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Assaf C, Dobos G, Zech IM, Doess A, May M, Jadasz J. Epidemiology of mature T/NK-cell lymphomas in Germany - A representative cross-sectional study based on SHI claims data. J Dtsch Dermatol Ges 2023; 21:1320-1327. [PMID: 37845021 DOI: 10.1111/ddg.15187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/18/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Primary cutaneous lymphomas (PCL) are rare skin tumors of lymphoproliferative neoplasms and belong to the heterogeneous group of non-Hodgkin's lymphomas. PCL encompass a broad spectrum of clinical and histologic manifestations, with cutaneous T-cell lymphoma (CTCL) being the most common (73%). Due to the rarity of the diseases, population-based studies of care and epidemiology are limited. PATIENTS AND METHODS Based on anonymized, age- and sex-adjusted SHI (statutory health insurance) claims data of approximately five million SHI-insured patients, a retrospective analysis was conducted over a six-year period (2012-2017) to determine the prevalence, incidence, and lethality in patients with mature-cell T/NK-cell lymphoma in Germany. RESULTS A total of 1,336 patients with T-cell lymphoma were identified during the observation period. The six-year prevalence ranged from 27.35 to 43.58 per 100,000. Patients were 65% male with a mean age of 66 years (SD 15). There were 246 patients (approx. 20%) who died within the 6 years, up to 7% per year. The calculated incidence in 153 identified patients in 2017 is 3.65 to 3.92 per 100,000. CONCLUSIONS For the first time, valid epidemiologic findings of patients with mature T-cell and NK-cell lymphomas were obtained using SHI claims data in Germany. Further analyses are needed to gain a deeper insight into the healthcare reality of patients with this rare disease.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology and Venerology, HELIOS Klinikum Krefeld, Krefeld, Germany
- Institute for Molecular Medicine, Hamburg Medical School, Hamburg, Germany
- Department of Dermatology, HELIOS Klinikum Schwerin, University Campus of the Hamburg Medical School, Schwerin, Germany
| | - Gabor Dobos
- Clinic for Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, Joint Faculty of Medicine of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany
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Assaf C, Dobos G, Zech IM, Doess A, Hibbe T, Jadasz JJ. Care structure of patients with mycosis fungoides and Sézary syndrome in Germany - Care research based on SHI claims data. J Dtsch Dermatol Ges 2022; 20:643-651. [PMID: 35499207 DOI: 10.1111/ddg.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cutaneous T-cell lymphomas (CTCLs) are rare forms of non-Hodgkin's lymphoma of T-cell origin that occur mainly in the skin. The most common form is mycosis fungoides (MF), but Sézary syndrome (SS), a more aggressive form of CTCL, is another relevant subgroup. Due to the rare nature of the disease, population-based studies of the epidemiology and disease burden and insights into care delivery are limited. PATIENTS AND METHODS Based on an anonymized, age and sex-adjusted routine dataset comprising approximately five million people with statutory health insurance, a retrospective, longitudinal healthcare research study was conducted over a six-year period (2012-2017). RESULTS In 55 % of patients with MF and SS, the initial diagnosis was documented in an outpatient setting; in 59 % of cases by a dermatologist. Immunophenotyping by flow cytometry is considered an important investigative tool for the detection and follow-up surveillance of blood involvement of cutaneous lymphomas, as the disease stage is the most important prognostic factor in MF and SS; this was performed in only 10 % of patients. The first-line treatment was topical (76 %), in particular with corticosteroids (66 %). CONCLUSIONS The findings from this healthcare research point to the need for increased guideline-based care.
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Affiliation(s)
- Chalid Assaf
- Helios Klinikum Krefeld.,Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin]
| | - Gabor Dobos
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin [Department of dermatology, venereology and allergology, Charité University Hospital Berlin].,Hopital Saint-Louis, AP-HP, Paris, France
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Surmanowicz P, Doherty S, Sivanand A, Parvinnejad N, Deschenes J, Schneider M, Hardin J, Gniadecki R. The Clinical Spectrum of Primary Cutaneous CD4+ Small/Medium-Sized Pleomorphic T-Cell Lymphoproliferative Disorder: An Updated Systematic Literature Review and Case Series. Dermatology 2020; 237:618-628. [PMID: 33326960 DOI: 10.1159/000511473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoproliferative disorder (SMPLPD) is a provisional entity within the 2016 World Health Organization classification of primary cutaneous lymphomas. The condition is currently classified as a lymphoproliferative disorder to emphasize its benign course and discourage aggressive, systemic treatment modalities. OBJECTIVE To provide a relevant synthesis for the dermatological practitioner on the prevalence, presentation, and treatment of SMPLPD. METHODS We conducted an updated systematic literature review and a retrospective chart review of diagnosed cases of SMPLPD from 2 Canadian academic cutaneous lymphoma centers. RESULTS A total of 23 studies with 136 cases were extracted from the systematic review and 24 patients from our retrospective chart review. SMPLPD proved relatively common accounting for 12.5% of all cutaneous T-cell lymphomas encountered in our cutaneous lymphoma clinics, second in frequency only to mycosis fungoides. The typical clinical presentation was that of an older individual (median age 59 years) with an asymptomatic solitary lesion on their upper extremity. The most common clinical differentials were cutaneous lymphoid hyperplasia, basal cell carcinoma, and lymphoma unspecified. T follicular helper markers were reliably detected. The main treatment modalities were surgical excision, local radiation therapy, and topical or intralesional steroids. Cure was achieved in the vast majority of cases. CONCLUSIONS SMPLPD is an underdiagnosed T-cell lymphoma with an overtly benign clinical course. The condition has an excellent prognosis and responds well to skin-directed therapies. Practitioners should be aware of this condition to avoid aggressive systemic treatments.
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Affiliation(s)
- Philip Surmanowicz
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Sean Doherty
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Arunima Sivanand
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Nikoo Parvinnejad
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean Deschenes
- Department of Pathology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Schneider
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jori Hardin
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada,
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8
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Dobos G, de Masson A, Ram-Wolff C, Beylot-Barry M, Pham-Ledard A, Ortonne N, Ingen-Housz-Oro S, Battistella M, d'Incan M, Rouanet J, Franck F, Vignon-Pennamen MD, Franck N, Carlotti A, Boulinguez S, Lamant L, Petrella T, Dalac S, Joly P, Courville P, Rivet J, Dereure O, Amatore F, Taix S, Grange F, Durlach A, Quéreux G, Josselin N, Moulonguet I, Mortier L, Dubois R, Maubec E, Laroche L, Michel L, Templier I, Barete S, Nardin C, Augereau O, Vergier B, Bagot M. Epidemiological changes in cutaneous lymphomas: an analysis of 8593 patients from the French Cutaneous Lymphoma Registry. Br J Dermatol 2020; 184:1059-1067. [PMID: 33131055 DOI: 10.1111/bjd.19644] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary cutaneous lymphomas (PCLs) are a heterogeneous group of T-cell (CTCL) and B-cell (CBCL) malignancies. Little is known about their epidemiology at initial presentation in Europe and about potential changes over time. OBJECTIVES The aim of this retrospective study was to analyse the frequency of PCLs in the French Cutaneous Lymphoma Registry (GFELC) and to describe the demography of patients. METHODS Patients with a centrally validated diagnosis of primary PCL, diagnosed between 2005 and 2019, were included. RESULTS The calculated incidence was unprecedently high at 1·06 per 100 000 person-years. The number of included patients increased yearly. Most PCL subtypes were more frequent in male patients, diagnosed at a median age of 60 years. The relative frequency of rare CTCL remained stable, the proportion of classical mycosis fungoides (MF) decreased, and the frequency of its variants (e.g. folliculotropic MF) increased. Similar patterns were observed for CBCL; for example, the proportion of marginal-zone CBCL increased over time. CONCLUSIONS Changes in PCL frequencies may be explained by the emergence of new diagnostic criteria and better description of the entities in the most recent PCL classification. Moreover, we propose that an algorithm should be developed to confirm the diagnosis of PCL by central validation of the cases.
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Affiliation(s)
- G Dobos
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - A de Masson
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - C Ram-Wolff
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - M Beylot-Barry
- Dermatology Department, Université de Bordeaux, Bordeaux, France
| | - A Pham-Ledard
- Dermatology Department, Université de Bordeaux, Bordeaux, France
| | - N Ortonne
- Pathology Department, Henri Mondor Hospital, INSERM U955, Université Paris Est, AP-HP, Paris, France
| | - S Ingen-Housz-Oro
- Dermatology Department, Henri Mondor Hospital, INSERM U955, Université Paris Est, AP-HP, Paris, France
| | - M Battistella
- INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France.,Pathology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - M d'Incan
- Dermatology and Cutaneous Oncology, Estaing University Hospital, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - J Rouanet
- Pathology Department, NHE Clermont et SIPATH UNILABS, Clermont-Ferrand, France
| | - F Franck
- Pathology Department, NHE Clermont et SIPATH UNILABS, Clermont-Ferrand, France
| | | | - N Franck
- Dermatology Department, Cochin Hospital, AP-HP, Paris, France
| | - A Carlotti
- Pathology Department, Cochin Hospital, AP-HP, Paris, France
| | - S Boulinguez
- Dermatology Department, Cahors Hospital, Toulouse, France
| | - L Lamant
- Pathology and Cytopathology Department, Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - T Petrella
- Pathology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - S Dalac
- Dermatology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - P Joly
- Dermatology Department, Rouen University Hospital, INSERM U1234, Rouen Institute for Research and Innovation in Biomedicine, Rouen, France
| | - P Courville
- Pathology Department, Rouen University Hospital, INSERM U1234, Rouen Institute for Research and Innovation in Biomedicine, Rouen, France
| | - J Rivet
- Dermatology Department, Université de Bordeaux, Bordeaux, France.,Pathology Department, Henri Mondor Hospital, INSERM U955, Université Paris Est, AP-HP, Paris, France
| | - O Dereure
- Dermatology Department, Montpellier University Hospital, Montpellier, France
| | - F Amatore
- Department of Dermatology and Oncodermatology, Aix-Marseille University, AP-HM, Timone Hospital, Marseille, France
| | - S Taix
- Department of Pathology, Aix-Marseille University, AP-HM, Timone Hospital, Marseille, France
| | - F Grange
- Dermatology Department, Robert Debré University Hospital, Reims, France
| | - A Durlach
- Pathology Department, Reims University Hospital, Reims, France
| | - G Quéreux
- Dermatology Department, Nantes University Hospital, Nantes, France
| | - N Josselin
- Pathology Department, Nantes University Hospital, Nantes, France
| | - I Moulonguet
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - L Mortier
- Dermatology Department, Claude Huriez University Hospital, INSERM U1189, Université de Lille, Lille, France
| | - R Dubois
- Pathology Department, Claude Huriez University Hospital, Lille, France
| | - E Maubec
- Dermatology Department, Avicenne Hospital, AP-HP, Paris, France
| | - L Laroche
- Dermatology Department, Avicenne Hospital, AP-HP, Paris, France
| | - L Michel
- INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
| | - I Templier
- Dermatology Department, Grenoble University Hospital, Grenoble, France
| | - S Barete
- Dermatology Department, Pité-Salpêtrière Hospital, AP-HP, Paris, France
| | - C Nardin
- Dermatology Department, Minjoz Hospital, Besancon, France, INSERM U1098, University of Franche Comté, EFS Bourgogne Franche-Comté and Franche-Comté University, Besançon, France
| | - O Augereau
- Pathology Department, Saint-André Hospital, Bordeaux University Hospital, INSERM U1053 - UMR BaRITOn, Eq 3 Oncogenèse des Lymphomes Cutanés, Université de Bordeaux, Bordeaux, France
| | - B Vergier
- Pathology Department, Saint-André Hospital, Bordeaux University Hospital, INSERM U1053 - UMR BaRITOn, Eq 3 Oncogenèse des Lymphomes Cutanés, Université de Bordeaux, Bordeaux, France
| | - M Bagot
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France.,INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France.,Université de Paris, Paris, France
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