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Melchers S, Roemer M, Albrecht JD, Assaf C, von Gugelberg C, Guenova E, Klemke CD, Moritz RKC, Schlaak M, Stadler R, Wehkamp U, Wobser M, Albrecht T, Goerdt S, Schneider S, Nicolay JP. Evaluation of Sézary cell marker expression and cell death behaviour upon in vitro treatment by flow cytometry in Sézary syndrome patients. Exp Dermatol 2024; 33:e15171. [PMID: 39219147 DOI: 10.1111/exd.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/12/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
The diagnosis of Sézary syndrome (SS) relies on the identification of blood Sézary cells (SC) by different markers via flow cytometry. Treatment of SS is challenging since its pathogenesis is characterized by cell death resistance rather than hyperproliferation. In this study, we establish an integrated approach that considers both the expression of SC markers and sensitivity to cell death both spontaneously and upon in vitro treatment. Peripheral blood mononuclear cells were isolated from 20 SS patients and analysed for the SC markers CD7 and CD26 loss as well as CD158k and PD1 gain. The cells were then treated with different established and experimental therapies in vitro and cell death was measured. Spontaneous and therapeutically induced cell death were measured and correlated to cellular marker profiles. In the marker-positive cells, spontaneous cell death sensitivity was reduced. Different treatments in vitro managed to specifically induce cell death in the putative CTCL cell populations. Interestingly, a repeated analysis after 3 months of treatment revealed the CTCL cell death sensitivity to be restored by therapy. We propose this novel integrated approach comprising the evaluation of SC marker expression and analysis of cell death sensitivity upon treatment that can also enable a better therapy stratification.
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Affiliation(s)
- S Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Roemer
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - J D Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Assaf
- Department of Dermatology, HELIOS Klinik Krefeld, Krefeld, Germany
| | - C von Gugelberg
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - E Guenova
- Department of Dermatology, Lausanne University Hospital, Lausanne, Switzerland
| | - C-D Klemke
- Department of Dermatology, Municipal Medical Center Karlsruhe, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - R K C Moritz
- Department of Dermatology, University Hospital Halle, Halle, Germany
- Department of Dermatology, Venerology and Allergology, Freie Universität Berlin and Humboldt-Universität zu Berlin, University Medical Centre Berlin, Berlin, Germany
| | - M Schlaak
- Department of Dermatology, University Hospital Munich, Munich, Germany
| | - R Stadler
- Department of Dermatology, Johannes-Wesling-Clinic Minden and University of Bochum, Bochum, Germany
| | - U Wehkamp
- Department of Dermatology, University Hospital Kiel, Kiel, Germany
| | - M Wobser
- Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany
| | - T Albrecht
- Department of Pathology, Ruprechts-Karls-University of Heidelberg, Heidelberg, Germany
| | - S Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
| | - S Schneider
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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2
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Pavone P, Arletti L, Ilariucci F, Albano T, Lusetti D, Corsini R, Merli F, Mezzadri S. Atypical Presentation of Invasive Aspergillosis during Treatment with Mogamulizumab. J Fungi (Basel) 2024; 10:584. [PMID: 39194909 DOI: 10.3390/jof10080584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
Treatment with CCR-4 antagonists has been shown to be protective against the development of invasive pulmonary aspergillosis in animal models. Herein, we present a case of fatal invasive pulmonary aspergillosis in a patient receiving Mogamulizumab. A 64-year-old man with refractory mycosis fungoides was found to have diffuse bilateral pulmonary nodules during a chest CT in June 2022. Bronchoalveolar lavage (BAL) fungal and bacterial cultures and galactomannan were negative, as well as serum beta-glucan and galactomannan. Histology showed a lymphoid infiltrate with a negative fungal stain, so a presumptive diagnosis of lymphoma infiltration was made, and the patient started the CCR-4 antagonist Mogamulizumab treatment in August 2022. He had no symptoms until November when he presented to the hematology clinic reporting dyspnea. He had neutrophilic leukocytosis (18.610 cells/µL), his c-reactive protein was 27 mg/dL, and his skin lesions from mycosis fungoides were just starting to improve. A CT scan showed large diffuse bilateral severely necrotic cavitated lesions with thick walls and apparently synchronous evolution. Beta-glucan was 31 pg/mL (wako method), while serum galactomannan 3.6. BAL was positive for Aspergillus fumigatus culture and galactomannan. Patient started voriconazole but, despite being in a stable condition, he suddenly died after two days. Discussion: Paradoxically, worsening of the chronic pulmonary aspergillosis has been reported after nivolumab treatment, and immune reconstitution syndromes are usually seen during neutrophil recovery after intensive chemotherapy. Our patient already presented indolent lung lesions from 5 months before and he remained completely asymptomatic until the aspergillosis diagnosis when he quickly passed away. Even if a progression of the lesions was expected in 5 months, this case had an atypical presentation. During the 5-month period, he had no pulmonary symptoms, and his c-reactive protein was negative. Furthermore, in the setting of the natural progression of subacute/chronic aspergillosis, a different radiological picture was expected with a less severe and probably asynchronous evolution. We think that the immune restoration associated with Mogamulizumab (also supported by the concurrent clinical response of the skin lesions) could have been detrimental in this case, exacerbating a catastrophic immune response or alternatively masquerading the clinical progression of aspergillosis. Clinicians should be aware of immune reconstitution syndromes possibly leading to fatal outcomes in immunocompromised patients starting CCR-4 antagonists.
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Affiliation(s)
- Paolo Pavone
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Laura Arletti
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Fiorella Ilariucci
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Tommaso Albano
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Deborah Lusetti
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Romina Corsini
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Francesco Merli
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
| | - Sergio Mezzadri
- Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Emilia-Romagna, Italy
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3
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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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Stammler R, Ta VA, Cohen E, Ram-Wolff C, Bozonnat A, Battesti G, Louveau B, Mourah S, Battistella M, Moins-Teisserenc H, de Masson A. Failure of second challenge with mogamulizumab in C-C chemokine receptor 4-positive cutaneous T-cell lymphoma. Br J Dermatol 2024; 190:920-921. [PMID: 38390970 DOI: 10.1093/bjd/ljae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 02/24/2024]
Abstract
We report three patients with Sézary syndrome who had previously been successfully treated with mogamulizumab and then failed a second course of the same treatment, despite positive CCR4 expression at the second initiation of mogamulizumab. This suggests that secondary resistance of blood disease to mogamulizumab may be independent of target expression.
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Affiliation(s)
| | - Van Anh Ta
- INSERM U1160, Institut de Recherche Saint-Louis
- Université Paris Cité, Paris, France
| | | | | | - Alizée Bozonnat
- Department of Dermatology
- INSERM U976
- Université Paris Cité, Paris, France
| | - Gilles Battesti
- Department of Dermatology
- INSERM U976
- Université Paris Cité, Paris, France
| | - Baptiste Louveau
- INSERM U976
- Université Paris Cité, Paris, France
- Department of Pharmacogenomics and Tumor Genomics
| | - Samia Mourah
- INSERM U976
- Université Paris Cité, Paris, France
- Department of Pharmacogenomics and Tumor Genomics
| | | | - Hélène Moins-Teisserenc
- INSERM U1160, Institut de Recherche Saint-Louis
- Université Paris Cité, Paris, France
- Haematology Laboratory, Saint Louis Hospital, AP-HP
| | - Adèle de Masson
- Department of Dermatology
- INSERM U976
- Université Paris Cité, Paris, France
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5
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Roccuzzo G, Roggo A, Ramelyte E, Marchisio S, Astrua C, Ribero S, Scarisbrick J, Fava P, Quaglino P. Advances in the pharmacological management of cutaneous T-cell lymphoma. Expert Opin Pharmacother 2024; 25:885-894. [PMID: 38828644 DOI: 10.1080/14656566.2024.2360646] [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: 02/14/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Current treatment guidelines for cutaneous T cell lymphoma (CTCL) advocate a stage-driven approach, considering clinical presentation, symptom burden, and patient comorbidities. Therapy selection hinges on factors like disease subtype, severity, and treatment availability. The primary goal is to enhance the quality of life by mitigating symptoms, as achieving lasting complete remission is infrequent. AREAS COVERED Over the past decade (2013-2023), the therapeutic landscape of CTCL has experienced substantial transformation with the introduction of innovative therapies. This review explores the main pivotal developments in traditional treatment schedules and recently introduced drugs, aiming to offer clinicians and researchers a thorough perspective on the decade's progress in the field. EXPERT OPINION Despite the progress made in CTCL therapeutics, ranging from topical chemotherapeutics to immunomodulatory agents, several unmet needs persist. Firstly, there is a pressing need for the incorporation of readily available predictors for treatment response, encompassing clinical, pathological, and molecular features. Secondly, a more profound comprehension of the tumor microenvironment is imperative to optimize the landscape of targetable molecules. Lastly, the undertaking of studies on combination regimens should be encouraged as it enhances therapy efficacies by synergistically combining agents with diverse modes of action.
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Affiliation(s)
- Gabriele Roccuzzo
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Andrea Roggo
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Egle Ramelyte
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Marchisio
- Laboratory of Immunogenetics, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Astrua
- 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
| | - Julia Scarisbrick
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paolo Fava
- 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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6
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Zengarini C, Guglielmo A, Mussi M, Motta G, Agostinelli C, Sabattini E, Piraccini BM, Pileri A. A Narrative Review of the State of the Art of CCR4-Based Therapies in Cutaneous T-Cell Lymphomas: Focus on Mogamulizumab and Future Treatments. Antibodies (Basel) 2024; 13:32. [PMID: 38804300 PMCID: PMC11130839 DOI: 10.3390/antib13020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
The CCR4 receptor is a pivotal target in cutaneous T-cell lymphoma (CTCL) therapy due to its role in impairing immune responses against malignant T-cells and expression profiles. Monoclonal antibodies like mogamulizumab effectively bind to CCR4, reducing tumour burden and enhancing patient outcomes by inhibiting the receptor's interaction with ligands, thereby hindering malignant T-cell migration and survival. Combining CCR4 antibodies with chemotherapy, radiation, and other drugs is being explored for synergistic effects. Additionally, small-molecular inhibitors, old pharmacological agents interacting with CCR4, and CAR-T therapies are under investigation. Challenges include drug resistance, off-target effects, and patient selection, addressed through ongoing trials refining protocols and identifying biomarkers. Despite advancements, real-life data for most of the emerging treatments are needed to temper expectations. In conclusion, CCR4-targeted therapies show promise for CTCL management, but challenges persist. Continued research aims to optimise treatments, enhance outcomes, and transform CTCL management. This review aims to elucidate the biological rationale and the several agents under various stages of development and clinical evaluation with the actual known data.
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Affiliation(s)
- Corrado Zengarini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alba Guglielmo
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Institute of Dermatology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Martina Mussi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giovanna Motta
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Division of Haematopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Agostinelli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Division of Haematopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Sabattini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Division of Haematopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro Pileri
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy; (C.Z.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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7
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L’Orphelin JM. An occurrence of eosinophilic folliculitis and alopecia associated with a sustained complete response to mogamulizumab in Sézary syndrome: a case report. Ther Adv Hematol 2024; 15:20406207241235777. [PMID: 38456078 PMCID: PMC10919142 DOI: 10.1177/20406207241235777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/03/2024] [Indexed: 03/09/2024] Open
Abstract
Mogamulizumab is a monoclonal antibody that binds to C-C chemokine receptor 4 (CCR4), initiating antibody-dependent cellular cytotoxicity. CCR4 is highly expressed in the cutaneous T-cell lymphoma subtypes mycosis fungoides and Sézary syndrome (SS), and mogamulizumab has been shown to be effective in patients with these conditions who were refractory to at least one prior systemic treatment. One of the more common adverse events encountered with mogamulizumab is rash, which may mimic disease progression and lead to premature discontinuation. Moreover, there has been some evidence to suggest that mogamulizumab-associated rash (MAR) is associated with improved outcomes in some patients, particularly those with SS. This report presents the case of a 72-year-old woman with SS, which manifested with macular and papular lesions and abnormal blood cytometry, who was treated with mogamulizumab after failure of bexarotene and photopheresis combination therapy. She achieved a complete response (CR), but experienced lymphopenia associated with histologically proven eosinophilic folliculitis (EF) of the scalp and alopecia. The EF responded well to initial topical corticosteroids, defined by regression of erythema and pustular involvement and reduction in pruritus-like symptoms, but without hair regrowth. Mogamulizumab was withdrawn after 32 cycles, but CR was maintained. To date, EF persists in the form of diffuse erythema without pustules or pruritus. A link between cluster of differentiation 4 lymphopenia and EF has previously been established; therefore, EF should be considered in patients who develop rash and lymphopenia while receiving treatment with mogamulizumab. MAR has been associated with clinical response to mogamulizumab, and this case report adds to the evidence that EF may also be associated with sustained clinical response following treatment cessation. However, regular monitoring is required to prevent a relapse of SS. Prospective studies are needed to confirm whether such an association between EF and CR following mogamulizumab exists.
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Affiliation(s)
- Jean-Matthieu L’Orphelin
- Department of Dermatology, Caen-Normandie University Hospital, Avenue de la Côte de Nacre, 14003 Caen, France
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8
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Fernández-Guarino M, Ortiz P, Gallardo F, Llamas-Velasco M. Clinical and Real-World Effectiveness of Mogamulizumab: A Narrative Review. Int J Mol Sci 2024; 25:2203. [PMID: 38396877 PMCID: PMC10889597 DOI: 10.3390/ijms25042203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Mogamulizumab (MOG) is an antibody targeting the CCR4 receptor, authorized for relapsed or refractory peripheral T-cell (PTCL) and cutaneous T-cell lymphomas (CTCL). Its adoption in guidelines and endorsement by FDA and EMA established it as a systemic treatment, especially for advanced disease stages due to its comparatively lower toxicity. Clinical trials and real-world evidence have underscored its efficacy in advanced CTCLs, including mycosis fungoides and Sézary syndrome; PTCLs; and adult T-cell leukemia/lymphoma (ATLL), showcasing positive outcomes. Notably, the drug has demonstrated significant response rates, disease stability, and extended periods of progression-free survival, suggesting its applicability in cases with multiple treatment lines. Its safety profile is generally manageable, with adverse events (AEs) primarily related to the skin, infusion-related reactions, drug eruptions, autoimmune diseases, and skin disorders. The latter seem to appear as CCR4 can promote the skin-specific homing of lymphocytes, and MOG is directed against this receptor. While combination with immunostimulatory agents like interferon alpha and interleukin 12 has shown promising results, caution is urged when combining with PD1 inhibitors due to the heightened risk of immune-mediated AEs. The introduction of MOG as a systemic treatment implies a significant advancement in managing these diseases, supported by its favorable safety profile and complementary mechanisms.
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Affiliation(s)
- Montserrat Fernández-Guarino
- Dermatology Department, Hospital Universitario Ramón y Cajal, Instituto de Investigación Sanitaria Ramón y Cajal (Irycis), 28034 Madrid, Spain;
| | - Pablo Ortiz
- Dermatology Department, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | | | - Mar Llamas-Velasco
- Dermatology Department, Hospital Universitario de la Princesa, Fundación de Investigación Biomédica de la Princesa, 28006 Madrid, Spain
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9
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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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10
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Mycosis Fungoides and Sézary Syndrome: Microenvironment and Cancer Progression. Cancers (Basel) 2023; 15:cancers15030746. [PMID: 36765704 PMCID: PMC9913729 DOI: 10.3390/cancers15030746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Mycosis fungoides and Sézary syndrome are epidermotropic cutaneous lymphomas, and both of them are rare diseases. Mycosis fungoides is the most frequent primary cutaneous lymphoma. In about 25% of patients with mycosis fungoides, the disease may progress to higher stages. The pathogenesis and risk factors of progression in mycosis fungoides and Sézary syndrome are not yet fully understood. Previous works have investigated inter- and intrapatient tumor cell heterogeneity. Here, we overview the role of the tumor microenvironment of mycosis fungoides and Sézary syndrome by describing its key components and functions. Emphasis is put on the role of the microenvironment in promoting tumor growth or antitumor immune response, as well as possible therapeutic targets. We focus on recent advances in the field and point out treatment-related alterations of the microenvironment. Deciphering the tumor microenvironment may help to develop strategies that lead to long-term disease control and cure.
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11
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Fay CJ, Awh KC, LeBoeuf NR, Larocca CA. Harnessing the immune system in the treatment of cutaneous T cell lymphomas. Front Oncol 2023; 12:1071171. [PMID: 36713518 PMCID: PMC9878398 DOI: 10.3389/fonc.2022.1071171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023] Open
Abstract
Cutaneous T cell lymphomas are a rare subset of non-Hodgkin's lymphomas with predilection for the skin with immunosuppressive effects that drive morbidity and mortality. We are now appreciating that suppression of the immune system is an important step in the progression of disease. It should come as no surprise that therapies historically and currently being used to treat these cancers have immune modulating functions that impact disease outcomes. By understanding the immune effects of our therapies, we may better develop new agents that target the immune system and improve combinatorial treatment strategies to limit morbidity and mortality of these cancers. The immune modulating effect of therapeutic drugs in use and under development for cutaneous T cell lymphomas will be reviewed.
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12
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Bakr FS, Whittaker SJ. Advances in the understanding and treatment of Cutaneous T-cell Lymphoma. Front Oncol 2022; 12:1043254. [PMID: 36505788 PMCID: PMC9729763 DOI: 10.3389/fonc.2022.1043254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 11/25/2022] Open
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of non-Hodgkin's lymphomas (NHL) characterised by the clonal proliferation of malignant, skin homing T-cells. Recent advances have been made in understanding the molecular pathogenesis of CTCL. Multiple deep sequencing studies have revealed a complex genomic landscape with large numbers of novel single nucleotide variants (SNVs) and copy number variations (CNVs). Commonly perturbed genes include those involved in T-cell receptor signalling, T-cell proliferation, differentiation and survival, epigenetic regulators as well as genes involved in genome maintenance and DNA repair. In addition, studies in CTCL have identified a dominant UV mutational signature in contrast to systemic T-cell lymphomas and this likely contributes to the high tumour mutational burden. As current treatment options for advanced stages of CTCL are associated with short-lived responses, targeting these deregulated pathways could provide novel therapeutic approaches for patients. In this review article we summarise the key pathways disrupted in CTCL and discuss the potential therapeutic implications of these findings.
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13
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Habault J, Thonnart N, Ram-Wolff C, Bagot M, Bensussan A, Poyet JL, Marie-Cardine A. Validation of AAC-11-Derived Peptide Anti-Tumor Activity in a Single Graft Sézary Patient-Derived Xenograft Mouse Model. Cells 2022; 11:cells11192933. [PMID: 36230895 PMCID: PMC9564267 DOI: 10.3390/cells11192933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Sézary syndrome (SS) is an aggressive cutaneous T cell lymphoma with poor prognosis mainly characterized by the expansion of a tumor CD4+ T cell clone in both skin and blood. So far, the development of new therapeutic strategies has been hindered by a lack of reproducible in vivo models closely reflecting patients’ clinical features. We developed an SS murine model consisting of the intravenous injection of Sézary patients’ PBMC, together with a mixture of interleukins, in NOD-SCID-gamma mice. Thirty-four to fifty days after injection, mice showed skin disorders similar to that observed in patients, with the detection of epidermis thickening and dermal tumor T cell infiltrates. Although experimental variability was observed, Sézary cells could be tracked in the blood stream, confirming that our model could efficiently exhibit both skin and blood involvement. Using this model, we evaluated the therapeutic potential of RT39, a cell-penetrating peptide derived from the survival protein anti-apoptosis clone 11 (AAC-11), that we previously characterized as specifically inducing apoptosis of Sézary patients’ malignant clone ex vivo. Systemic administration of RT39 led to cutaneous tumor T cells depletion, demonstrating efficient malignant cells’ targeting and a favorable safety profile. These preclinical data confirmed that RT39 might be an innovative therapeutic tool for Sézary syndrome.
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Affiliation(s)
- Justine Habault
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Nicolas Thonnart
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Caroline Ram-Wolff
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
- Department of Dermatology, Saint Louis Hospital, AP-HP, 75010 Paris, France
| | - Martine Bagot
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
- Department of Dermatology, Saint Louis Hospital, AP-HP, 75010 Paris, France
| | - Armand Bensussan
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Jean-Luc Poyet
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Anne Marie-Cardine
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
- Correspondence:
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