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Ivert LU, Winther AH, Jonsson P, Brauner H. Exploring the educational needs of patients with cutaneous lymphoma using an educational needs assessment tool. Front Oncol 2024; 14:1433821. [PMID: 39169940 PMCID: PMC11335495 DOI: 10.3389/fonc.2024.1433821] [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: 05/16/2024] [Accepted: 07/23/2024] [Indexed: 08/23/2024] Open
Abstract
Background Cutaneous T-cell lymphomas (CTCL) are a group of rare non-Hodgkin lymphomas characterized by initial localization of malignant T-lymphocytes in the skin. Support and information from nurses and patient support groups have proven useful for patients with CTCL, but little is known about the educational needs of these patients. Objectives To investigate the self-reported educational needs among CTCL patients using an educational needs assessment tool and to explore differences related to sex, age, disease duration, clinical stage, and education. Methods This observational single center study analyzed 70 patients with CTCL in routine dermatological outpatient care. The patients were asked to complete a questionnaire to capture their educational needs in regard to CTCL. The questionnaire was inspired by the educational needs assessment tool, designed and validated for patients with rheumatoid disease. The questionnaire included a general question, "In general, how much information do you want to receive about your lymphoma disease?", and five domains covering information relating to disease process (6 items), treatment (4 items), feelings (2 items), self-management of itch, sleep, and rest (2 items), and support systems (3 items). The domain scores ranged from 0 to 18 and the total score from 0 to 51, with a higher score indicating a greater need for education. Results When asked "In general, how much information do you need?", females wanted to know more compared with males (2.6 vs. 2.1, p=0.006), and patients with higher education wanted to know more than patients with lower education (2.5 vs. 2.0, p=0.025). The domains concerning treatment (80%) and disease process (75%) revealed the greatest needs for education. Patients with a disease duration <2 years reported a greater educational need for the domain support system, compared with patients with longer disease duration. Patients with lower education reported a greater educational need about feelings compared with patients with higher education. Conclusions We found that 65% of the CTCL patients in the cohort, particularly females, expressed a need for education, especially regarding disease process and treatment. A deeper understanding of the educational needs would enable healthcare providers to give personalized information.
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Affiliation(s)
- Lina U. Ivert
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna H. Winther
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Jonsson
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Brauner
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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2
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Schirren AEC, Albrecht JD, Melchers S, Weiß C, Büttner S, Dippel E, Gosmann J, Jonak C, Klemke CD, Laturnus-Chang M, Livingstone E, Mitteldorf C, Schummer P, Stadler R, Stranzenbach R, Weyer-Fahlbusch SS, Wobser M, Ziemer M, Nicolay JP. Health-related quality of life and its influencing factors in patients with primary cutaneous B-cell lymphomas: A multicentric study in 100 patients. J Eur Acad Dermatol Venereol 2024; 38:954-966. [PMID: 38279594 DOI: 10.1111/jdv.19799] [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: 05/22/2023] [Accepted: 12/11/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas (CBCL) are a group of rare malignant skin diseases that represent approximately 20%-30% of all primary cutaneous lymphomas (PCL). Previous studies revealed impaired health-related quality of life (HRQoL) in patients diagnosed with primary cutaneous T-cell lymphoma (CTCL). Currently, only small-sized studies investigated HRQoL in CBCL patients and lacked detailed analysis of respective subtypes. OBJECTIVES This study aims to investigate HRQoL in CBCL patients to identify independent factors of HRQoL impairment in CBCL patients. METHODS One hundred CBCL patients were recruited from eight German PCL centres in this multicentric, cross-sectional study from 2021 to 2022. The patients completed the dermatologic HRQoL questionnaire Skindex-29 and an investigator-designed 'CBCL-Questionnaire' with additional questions on HRQoL and clinical characteristics. RESULTS The Skindex-29 revealed that HRQoL in CBCL patients is impaired on a mild to moderate level. The multiple regression analysis identified parameters like worries about dying, feeling prejudiced/discriminated and impairment of daily activities to be independently associated with impairment of HRQoL. Highest scores for HRQoL impairment were found in patients with primary cutaneous follicle centre lymphoma while on rituximab treatment and in patients with primary cutaneous marginal zone lymphoma while on watchful waiting. CONCLUSIONS HRQoL is impaired in CBCL patients, even though, in the face of indolent disease course and favourable prognosis in the majority of cases. Of note, our investigator-designed tool identified worries about dying, feeling prejudiced/discriminated, and the type of treatment to have a negative impact on patients' HRQoL. Our study highlights the importance of a thorough patient-doctor communication to capture overall disease burden because generic HRQoL tools might lack of disease-specific items.
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Affiliation(s)
- A E C Schirren
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J D Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - S Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C Weiß
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim of the University of Heidelberg and University Medical Centre Mannheim, Mannheim, Germany
| | - S Büttner
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim of the University of Heidelberg and University Medical Centre Mannheim, Mannheim, Germany
| | - E Dippel
- Department of Dermatology, Ludwigshafen Medical Centre, Ludwigshafen, Germany
| | - J Gosmann
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Minden, Germany
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C-D Klemke
- Department of Dermatology and Skin Cancer Centre, Municipal Hospital Karlsruhe, Academic Educational Hospital of the University of Freiburg, Karlsruhe, Germany
| | - M Laturnus-Chang
- Department of Dermatology, Ludwigshafen Medical Centre, Ludwigshafen, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - C Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - P Schummer
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - R Stadler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - R Stranzenbach
- Department of Dermatology, Bochum Medical Centre, Bochum, Germany
| | | | - M Wobser
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - M Ziemer
- Department of Dermatology, University Medical Centre, Leipzig, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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3
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Gunter SJ, Kim EJ. Changes to Registered and Pivotal Clinical Trials after the 2011 Tri-Societies Guidelines for Clinical Endpoints and Response Criteria in Mycosis Fungoides and Sézary Syndrome. J Invest Dermatol 2024; 144:855-861.e1. [PMID: 37925066 DOI: 10.1016/j.jid.2023.10.011] [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: 07/04/2023] [Revised: 09/09/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023]
Abstract
Guidelines for mycosis fungoides and Sézary syndrome clinical trials were published in 2011 to standardize endpoint criteria and trial design. Our retrospective cohort study of mycosis fungoides/Sézary syndrome clinical trials registered on ClinicalTrials.gov and pivotal trials supporting drug approvals and label extensions evaluates adherence to these guidelines. Sixty-three trials met our inclusion criteria. In a subpopulation of trials, mean adherence to the guidelines was approximately 60%. When comparing trials that began in the first 6 years after their publication with those that started after, we found no difference in mean adherence (4.12 vs 3.41) (P = .15). Among the 8 pivotal trials supporting new mycosis fungoides or Sézary syndrome systemic therapies from 1990 to 2020, systemic trials published after 2011 were more likely to randomize patients (100 vs 0%, P = .036), perform superiority testing (100 vs 0%, P = .036), and use an intention-to-treat analysis (100 vs 0%, P = .036). The design of trials registered on Clinicaltrials.gov did not change significantly between the first 6 years after the publication of the guidelines and after. This demonstrates that the guidelines are still not consistently implemented across all trials. However, registrational trials were more likely to implement the recommendations.
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Affiliation(s)
| | - Ellen J Kim
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Ottevanger R, van Beugen S, Kersten JM, Evers AWM, Vermeer MH, Willemze R, Quint KD. Evaluation of Quality of Life and Treatment Satisfaction in Newly Diagnosed Cutaneous T-Cell Lymphoma Patients. Cancers (Basel) 2024; 16:937. [PMID: 38473299 DOI: 10.3390/cancers16050937] [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: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about the impact of MF on quality of life (QoL) in newly diagnosed patients. OBJECTIVES To describe the impact of the MF diagnosis on QoL, patient expectations, and treatment satisfaction over the first 6 months after diagnosis. METHODS Outcomes of this prospective cohort study of newly diagnosed MF patients conducted between 2020 and 2022 at the Leiden University Medical Center included the Skindex-29, RAND-12 Health Survey, degree of itch, pain, and fatigue (Visual Analogue Scale (VAS)), patient expectations, and Client Satisfaction Questionnaire-8 (CSQ-8), measured at baseline and after six months. RESULTS A total of 28 patients with MF were included. At baseline, 66% (n = 18) "strongly-totally" expected positive effects of the treatment. At the time of diagnosis, 28% of the patients (n = 8) were moderately to severely affected. There was no statistical change in the Skindex-29 score sum score (20 [10-34] vs. 20 [9-36]; p = 0.81) or in the other three subdomains, the RAND-12 scores, and the VAS itch, pain, and fatigue over time. Treatment satisfaction was high overall. CONCLUSION Despite that the newly diagnosed MF patients anticipate a positive treatment effect, few improvements in QoL and symptom reduction were found. These data can be used for adequate expectation management and provide a rationale for further evaluation of treatment regimens in these patients.
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Affiliation(s)
- Rosanne Ottevanger
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Sylvia van Beugen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, 2311 EZ Leiden, The Netherlands
| | - Juliette M Kersten
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, 2311 EZ Leiden, The Netherlands
| | - Maarten H Vermeer
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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5
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Barta SK, Liu N, DerSarkissian M, Chang R, Ye M, Duh MS, Surinach A, Fanale M, Yu KS. Real-World Treatment Patterns and Clinical Outcomes With Brentuximab Vedotin or Other Standard Therapies in Patients With Previously Treated Cutaneous T-Cell Lymphoma in the United States. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e21-e32.e4. [PMID: 37919137 DOI: 10.1016/j.clml.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION/BACKGROUND Primary cutaneous anaplastic large-cell lymphomas (pcALCLs) are a type of cutaneous T-cell lymphoma (CTCL) in which CD30 is uniformly expressed. In mycosis fungoides (MF), another CTCL, CD30 is heterogeneously expressed. In ALCANZA, patients with pcALCLs or CD30-positive MF randomized to brentuximab vedotin (BV) vs. physician's choice of methotrexate or bexarotene had significantly improved outcomes, including higher objective response rates (ORR) lasting ≥4 months (ORR4), as well as longer median progression-free survival (PFS) and time to next treatment (TTNT). In this study, we sought to assess the real-world impact of treatment with BV in second or later lines of therapy for CTCL. MATERIALS AND METHODS This retrospective chart review describes patient characteristics, treatment patterns, clinical outcomes, and healthcare resource use (HRU) in patients with pcALCLs or MF previously treated with ≥1 systemic therapy and subsequently treated with BV (n = 139) or other standard therapy (OST; n = 164). RESULTS Most patients in the BV cohort (96.4%) received BV as second-line (2L) systemic therapy. The most common OSTs were methotrexate (11.6%), mogamulizumab (9.1%), and bendamustine (9.1%) monotherapies. For 2L BV and OST, median duration of therapy was 8.4 and 5.2 months, real-world ORR was 82.1% and 66.5%, and real-world ORR4 was 42.5% and 25.0%. Real-world 1- and 2-year PFS, TTNT, and OS were significantly longer (all P < .01) and HRU was lower for BV vs. OST. CONCLUSION These real-world outcomes are consistent with ALCANZA results, demonstrating favorable outcomes with BV vs. OST in patients with CTCL previously treated with ≥1 systemic therapy.
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Affiliation(s)
- Stefan K Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA.
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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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7
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Ninosu N, Melchers S, Kappenstein M, Booken N, Hansen I, Blanchard M, Guenova E, Assaf C, Goerdt S, Nicolay JP. Mogamulizumab Combined with Extracorporeal Photopheresis as a Novel Therapy in Erythrodermic Cutaneous T-cell Lymphoma. Cancers (Basel) 2023; 16:141. [PMID: 38201568 PMCID: PMC10778082 DOI: 10.3390/cancers16010141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Primary cutaneous T-cell lymphomas (CTCLs) are rare lymphoproliferative malignancies characterized by significant morbidity and mortality in advanced disease stages. As curative approaches apart from allogeneic stem cell transplantation are lacking, establishing new treatment options, especially combination therapies, is crucial. METHODS This retrospective study included 11 patients with SS or MF receiving therapy with mogamulizumab in combination with ECP from four European expert centers. The response rates in the skin and blood as well as treatment use and adverse events (AE) were described. RESULTS 8/11 patients (73%) showed an overall response (OR) in the skin. The mean mSWAT decreased from 98.2 ± 40.8 to 34.6 ± 23.8. The overall response rate (ORR) in the blood was 64% with two complete responses. During combination therapy, the mean number of Sézary cells decreased from 3365.3 × 106/L before treatment to 1268.6 × 106/L. The mean minimum known period without progress was 7.2 months in the skin and 7.6 months in the blood. The most common AEs were mogamulizumab-associated rash (MAR) (45.5%), anemia (27.3%), lymphocytopenia (27.8%), and infusion related reaction (16.7%). No AE led to treatment discontinuation. CONCLUSIONS Our study presents the combination of mogamulizumab and ECP as an effective therapy in the blood and skin in CTCL with good tolerability, similar to mogamulizumab monotherapy.
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Affiliation(s)
- Nadia Ninosu
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (N.N.); (S.M.); (S.G.)
| | - Susanne Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (N.N.); (S.M.); (S.G.)
- Skin Cancer Unit, German Cancer Research Center, 69120 Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Max Kappenstein
- Department of Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany;
| | - Nina Booken
- Department of Dermatology and Venereology, University Skin Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (N.B.); (I.H.)
| | - Inga Hansen
- Department of Dermatology and Venereology, University Skin Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (N.B.); (I.H.)
| | - Maël Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland; (M.B.); (E.G.)
| | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, 1007 Lausanne, Switzerland; (M.B.); (E.G.)
| | - Chalid Assaf
- Department of Dermatology, Helios Hospital Krefeld, 47805 Krefeld, Germany;
- Institute for Molecular Medicine, Medical School Hamburg, 20457 Hamburg, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (N.N.); (S.M.); (S.G.)
| | - Jan P. Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (N.N.); (S.M.); (S.G.)
- Skin Cancer Unit, German Cancer Research Center, 69120 Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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8
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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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9
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Guenova E, Ortiz-Romero PL, Poligone B, Querfeld C. Mechanism of action of chlormethine gel in mycosis fungoides. J Eur Acad Dermatol Venereol 2023; 37:1739-1748. [PMID: 37262305 DOI: 10.1111/jdv.19237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023]
Abstract
Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, is characterized by proliferation of malignant skin-tropic T cells. Progression from early-stage disease (skin patches and/or plaques) to more advanced stages (cutaneous tumours, erythroderma or extracutaneous involvement) occurs slowly and can be discontinuous. Prognosis is poor for the ~25% of patients who progress to advanced disease. Patients at any stage of MF may experience reduced health-related quality of life (QoL) via a spectrum of physically and psychologically debilitating symptoms that can impact many aspects of daily life. Allogeneic stem-cell transplantation is a curative treatment option for some patients with advanced disease, but otherwise there is currently no cure for MF; patients are often refractory to several treatments and require lifelong management. The goals of therapy are symptom control, prevention of disease progression, avoidance of treatment-related toxicity and maintenance/improvement of QoL. Although treatment regimens exist it can be difficult to know how to prioritize them, hence therapies are tailored according to patient needs and drug availabilities, following clinical recommendations. International consensus guidelines recommend skin-directed therapies (SDTs) as first-line treatment for early-stage disease, and SDTs combined with systemic therapy for advanced stages. Chlormethine (CL), also known as mechlorethamine, chlorethazine, mustine, HN2, caryolysine and embichin, is a synthetic deoxyribonucleic acid-alkylating agent that was used as a chemical weapon (mustard gas) during the First World War. Subsequent investigation revealed that survivors of mustard gas exposure had lymphocytopenia, and that CL could inhibit rapidly proliferating malignant T cells. CL has since been developed as a topical treatment for MF and prescribed as such for over 70 years. This review aims to summarize the current knowledge regarding the mechanism of action of CL in the cutaneous micro-environment, in the specific context of MF treatment.
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Affiliation(s)
- E Guenova
- University Hospital Lausanne (CHUV), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P L Ortiz-Romero
- Department of Dermatology, Institute i+12, CIBERONC, Medical School, Hospital 12 de Octubre, University Complutense, Madrid, Spain
| | - B Poligone
- Rochester Skin Lymphoma Medical Group, Fairport, New York, USA
| | - C Querfeld
- Division of Dermatology, Department of Pathology, City of Hope National Medical Center, Beckman Research Institute, Duarte, California, USA
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10
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Nicolay JP, Melchers S, Albrecht JD, Assaf C, Dippel E, Stadler R, Wehkamp U, Wobser M, Zhao J, Burghaus I, Schneider S, Gülow K, Goerdt S, Schürch CM, Utikal JS, Krammer PH. Dimethyl fumarate treatment in relapsed and refractory cutaneous T-cell lymphoma: a multicenter phase 2 study. Blood 2023; 142:794-805. [PMID: 37217183 PMCID: PMC10644069 DOI: 10.1182/blood.2022018669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
Targeted therapies for cutaneous T-cell lymphoma (CTCL) are limited and curative approaches are lacking. Furthermore, relapses and drug induced side effects are major challenges in the therapeutic management of patients with CTCL, creating an urgent need for new and effective therapies. Pathologic constitutive NF-κB activity leads to apoptosis resistance in CTCL cells and, thus, represents a promising therapeutic target in CTCL. In a preclinical study we showed the potential of dimethyl fumarate (DMF) to block NF-κB and, specifically, kill CTCL cells. To translate these findings to applications in a clinical setting, we performed a multicentric phase 2 study evaluating oral DMF therapy in 25 patients with CTCL stages Ib to IV over 24 weeks (EudraCT number 2014-000924-11/NCT number NCT02546440). End points were safety and efficacy. We evaluated skin involvement (using a modified severity weighted assessment tool [mSWAT]), pruritus, quality of life, and blood involvement, if applicable, as well as translational data. Upon skin analysis, 7 of 23 (30.4%) patients showed a response with >50% reduction in the mSWAT score. Patients with high tumor burden in the skin and blood responded best to DMF therapy. Although not generally significant, DMF also improved pruritus in several patients. Response in the blood was mixed, but we confirmed the NF-κB-inhibiting mechanism of DMF in the blood. The overall tolerability of the DMF therapy was very favorable, with mostly mild side effects. In conclusion, our study presents DMF as an effective and excellently tolerable therapeutic option in CTCL to be further evaluated in a phase 3 study or real-life patient care as well as in combination therapies. This trial was registered at www.clinicaltrials.gov as #NCT02546440.
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Affiliation(s)
- Jan P. Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/ University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center, Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Susanne Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/ University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center, Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jana D. Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/ University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center, Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Chalid Assaf
- Department of Dermatology and Venereology, Helios Klinikum Krefeld, Krefeld, Germany
- Institute for Molecular Medicine, Medical School Hamburg, Hamburg, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Center, Minden, Germany
| | - Ulrike Wehkamp
- Department of Dermatology, Campus Kiel, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marion Wobser
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Jing Zhao
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Ina Burghaus
- Clinical Study Coordination Center, University of Heidelberg, Heidelberg, Germany
| | - Sven Schneider
- Institute for Clinical Chemistry, University Medical Center Mannheim, Mannheim, Germany
| | - Karsten Gülow
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/ University of Heidelberg, Mannheim, Germany
| | - Christian M. Schürch
- Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tübingen, Tübingen, Germany
| | - Jochen S. Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/ University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center, Heidelberg, Germany
- DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Peter H. Krammer
- Department of Immunogenetics D030, German Cancer Research Center, Heidelberg, Germany
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11
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Beltraminelli H. Cutaneous T-cell lymphoma-Focus on some problems, and some solutions. Hematol Oncol 2023; 41 Suppl 1:20-24. [PMID: 37294972 DOI: 10.1002/hon.3147] [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: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
Cutaneous lymphomas are a heterogeneous group of several distinct entities of lymphoproliferative diseases. The diagnosis of a cutaneous lymphoma is a challenge, and it is always the result of a careful analysis of several information's consisting of clinical history, clinical picture, histological and molecular analyses. For this reason, experts taking care of patients with a skin lymphoma need to know all the peculiar diagnostic elements very well, in order not to run into mistakes. In this article, we will focus the discussion on some issues as the skin biopsy (when and where). In addition, we will discuss the approach to the erythrodermic patient, whose differential diagnoses include mycosis fungoides, and Sézary syndrome, beside more frequent inflammatory conditions. Finally, we will address the issue of quality of life and the possible support of the suffering patient with a cutaneous lymphoma, well knowing that the current therapeutic possibilities are unfortunately limited.
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Affiliation(s)
- Helmut Beltraminelli
- Head of Dermatology, Responsible of Dermatopathology at Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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12
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Total Skin Treatment with Helical Arc Radiotherapy. Int J Mol Sci 2023; 24:ijms24054492. [PMID: 36901922 PMCID: PMC10002962 DOI: 10.3390/ijms24054492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
For widespread cutaneous lymphoma, such as mycosis fungoides or leukemia cutis, in patients with acute myeloid leukemia (AML) and for chronic myeloproliferative diseases, total skin irradiation is an efficient treatment modality for disease control. Total skin irradiation aims to homogeneously irradiate the skin of the entire body. However, the natural geometric shape and skin folding of the human body pose challenges to treatment. This article introduces treatment techniques and the evolution of total skin irradiation. Articles on total skin irradiation by helical tomotherapy and the advantages of total skin irradiation by helical tomotherapy are reviewed. Differences among each treatment technique and treatment advantages are compared. Adverse treatment effects and clinical care during irradiation and possible dose regimens are mentioned for future prospects of total skin irradiation.
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13
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Boh E, Kuraitis D, Jacobson A, Sikes M. Healthcare Provider Experience in Diagnosing and Treating Cutaneous T-Cell Lymphoma. Dermatol Ther (Heidelb) 2023; 13:835-842. [PMID: 36729236 PMCID: PMC9984617 DOI: 10.1007/s13555-023-00895-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cutaneous T-cell lymphoma (CTCL) is a rare, heterogeneous group of non-Hodgkin lymphomas characterized by various clinical, molecular, and histopathologic features of the skin. Variants of CTCL share many clinical features with common inflammatory skin diseases such as atopic dermatitis and psoriasis, making accurate and early diagnosis challenging in clinical settings. Inappropriate treatment or a delay in diagnosis can lead to increased morbidity and mortality. Here, we report findings from an online survey that investigated dermatology community practice, knowledge, and education surrounding CTCL. METHODS An electronic survey of ten questions was developed and approved by physician experts in CTCL to assess experiences in diagnosing and treating CTCL among healthcare providers (HCPs). The survey was deployed to 10,600 US dermatology HCPs, including medical doctors (MDs), doctors of osteopathic medicine (DOs), nurse practitioners (NPs), and physician assistants (PAs) and excluding HCPs associated with CTCL centers of excellence. RESULTS Among 44 HCPs who responded and were eligible for inclusion, 82% had diagnosed between one and ten CTCL cases in the last 5 years. Most respondents (91%) reported that they include CTCL in their differential diagnoses after patients do not respond to treatment of more common conditions. Patients with CTCL were frequently diagnosed with other inflammatory dermatoses-most commonly dermatitis and psoriasis-before a CTCL diagnosis, and many were treated with ineffective therapies for years. The most common length of time before a CTCL diagnosis was made was between 1 and 3 years, though 16% of HCPs reported that patients were treated for other diseases or skin conditions for ≥ 5 years. Two-thirds of HCPs agreed that further education surrounding CTCL is needed. CONCLUSIONS Given the infrequency of CTCL and its similar presentation to other common dermatologic conditions, increased education of CTCL is needed in the dermatology community to improve patient outcomes.
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Affiliation(s)
- Erin Boh
- Tulane University, 1430 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Drew Kuraitis
- grid.265219.b0000 0001 2217 8588Tulane University, 1430 Tulane Ave, New Orleans, LA 70112 USA ,grid.240614.50000 0001 2181 8635Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Abby Jacobson
- grid.433688.20000 0004 0380 1655Ortho Dermatologics (a Division of Bausch Health US, LLC), Bridgewater, NJ USA
| | - Martha Sikes
- grid.433688.20000 0004 0380 1655Ortho Dermatologics (a Division of Bausch Health US, LLC), Bridgewater, NJ USA
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14
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Cutaneous lymphomas—fast facts about an orphan disease—a short review. MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2023. [DOI: 10.1007/s12254-022-00863-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
SummaryCutaneous lymphomas are a rare group of primary skin lymphoproliferative disorders, divided into T and B cell lymphomas. They differ substantially in clinical course and therapy. The two main subtypes of primary cutaneous T‑cell lymphomas include mycosis fungoides, which is the most common, and Sézary syndrome, the rare leukemic variant. Skin lesions seen in mycosis fungoides patients are erythematous patches, plaques, or tumors. Most patients remain at patch/plaque (early) stage, while some progress to tumor (advanced) stage during their clinical course. Sézary syndrome is characterized by erythroderma and involvement of lymph nodes and the peripheral blood. Treatment is dependent on the disease stage. Therapeutic options include skin-directed and systemic therapies. In localized, early stage mycosis fungoides, prognosis is usually good which changes in advanced stages. Significant progress has been made in recent years in the clinical management of progressive or relapsed cutaneous T‑cell lymphomas by the approval of new targeted therapies. Although there are no curative treatment options apart from allogeneic transplantation, response rates are often encouraging, in particular when using combination therapies. Primary cutaneous B cell lymphomas are rare and three main subtypes are recognized: primary cutaneous marginal zone lymphoma, primary cutaneous follicle center lymphoma, and primary cutaneous diffuse large B‑cell lymphoma, leg type. An accurate diagnosis of the subtype is important for therapeutic management. The most common clinical presentations are red-to-violaceous cutaneous nodules and papules. Primary cutaneous marginal and follicle center lymphoma have excellent 5‑year survival rates of 95–99%.
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15
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Malignant T cells induce skin barrier defects through cytokine-mediated JAK/STAT signaling in cutaneous T-cell lymphoma. Blood 2023; 141:180-193. [PMID: 36122387 DOI: 10.1182/blood.2022016690] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 01/17/2023] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a devastating lymphoid malignancy characterized by the accumulation of malignant T cells in the dermis and epidermis. Skin lesions cause serious symptoms that hamper quality of life and are entry sites for bacterial infection, a major cause of morbidity and mortality in advanced diseases. The mechanism driving the pathological processes that compromise the skin barrier remains unknown. Here, we report increased transepidermal water loss and compromised expression of the skin barrier proteins filaggrin and filaggrin-2 in areas adjacent to TOX-positive T cells in CTCL skin lesions. Malignant T cells secrete mediators (including cytokines such as interleukin 13 [IL-13], IL-22, and oncostatin M) that activate STAT3 signaling and downregulate filaggrin and filaggrin-2 expression in human keratinocytes and reconstructed human epithelium. Consequently, the repression of filaggrins can be counteracted by a cocktail of antibodies targeting these cytokines/receptors, small interfering RNA-mediated knockdown of JAK1/STAT3, and JAK1 inhibitors. Notably, we show that treatment with a clinically approved JAK inhibitor, tofacitinib, increases filaggrin expression in lesional skin from patients with mycosis fungoides. Taken together, these findings indicate that malignant T cells secrete cytokines that induce skin barrier defects via a JAK1/STAT3-dependent mechanism. As clinical grade JAK inhibitors largely abrogate the negative effect of malignant T cells on skin barrier proteins, our findings suggest that such inhibitors provide novel treatment options for patients with CTCL with advanced disease and a compromised skin barrier.
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16
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Kwesi-Maliepaard EM, Malik M, van Welsem T, van Doorn R, Vermeer MH, Vlaming H, Jacobs H, van Leeuwen F. DOT1L inhibition does not modify the sensitivity of cutaneous T cell lymphoma to pan-HDAC inhibitors in vitro. Front Genet 2022; 13:1032958. [PMID: 36425063 PMCID: PMC9681147 DOI: 10.3389/fgene.2022.1032958] [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: 08/31/2022] [Accepted: 10/24/2022] [Indexed: 08/30/2023] Open
Abstract
Cutaneous T-cell lymphomas (CTCLs) are a subset of T-cell malignancies presenting in the skin. The treatment options for CTCL, in particular in advanced stages, are limited. One of the emerging therapies for CTCL is treatment with histone deacetylase (HDAC) inhibitors. We recently discovered an evolutionarily conserved crosstalk between HDAC1, one of the targets of HDAC inhibitors, and the histone methyltransferase DOT1L. HDAC1 negatively regulates DOT1L activity in yeast, mouse thymocytes, and mouse thymic lymphoma. Here we studied the functional relationship between HDAC inhibitors and DOT1L in two human CTCL cell lines, specifically addressing the question whether the crosstalk between DOT1L and HDAC1 observed in mouse T cells plays a role in the therapeutic effect of clinically relevant broad-acting HDAC inhibitors in the treatment of human CTCL. We confirmed that human CTCL cell lines were sensitive to treatment with pan-HDAC inhibitors. In contrast, the cell lines were not sensitive to DOT1L inhibitors. Combining both types of inhibitors did neither enhance nor suppress the inhibitory effect of HDAC inhibitors on CTCL cells. Thus our in vitro studies suggest that the effect of commonly used pan-HDAC inhibitors in CTCL cells relies on downstream effects other than DOT1L misregulation.
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Affiliation(s)
| | - Muddassir Malik
- Division of Gene Regulation, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Tibor van Welsem
- Division of Gene Regulation, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, Netherlands
| | - Hanneke Vlaming
- Division of Gene Regulation, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Heinz Jacobs
- Division of Tumor Biology and Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Fred van Leeuwen
- Division of Gene Regulation, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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17
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Pandey S, Dolan A, Norton-Westbrook M, Desai AV. "Knock Me Out": The Challenges of Managing Pain Due to Cutaneous T Cell Lymphomas: A Case Report. J Palliat Med 2022; 25:1740-1746. [PMID: 35420490 PMCID: PMC9836697 DOI: 10.1089/jpm.2021.0561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cutaneous T cell lymphomas are associated with distressing symptoms, including pain and pruritus that negatively impact quality of life. Early involvement of palliative care can provide relief of symptoms and address multifaceted distress. This case highlights the complex management of cutaneous T cell lymphoma pain and associated symptoms, including existential and psychosocial distress. Our patient required frequent titration and rotation of high-dose opioids and adjuvant analgesics, ultimately requiring transfer to the intensive care unit for analgosedation. Total skin loss and disease complications led to his death after a compassionate withdrawal of life support. Cutaneous T cell lymphoma pain can be successfully managed with an interdisciplinary approach, early palliative care, and aggressive pain management. Complications from advanced disease, superinfection, and multidimensional distress complicate the efficacy of a multimodal analgesic approach. Further research is needed to deepen our understanding of how to optimally alleviate suffering within this vulnerable population.
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Affiliation(s)
- Shila Pandey
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrea Dolan
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moe Norton-Westbrook
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anjali V Desai
- Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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18
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Parsons MW, Wada DA, Halwani AS, Tao R, Gaffney DK. Improved overall survival over time in advanced stage mycosis fungoides: a cross-sectional study. Leuk Lymphoma 2022; 63:2428-2435. [DOI: 10.1080/10428194.2022.2081322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Matthew W. Parsons
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David A. Wada
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Ahmad S. Halwani
- Division of Hematology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David K. Gaffney
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
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19
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Ortiz-Romero PL, Maroñas Jiménez L, Muniesa C, Estrach T, Servitje O, Fernández-de-Misa R, Gallardo F, Sanmartín O, Riveiro-Falkenbach E, García-Díaz N, Vega R, Lora D, Postigo C, Jiménez B, Sánchez-Beato M, Pedro Vaqué J, Rodríguez Peralto JL, de la Cámara AG, de la Cruz J, Piris Pinilla MÁ. Activity and safety of topical pimecrolimus in patients with early stage mycosis fungoides (PimTo-MF): a single-arm, multicentre, phase 2 trial. THE LANCET HAEMATOLOGY 2022; 9:e425-e433. [DOI: 10.1016/s2352-3026(22)00107-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/25/2022] [Accepted: 03/30/2022] [Indexed: 12/19/2022]
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20
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Di Raimondo C, Vaccarini S, Nunzi A, Rapisarda V, Zizzari A, Meconi F, Monopoli A, Narducci MG, Scala E, Bianchi L, Tesei C, Cantonetti M. Continuous low-dose gemcitabine in primary cutaneous T cell lymphoma: a retrospective study. Dermatol Ther 2022; 35:e15482. [PMID: 35373414 DOI: 10.1111/dth.15482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE the aim of our retrospective study was to evaluate the efficacy of a continuous therapy with a lower dosage of gemcitabine compared to those usually administered in patients with CTCL. MATERIAL AND METHODS twenty-two patients received different dosages of gemcitabine. Dosage and schedule of the drug were chosen on the basis of clinical features. Gemcitabine was given at 1000 mg every 15 days in 13 patients (4 MF, 9 SS); at 1000 mg at days +1, +8, +15 in 6 cases (3 MF, 3 SS). RESULTS All patients had been previously treated: four patients had received both skin directed and systemic treatments. Eighteen patients had received photopheresis, IFN, chemotherapy and immunotherapy. The Objective Response Rate (CR+PR) among all patients was 54.5% (12 of 22 patients) with a CR of 4.5% (1 of 22 patients) and a PR of 50% (11 of 22 patients). Patients with SS had an ORR of 61.5% (8 of 13 patients) with 1 CR (7%) and 7 PR (53.8%); patients with MF showed an ORR of 55.6% (5 of 9 patients) but no patients experienced CR (0%). The schedule with the highest efficacy and the lowest toxicity profile was 1000 mg every 15 days. Median PFS and OS in all patients were 17 and 45 months respectively. Gemcitabine was generally well tolerated. This article is protected by copyright. All rights reserved. CONCLUSIONS we have demonstrated that a much lower dose of gemcitabine (1000 mg once every 15 days) in patients with advanced-stage and refractory CTCL can lead to a durable response, with tolerable and manageable adverse effects. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cosimo Di Raimondo
- Department of Dermatology, University of Roma Tor Vergata, Rome, IT.,Istituto dermopatico dell'Immacolata, IDI-IRCCS, Rome, IT
| | - Sara Vaccarini
- Department of Hematology, University of Roma Tor Vergata, Rome, IT
| | - Andrea Nunzi
- Department of Hematology, University of Roma Tor Vergata, Rome, IT
| | - Vito Rapisarda
- Department of Hematology, University of Roma Tor Vergata, Rome, IT
| | | | - Federico Meconi
- Department of Hematology, University of Roma Tor Vergata, Rome, IT
| | | | | | - Enrico Scala
- Istituto dermopatico dell'Immacolata, IDI-IRCCS, Rome, IT
| | - Luca Bianchi
- Department of Dermatology, University of Roma Tor Vergata, Rome, IT
| | - Cristiano Tesei
- Department of Hematology, University of Roma Tor Vergata, Rome, IT
| | - Maria Cantonetti
- Department of Hematology, University of Roma Tor Vergata, Rome, IT
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21
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Matsuda Y, Ikeda S, Abe F, Takahashi Y, Kitadate A, Takahashi N, Wakui H, Tagawa H. Downregulation of miR-26 promotes invasion and metastasis via targeting interleukin-22 in cutaneous T-cell lymphoma. Cancer Sci 2022; 113:1208-1219. [PMID: 35133054 PMCID: PMC8990290 DOI: 10.1111/cas.15296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
It has been reported that certain microRNAs (miRNA) are associated with the pathogenesis of lymphoma. We have previously demonstrated that histone deacetylase inhibitors restore tumor-suppressive miRNAs, such as miR-16, miR-29, miR-150, and miR-26, in advanced cutaneous T-cell lymphoma (CTCL). Among these, the function of miR-26 remains unclear. In this study, we aimed to reveal the function of miR-26 in CTCL oncogenesis. First, we confirmed that the miR-26 family was markedly dysregulated in CTCL cell lines and primary samples. In vivo analysis using miR-26a-transduced CTCL cells injected into immunodeficient NOG mice demonstrated the significant prolonged survival of the mice, suggesting that the miRNA had a tumor-suppressive function. We performed gene expression assays and identified 12 candidate miR-26 targets, namely RGS13, FAM71F1, OAF, SNX21, CDH2, PTPLB, IL22, DNAJB5, CASZ1, CACNA1C, MYH10, and CNR1. Among these, IL22 was the most likely candidate target because the IL-22-STAT3-CCL20-CCR6 cascade is associated with tumor invasion and metastasis of advanced CTCL. In vitro analysis of IL22 and IL22RA knockdown and miR-26 transduction demonstrated inhibited CTCL cell migration. In particular, IL22 knockdown induced cell apoptosis. Finally, we conducted in vivo inoculation analysis of mice injected with shIL22-transfected CTCL cells, and found no tumor invasion or metastasis in the inoculated mice, although the control mice showed multiple tumor invasions and metastases. These results, along with our previous data, demonstrated that miR-26 is a tumor suppressor that is associated with tumor invasion and the metastasis of advanced CTCL by regulating the IL-22-STAT3-CCL20 cascade. Therefore, a IL-22-targeting therapy could be a novel therapeutic strategy for advanced CTCL.
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Affiliation(s)
- Yuka Matsuda
- Department of Life ScienceGraduate School of Engineering ScienceAkita UniversityAkitaJapan
| | - Sho Ikeda
- Department of Hematology, Nephrology, and RheumatologyAkita University Graduate School of MedicineAkitaJapan
| | - Fumito Abe
- Department of Hematology, Nephrology, and RheumatologyAkita University Graduate School of MedicineAkitaJapan
| | - Yuto Takahashi
- Department of Life ScienceGraduate School of Engineering ScienceAkita UniversityAkitaJapan
| | - Akihiro Kitadate
- Department of Hematology, Nephrology, and RheumatologyAkita University Graduate School of MedicineAkitaJapan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and RheumatologyAkita University Graduate School of MedicineAkitaJapan
| | - Hideki Wakui
- Department of Life ScienceGraduate School of Engineering ScienceAkita UniversityAkitaJapan
| | - Hiroyuki Tagawa
- Department of Hematology, Nephrology, and RheumatologyAkita University Graduate School of MedicineAkitaJapan
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22
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Liang JJ, Pitsillou E, Ververis K, Guallar V, Hung A, Karagiannis TC. Investigation of small molecule inhibitors of the SARS-CoV-2 papain-like protease by all-atom microsecond modelling, PELE Monte Carlo simulations, and in vitro activity inhibition. Chem Phys Lett 2022; 788:139294. [PMID: 34961797 PMCID: PMC8693950 DOI: 10.1016/j.cplett.2021.139294] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/03/2021] [Accepted: 12/15/2021] [Indexed: 12/16/2022]
Abstract
The SARS-CoV-2 papain-like (PLpro) protease is essential for viral replication. We investigated potential antiviral effects of hypericin relative to the well-known noncovalent PLpro inhibitor GRL-0617. Molecular dynamics and PELE Monte Carlo simulations highlight favourable binding of hypericin and GRL-0617 to the naphthalene binding pocket of PLpro. Although not potent as GRL-0617 (45.8 vs 1.6 µM for protease activity, respectively), in vitro fluorogenic enzymatic assays with hypericin show concentration-dependent inhibition of both PLpro protease and deubiquitinating activities. Given its use in supplementations and the FDA conditional approval of a synthetic version, further evaluation of hypericin as a potential SARS-CoV-2 antiviral is warranted.
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Affiliation(s)
- Julia J. Liang
- Epigenomic Medicine, Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia,School of Science, STEM College, RMIT University, VIC 3001, Australia
| | - Eleni Pitsillou
- Epigenomic Medicine, Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia,School of Science, STEM College, RMIT University, VIC 3001, Australia
| | - Katherine Ververis
- Epigenomic Medicine, Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Victor Guallar
- Barcelona Supercomputing Center, Jordi Girona 29, E-08034 Barcelona, Spain,ICREA, Passeig Lluís Companys 23, E-08010 Barcelona, Spain
| | - Andrew Hung
- School of Science, STEM College, RMIT University, VIC 3001, Australia
| | - Tom C. Karagiannis
- Epigenomic Medicine, Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia,Department of Clinical Pathology, The University of Melbourne, Parkville, VIC 3052, Australia,Corresponding author at: Head Epigenomic Medicine Program, Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
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23
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Salant JA, Khan N, Nelson JE, Norton-Westbrook M, Desai AV. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Cutaneous T Cell Lymphoma. J Palliat Med 2021; 25:958-963. [PMID: 34978848 DOI: 10.1089/jpm.2021.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cutaneous T cell lymphoma and its subtypes, mycosis fungoides (MF) and Sézary syndrome (SS), comprise a spectrum of chronic lymphoproliferative disorders in which neoplastic T cells accumulate within the skin and visceral organs. This process is frequently characterized by severe pain, nonpain symptoms, and physical disfigurement. Significant emotional, spiritual, and existential distress is also felt by many of these patients as they experience a chronic, often incurable disease. Patients suffering from these diseases, though not commonly encountered, can benefit greatly from palliative care support. In this article, a team of palliative care clinicians, critical care physicians, and an oncologist specializing in lymphoma offer 10 tips to help palliative care teams to support these vulnerable and often-distressed patients and their caregivers.
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Affiliation(s)
- Jennifer A Salant
- Pediatric Advanced Care Team, Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Niloufer Khan
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Judith E Nelson
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Critical Care Service, Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moe Norton-Westbrook
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anjali V Desai
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Podkonjak T, Cranmer H, Scarisbrick J, McCarthy G, Lilley C, Cheng LI. Cost-effectiveness of brentuximab vedotin for the treatment of cutaneous T-cell lymphoma. J Comp Eff Res 2021; 11:193-202. [PMID: 34879742 DOI: 10.2217/cer-2021-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the cost-effectiveness of brentuximab vedotin (BV) versus physician's choice (methotrexate or bexarotene) for treating advanced cutaneous T-cell lymphoma. Materials & methods: A partitioned-survival model was developed from the National Health Service perspective in England and Wales. Model inputs were informed by the ALCANZA trial, real-world UK data, published literature or clinical experts. Results: Over the modeled lifetime, BV dominated physician's choice and provided an additional 1.58 life-years and 1.09 higher quality-adjusted life years with a net cost saving of £119,565. The net monetary benefit was £152,326 using a willingness-to-pay threshold of £30,000/quality-adjusted life year. Results were robust in sensitivity and scenario analyses. Conclusion: BV is a highly cost-effective treatment for advanced cutaneous T-cell lymphoma.
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Affiliation(s)
| | - Holly Cranmer
- Takeda Pharmaceuticals International Co., London, UK
| | - Julia Scarisbrick
- Department of Dermatology, University Hospital Birmingham, Birmingham B15 2TH, UK
| | | | | | - Lung-I Cheng
- Global Value & Access Oncology, Takeda Pharmaceutical America, Inc., Lexington, MA 02421, USA
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Ottevanger R, van Beugen S, Evers AWM, Willemze R, Vermeer MH, Quint KD. Quality of life in patients with Mycosis Fungoides and Sézary Syndrome: a systematic review of the literature. J Eur Acad Dermatol Venereol 2021; 35:2377-2387. [PMID: 34331819 PMCID: PMC9291074 DOI: 10.1111/jdv.17570] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/20/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
Cutaneous T‐cell Lymphoma’s (CTCL) are a rare, heterogeneous group of T‐cell lymphomas that primarily manifest in the skin. Mycosis fungoides (MF) and Sézary syndrome (SS) are considered the classic types of CTCL. The diverse manifestation of CTCL results in a wide range of symptoms with a possible mild to severe impact on Quality of Life (QoL) depending on the disease stage. Previous studies on QoL in CTCL patients report diverse patient populations and use many different QoL instruments. In the current literature, a clear overview on the influence of the different stages of disease (early MF, late‐stage MF/SS or total group) on the QoL is lacking. Therefore, a systematic search of the literature was conducted using the PubMed, Embase, PsycINFO and Web of Science databases. Studies were included if they described QoL in patients with MF and SS retrieved by standardized instruments or qualitative interviews. In total, 24 studies were included using 18 different questionnaires to report on dermatology‐specific, cancer‐specific and generic QoL. The effect on QoL was found to be greater in patients with late‐stage disease as compared to early stage disease, with significant impairments on functional, emotional and physical domains. Nonetheless, even in patients with limited disease, QoL was mildly to moderately affected. Overall, pruritus was the most frequent reported and most bothersome symptom. Significant influence of the disease on daily life activities were found, not only in patients but also on caregivers and family. This broad, structured overview on QoL in MF and SS patients underlines the influence of disease stage on QoL, and therefore, recommends future studies to distinguish between disease stages when reporting results. Furthermore, this overview can inform clinicians in clinical practice by creating awareness of QoL deficits according to disease stage.
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Affiliation(s)
- R Ottevanger
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - S van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - A W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - R Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - M H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - K D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
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