.s138661] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Mycosis fungoides (MF) is a low-grade cutaneous lymphoma accounting for more than half of primary cutaneous T-cell lymphomas (CTCLs). Due to the rarity of CTCL, randomized studies are lacking, and treatment is based mainly on the recent published European Organisation for Research and Treatment of Cancer guidelines. Basically, early-stage MF is treated with skin-directed treatments, whereas advanced-stage MF requires more aggressive therapies. Among the skin-directed therapies, nitrogen mustard has been used for more than 50 years. A gel formulation was developed recently, showing a slight decrease in efficacy, counterbalanced by better tolerance (essentially due to a decrease in delayed hypersensitivity reactions). This review aims to summarize the current management of MF and the role of chlormethine gel in the treatment of the disease.
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Affiliation(s)
- Daphné Denis
- Dermatology Department, Centre Hospitalier Le Mans, Le Mans, France,
| | - Nathalie Beneton
- Dermatology Department, Centre Hospitalier Le Mans, Le Mans, France,
| | - Kamel Laribi
- Haematology Department, Centre Hospitalier Le Mans, Le Mans, France
| | - Hervé Maillard
- Dermatology Department, Centre Hospitalier Le Mans, Le Mans, France,
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Wain T, Venning VL, Consuegra G, Fernandez‐Peñas P, Wells J. Management of cutaneous T‐cell lymphomas: Established and emergent therapies. Australas J Dermatol 2019; 60:200-208. [DOI: 10.1111/ajd.13011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/28/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Thevaki Wain
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
| | - Victoria L Venning
- The Skin Hospital WestmeadNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
| | - Germana Consuegra
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
| | - Pablo Fernandez‐Peñas
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
- The Skin Hospital WestmeadNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
| | - Jillian Wells
- Department of Dermatology Westmead Hospital SydneyNew South Wales Australia
- Faculty of Medicine University of Sydney Sydney New South Wales Australia
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Dereure O. [Primary skin lymphomas: Current therapy]. Ann Dermatol Venereol 2019; 146:92-99. [PMID: 30709635 DOI: 10.1016/j.annder.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/16/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
Therapeutic progress in primary cutaneous lymphomas continues to be largely dominated by the T-cell lymphomas, towards which the great majority of recent therapeutic innovations have been directed. The latter include local treatments consisting either of relatively classical but "revamped" approaches involving different pharmaceutical forms (example: chlormethine gel) or else lower but seemingly equally effective dosages (electron therapy), or of more innovative approaches (example: UVA-1, dynamic phototherapy, imiquimod, resimiquimod). However, significant progress has been made chiefly in terms of systemic treatments with the emergence of "targeted" drugs that directly and specifically target tumour cells (monoclonal antibodies directed against CD30, CCR4 or CD158k) and the further development of "small" molecules such as histone deacetylase inhibitors and new cytostatics. Immunotherapies, which have proven so effective in other areas of oncodermatology, are also of great interest, while allogeneic haematopoietic stem-cell transplantation has clearly shown its superiority over autologous transplantation and now constitutes a significant component of the therapeutic arsenal in advanced disease. While the innovations in terms of B-cell lymphomas are certainly less significant, mention must also be made of the value of rituximab combined with polychemotherapy (CHOP) and of lenalidomide (as second-line therapy) in primary cutaneous diffuse large B-cell lymphoma, leg type, along with the development of localized (very) low-dose radiotherapy in unilesional or paucilesional indolent forms.
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Affiliation(s)
- O Dereure
- Unité Inserm U1058, département de dermatologie, université Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
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Abstract
Cutaneous T-cell lymphomas (CTCLs) are a group of non-Hodgkin's lymphomas that present in the skin. In early-stage disease, the course is generally chronic and indolent; however, in advanced stages of disease, therapies rarely provide long-lasting responses, and the only potential curative therapy is allogeneic hematopoietic stem-cell transplantation. This has led to the search for novel targeted therapies to better treat more advanced stages of CTCLs that cannot be controlled by typical treatment regimens. One area of advancement has been the development of antibodies specifically targeted to cell types that are known to be involved in CTCL. At present, brentuximab vedotin, an antibody-drug conjugate composed of an anti-cluster of differentiation (CD)-30 antibody covalently linked to monomethyl auristatin E, is approved for the treatment of CD30+ lymphoproliferative disorders [lymphomatoid papulosis (LyP) and primary cutaneous-anaplastic large-cell lymphoma (pc-ALCL)] as well as transformed CD30+ mycosis fungoides (MF). Additionally, mogamulizumab, an anti-chemokine receptor 4 (CCR4) monoclonal antibody, is approved for patients with MF or Sézary syndrome (SS) for whom one prior systemic therapy has failed. Trials are underway looking into the use of immune checkpoint inhibitors in the treatment of CTCLs. As we continue to research CTCL, and as antibody-based therapies continue to advance, more antibody-specific targeted therapy could provide alternative treatment regimens for patients with advanced CTCL.
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Abstract
Adequate therapeutic management of cutaneous T-cell lymphoma (CTCL) requires the identification of the exact CTCL stage and entity within the current WHO classification. There is no curative therapy for CTCL yet, so that treatment currently aims at improving symptoms and quality of life as well as reducing relapse rates. The treatment has to be stage-adapted. Therapeutic options comprise skin-directed as well as systemic treatment. In early stages, phototherapy and local steroids are the first-line therapeutic options. For the therapy of higher stages, interferon alpha and the RXR-specific retinoid bexarotene are used as first-line medications. Second-line treatment comprises monochemotherapy with agents like gemcitabine or liposomal doxorubicine. Nevertheless, the high relapse rates in higher stages make novel alternative treatment options necessary. As future therapy, especially the fusion protein brentuximab-vedotin directed against CD30 shows promising potential in clinical studies.
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Affiliation(s)
- J P Nicolay
- Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland.
| | - C Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld, Krefeld, Deutschland
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Kutane Lymphome. MEDIKAMENTÖSE TUMORTHERAPIE IN DER DERMATO-ONKOLOGIE 2019. [PMCID: PMC7121154 DOI: 10.1007/978-3-662-58012-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Kutane Lymphome (cutaneous lymphomas: CL) umfassen die Gruppe der kutanen T-Zell-Lymphome (cutaneous T-cell lymphomas: CTCL), kutanen B-Zell-Lymphome (cutaneous B-cell lymphomas: CBCL) und die sog. hämatodermischen Neoplasien (HN). CL gehören zur Gruppe der Non-Hodgkin-Lymphome (NHL) und stellen in der Subgruppe der extranodalen NHL die zweithäufigste Gruppe hinter den gastrointestinalen Lymphomen dar (Jaffe et al. 2009). Man unterscheidet zwischen primären und sekundären CL. Primäre CL haben ihren Ursprung in der Haut und bleiben in der Regel darauf auch längere Zeit beschränkt, während sekundäre CL kutane Manifestationen von primär nodalen oder extranodalen Lymphomen darstellen (Willemze 2005). Die primären CL unterscheiden sich hinsichtlich klinischem Verlauf, Therapieoptionen und Prognose erheblich von nodalen und extrakutanen Lymphomen. So zeigen z. B. die primär kutanen CD30+-T-Zell-Lymphome einen gutartigen Verlauf, wogegen die nodalen Varianten als aggressiv eingestuft werden. Da die CL zumeist weniger aggressiv sind, werden sie auch weniger aggressiv behandelt.
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Van Der Weyden C, Dickinson M, Whisstock J, Prince HM. Brentuximab vedotin in T-cell lymphoma. Expert Rev Hematol 2018; 12:5-19. [DOI: 10.1080/17474086.2019.1558399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - James Whisstock
- ARC Centre of Excellence in Advanced Molecular Imaging, Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Melbourne, Australia
| | - H. Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Richmond, Australia
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Gilson D, Whittaker S, Child F, Scarisbrick J, Illidge T, Parry E, Mohd Mustapa M, Exton L, Kanfer E, Rezvani K, Dearden C, Morris S, McHenry P, Leslie T, Wakelin S, Hunasehally R, Cork M, Johnston G, Chiang N, Worsnop F, Salim A, Buckley D, Petrof G, Callachand N, Flavell T, Salad A. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol 2018; 180:496-526. [DOI: 10.1111/bjd.17240] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Affiliation(s)
- D. Gilson
- Leeds Cancer Centre St James's University Hospital Leeds LS9 7TF U.K
| | - S.J. Whittaker
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - F.J. Child
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - J.J. Scarisbrick
- Queen Elizabeth Hospital University Hospital Birmingham Birmingham B15 2TH U.K
| | - T.M. Illidge
- Institute of Cancer Sciences University of Manchester The Christie NHS Foundation Trust Manchester M20 4BX U.K
| | - E.J. Parry
- Tameside Hospital Integrated Care NHS Foundation Trust Ashton‐under‐Lyne OL6 9RW U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - E. Kanfer
- Haematology Department Hammersmith Hospital Du Cane Road London W12 0HS U.K
| | - K. Rezvani
- The University of Texas MD Anderson Cancer Centre Houston TX U.S.A
| | - C.E. Dearden
- Chronic Lymphocytic Leukaemia (CLL) Unit The Royal Marsden NHS Foundation Trust Sutton SW3 6JJ U.K
| | - S.L. Morris
- Guy's and St Thomas’ NHS Foundation Trust Guy's Hospital London SE1 9RT U.K
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Current Immunotherapeutic Approaches in T Cell Non-Hodgkin Lymphomas. Cancers (Basel) 2018; 10:cancers10090339. [PMID: 30231561 PMCID: PMC6162531 DOI: 10.3390/cancers10090339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 12/13/2022] Open
Abstract
T cell non-Hodgkin lymphoma (T-NHL) is a rare and heterogeneous group of neoplasms of the lymphoid system. With the exception of a few relatively indolent entities, T-NHL is typically aggressive, treatment resistant, and associated with poor prognosis. Relatively few options with proven clinical benefit are available for patients with relapsed or refractory disease. Immunotherapy has emerged as a promising treatment for the management of patients with hematological malignancies. The identification of tumor antigens has provided a large number of potential targets. Therefore, several monoclonal antibodies (alemtuzumab, SGN-30, brentuximab vedotin, and mogamulizumab), directed against tumor antigens, have been investigated in different subtypes of T-NHL. In addition to targeting antigens involved in cancer cell physiology, antibodies can stimulate immune effector functions or counteract immunosuppressive mechanisms. Chimeric antigen receptor (CAR)-T cells directed against CD30 and immune checkpoint inhibitors are currently being investigated in clinical trials. In this review, we summarize the currently available clinical evidence for immunotherapy in T-NHL, focusing on the results of clinical trials using first generation monoclonal antibodies, new immunotherapeutic agents, immune checkpoint inhibitors, and CAR-T cell therapies.
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Van Der Weyden C, Bagot M, Neeson P, Darcy PK, Prince HM. IPH4102, a monoclonal antibody directed against the immune receptor molecule KIR3DL2, for the treatment of cutaneous T-cell lymphoma. Expert Opin Investig Drugs 2018; 27:691-697. [DOI: 10.1080/13543784.2018.1498081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Carrie Van Der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
- Inserm U976, Paris, France
| | - Paul Neeson
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Phil K. Darcy
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - H. Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- Epworth Healthcare, Richmond, Victoria, Australia
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Abstract
PURPOSE OF REVIEW Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma. Globally, the most common subtypes of CTCL are mycosis fungoides and Sézary syndrome. CTCL can confer significant morbidity and even mortality in advanced disease. Here we review the current and potential future treatments for advanced-stage CTCL. RECENT FINDINGS Heterogeneity of treatment choice has been demonstrated both in US and non-US centers. Systemic treatment choice is currently guided by prognostic features, incorporating stage, immunophenotypic and molecular findings, and patient-specific factors such as age and comorbidities. Randomized controlled studies are uncommon, and the literature is composed predominantly of retrospective, cohort, and early-phase studies. International consensus guidelines are available; however, the lack of comparative trials means that there is no clear algorithmic approach to treatment. This review article reports on the systemic treatment options in current use for advanced CTCL, and on the possible future therapies, acknowledging that an algorithmic approach is not yet forthcoming to guide treatment prioritization.
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Janiga J, Kentley J, Nabhan C, Abdulla F. Current systemic therapeutic options for advanced mycosis fungoides and Sézary syndrome. Leuk Lymphoma 2018; 59:562-577. [PMID: 29308723 DOI: 10.1080/10428194.2017.1347650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common cutaneous T-cell lymphomas (CTCLs). Both lack curative options, and advanced-stage carries a poor prognosis. Whilst there are a number of treatments available, achieving and maintaining a durable remission remains challenging. We review current systemic treatment options as monotherapy for advanced-stage MF (IIB-IV), appraising their mechanism of action, analyzing their efficacy, and describing toxicities. Individually, reported overall response rates (ORR) vary widely in the literature and duration of responses are typically short, ranging from 7.5 to 22.4 months. Combined therapy is frequently used in an effort to boost responses, although prospective studies comparing combinations to single agent therapies are rarely conducted. While recent translational research has led to increased understanding of the immunopathogenesis of MF and SS and the development of new treatments, current standard of care therapies are not curative and have low ORR for advanced-stage disease.
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Affiliation(s)
- Jenna Janiga
- a Stritch School of Medicine , Loyola University , Chicago , IL , USA
| | - Jonathan Kentley
- b Department of Dermatology , Royal London Hospital, Barts Health NHS Trust , London , UK
| | - Chadi Nabhan
- c Cardinal Health Specialty Solutions , Waukegan , IL , USA
| | - Farah Abdulla
- d Department of Medicine, Section of Dermatology , University of Chicago Medicine and Biological Sciences , Chicago , IL , USA
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