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Martínez-Banaclocha N, Martínez-Madueño F, Caballé B, Badia J, Blanes M, Bujanda DA, Calvo V, Gómez Codina J, Blanco CQ, Espinosa P, Lavernia J, Arroyo FRG, Risueño MG, Llorca C, Cumeras R, Pulla MP, Gumà J. A Descriptive Study of 103 Primary Cutaneous B-Cell Lymphomas: Clinical and Pathological Characteristics and Treatment from the Spanish Lymphoma Oncology Group (GOTEL). Cancers (Basel) 2024; 16:1034. [PMID: 38473391 DOI: 10.3390/cancers16051034] [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: 02/12/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Primary cutaneous B-cell lymphomas (PCBCLs) are B-cell lymphomas that can occur in the skin without evidence of extracutaneous involvement. The 2005 WHO/EORTC classification of cutaneous lymphomas and its 2018 update have distinguished three main categories based on clinicopathological, immunohistochemical, and genetic characteristics: primary cutaneous marginal zone lymphoma (PCMZL), primary cutaneous follicle centre lymphoma (PCFCL), and primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT). PCMZL and PCFCL are clinically indolent, while PCDLBCL-LT is an aggressive lymphoma. Due to its low incidence and lack of prospective studies, it is difficult to establish a standard treatment for each subgroup. The objective of our study was to describe the clinical and pathological characteristics of 103 patients with cutaneous B-cell lymphoma from 12 centres belonging to the Spanish Lymphoma Oncology Group. The median age was 53 years (40-65). According to skin extension, 62% had single-site lymphoma, 17% had regional lymphoma, and 20% had multifocal lymphoma. Histology: 66% had PCMZL, 26% had PCFCL, and 8% had PCDLBCL-LT. Twenty-three percent of the patients were treated exclusively with surgery, 26% with radiotherapy only, 21% with surgery plus radiotherapy, 10% with polychemotherapy, and 5% with rituximab monotherapy. Overall, 96% of patients achieved a complete response, and 44% subsequently relapsed, most of them relapsing either locally or regionally. The 10-year OS was 94.5% for the entire cohort, 98% for the PCMZL cohort, 95% for the PCFCL cohort, and 85.7% for the PCDLBCL-LT cohort. Our data are comparable to those of other published series, except for the high frequency of PCMZL. The expected heterogeneity in therapeutic management has been observed.
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Affiliation(s)
- Natividad Martínez-Banaclocha
- Medical Oncology Department, Hospital General Universitario Dr. Balmis, Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Francisca Martínez-Madueño
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Berta Caballé
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Joan Badia
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Mar Blanes
- Dermatology Department, Hospital General Universitario Dr. Balmis, Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - David Aguiar Bujanda
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrin, 35010 Las Palmas de Gran Canaria, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain
| | - Jose Gómez Codina
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Cristina Quero Blanco
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Pablo Espinosa
- Dermatology Department, Hospital Infanta Cristina, 28981 Parla, Spain
| | - Javier Lavernia
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología (I.V.O.), 46009 Valencia, Spain
| | | | - María Guirado Risueño
- Medical Oncology Department, Hospital General Universitario de Elche, 03203 Alicante, Spain
| | - Cristina Llorca
- Medical Oncology Department, Hospital General Universitario de Elda, 03600 Alicante, Spain
| | - Raquel Cumeras
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
| | - Mariano Provencio Pulla
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Madrid, Spain
| | - Josep Gumà
- Southern Catalonia Institute of Oncology, Hospital Universitari Sant Joan de Reus, IISPV-URV-CERCA, 43204 Reus, Spain
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Wang S, Perlmutter JW, Johnston J, Nugent Z, Wiseman M. Rituximab Treatment of Primary Cutaneous Follicle Center Lymphoma: A Retrospective Review. J Cutan Med Surg 2022; 26:604-612. [PMID: 36134749 DOI: 10.1177/12034754221126119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary cutaneous B-cell lymphoma (PCBCL) presents only in the skin at the time of diagnosis with no evidence of extracutaneous disease, and primary cutaneous follicle center lymphoma (PCFCL) is the most common subtype. There is currently a lack of prospective randomized control trials and large retrospective studies investigating the efficacy of different treatment options for PCFCL. This retrospective study was conducted to describe our local clinical experience and outcomes of patients treated with rituximab-containing regimens. OBJECTIVES To describe our local clinical experience and treatment outcomes of patients treated with rituximab-containing regimens. METHODS A retrospective study consisting of 25 PCFCL patients treated with different modalities. Patient records were reviewed and analyzed using a Kaplan-Meier estimation and SAS 9.4 software. RESULTS After the initial treatment, all patients had CR except for 1 patient in the observation group. Further, 60% of patients in surgery, 20% in chemoimmunotherapy, 67% in rituximab monotherapy, 33% in steroid injection/systemic prednisone, and 33% in observation experienced a relapse. Although no significant difference was found between treatment groups due to the small sample size, time to relapse trends provides insight into treatment responses. Chemoimmunotherapy had the lowest relapse rate in the first 5 years post-treatment, whereas surgery had a higher tendency to relapse. CONCLUSIONS Despite the potential for rituximab-containing chemoimmunotherapy to yield adverse effects, it is effective in achieving a prolonged clinical remission in patients with PCFCL. It remains a reasonable treatment option for diffuse, extensive, or treatment-resistant disease.
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Affiliation(s)
- Siru Wang
- 12359 University of Manitoba, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Jonah W Perlmutter
- 8665 Department of Biochemistry, University of Winnipeg, Winnipeg, MB, Canada
| | - James Johnston
- 8647 Department of Hematology and Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Zoann Nugent
- 8647 Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Marni Wiseman
- 8664 Section of Dermatology, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.,SKiNWISE DERMATOLOGY, Winnipeg, Manitoba, Canada
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Yonekura K. Current treatment strategies and emerging therapies for cutaneous lymphoma. J Dermatol 2021; 49:223-231. [PMID: 34958516 DOI: 10.1111/1346-8138.16289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
Cutaneous lymphoma is generally treated with skin-directed therapies (SDT) during the early and localized stages. For the refractory or advanced stages, systemic therapies are used. Previously, retinoids and interferons were used for SDT-resistant cases. Only a few chemotherapy options were available for more advanced disease. In recent years, many novel agents have been introduced and the strategy for systemic therapy has changed, especially for cutaneous T-cell lymphoma (CTCL). For SDT, helical tomotherapy, a new radiation modality, has been drawing attention as an option for radiotherapy. Targeted therapies such as histone deacetylase inhibitors, mogamulizumab, brentuximab vedotin, and denileukin diftitox are new treatment options. Chemotherapy agents such as gemcitabine and pralatrexate have been introduced; they are expected to have meaningful efficacy as monotherapy. Allogeneic hematopoietic stem cell transplantation is still considered for young patients with advanced CTCL as the only potentially curative treatment.
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Affiliation(s)
- Kentaro Yonekura
- Department of Dermatology, Imamura General Hospital, Kagoshima, Japan
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Ohtsuka M, Hamada T, Miyagaki T, Shimauchi T, Yonekura K, Kiyohara E, Fujita H, Izutsu K, Okuma K, Kawai K, Koga H, Sugaya M. Outlines of the Japanese guidelines for the management of primary cutaneous lymphomas 2020. J Dermatol 2020; 48:e49-e71. [PMID: 33245165 DOI: 10.1111/1346-8138.15707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 01/06/2023]
Abstract
Since the publication of the Japanese "Guidelines for the management of cutaneous lymphomas" in 2011, the World Health Organization (WHO) classification of hematolymphoid neoplasms and the WHO-European Organisation for Research and Treatment of Cancer classification for primary cutaneous lymphomas were updated and a number of novel systemic drugs for cutaneous T-cell lymphoma had been approved in Japan. In 2020, we revised the Japanese guidelines for the management of cutaneous lymphomas with consideration of the recent advances in the understanding of the pathophysiology and classification of cutaneous lymphomas together with the update of treatment strategies reflecting the advent of novel drugs. In addition to a brief explanation of epidemiology, diagnosis, staging system, prognosis and management of each subtype of cutaneous lymphomas, the recommendations for nine clinical questions regarding treatment options that can vary even among experts are also described. A systematic review process and determination of recommendations in answer to each clinical question have been performed in accordance with the Grading of Recommendations, Assessment, Development and Evaluation scheme by a multidisciplinary expert panel consisting of dermatologists, a hematologist and a radiation oncologist. In this article, we present the outlines of the revised Japanese "Guidelines for the management of cutaneous lymphomas".
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Affiliation(s)
- Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toshihisa Hamada
- Department of Dermatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Takatoshi Shimauchi
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kentaro Yonekura
- Department of Dermatology, Imamura General Hospital, Kagoshima, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University School of Medicine, Suita, Japan
| | - Hideki Fujita
- Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Koji Izutsu
- Department of Hematology, National Cancer Center Hospital, Tokyo, Japan
| | - Kae Okuma
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuhiro Kawai
- Department of Dermatology, Kido Hospital, Niigata, Japan
| | - Hiroshi Koga
- Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Makoto Sugaya
- Department of Dermatology, International University of Health and Welfare, Narita, Japan
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Lima M. Cutaneous primary B-cell lymphomas: from diagnosis to treatment. An Bras Dermatol 2016; 90:687-706. [PMID: 26560215 PMCID: PMC4631235 DOI: 10.1590/abd1806-4841.20153638] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/05/2014] [Indexed: 12/19/2022] Open
Abstract
Primary cutaneous B-cell lymphomas are a heterogeneous group of mature B-cells neoplasms with tropism for the skin, whose biology and clinical course differ significantly from the equivalent nodal lymphomas. The most indolent forms comprise the primary cutaneous marginal zone and follicle center B-cell lymphomas that despite the excellent prognosis have cutaneous recurrences very commonly. The most aggressive forms include the primary cutaneous large B-cell lymphomas, consisting in two major groups: the leg type, with poor prognosis, and others, the latter representing a heterogeneous group of lymphomas from which specific entities are supposed to be individualized over time, such as intravascular large B-cell lymphomas. Treatment may include surgical excision, radiotherapy, antibiotics, corticosteroids, interferon, monoclonal antibodies and chemotherapy, depending on the type of lymphoma and on the type and location of the skin lesions. In subtypes with good prognosis is contraindicated overtreatment and in those associated with a worse prognosis the recommended therapy relies on CHOP-like regimens associated with rituximab, assisted or not with local radiotherapy. We review the primary cutaneous B-cell lymphomas, remembering the diagnostic criteria, differential diagnosis, classification, and prognostic factors and presenting the available therapies.
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Affiliation(s)
- Margarida Lima
- Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
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Abstract
PURPOSE OF REVIEW In the last decade, there has been considerable debate regarding the classification and terminology of the group of primary cutaneous B-cell lymphomas (CBCLs). With the introduction of the WHO-EORTC classification for cutaneous lymphomas, three main types of CBCLs are recognized: primary cutaneous marginal zone B-cell lymphoma (PCMZL), primary cutaneous follicle centre lymphoma (PCFCL) and primary cutaneous large B-cell lymphoma, leg type (PCLBCL, LT). RECENT FINDINGS Epidemiological studies performed on different patient cohorts showed that the CBCL entities described in the WHO-EORTC classification and the 4th WHO classification of tumours of haematopoietic and lymphoid tissues are reproducible worldwide and are clinically relevant, thereby illustrating the clinical usefulness of the WHO-EORTC classification. Furthermore, collaborative studies between the ISCL and EORTC lymphoma group resulted in recommended staging procedures and consensus treatment recommendations for different CBCL subtypes. SUMMARY The advances in the classification, staging procedures and treatment of CBCLs have led to a major improvement in clinical care. The progress in CBCL classification enables molecular studies on well defined groups of patients and facilitates comparison of treatment results between different centres. Recent studies found that intralesional/intravenous rituximab has a therapeutic value in PCFCL and PCMZL with widespread cutaneous lesions and suggest that therapies targeting the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) pathway could be helpful in DLBCL, LT.
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Dreno B, Urosevic-Maiwald M, Kim Y, Guitart J, Duvic M, Dereure O, Khammari A, Knol AC, Derbij A, Lusky M, Didillon I, Santoni AM, Acres B, Bataille V, Chenard MP, Bleuzen P, Limacher JM, Dummer R. TG1042 (Adenovirus-interferon-γ) in primary cutaneous B-cell lymphomas: a phase II clinical trial. PLoS One 2014; 9:e83670. [PMID: 24586226 PMCID: PMC3933342 DOI: 10.1371/journal.pone.0083670] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 10/30/2013] [Indexed: 11/25/2022] Open
Abstract
Rational While a variety of registered therapies exist for Cutaneous T Cell Lymphoma, no such therapy is available for Cutaneous B Cell Therapy. In this context we performed a phase II, open label, multicenter, non-comparative study to evaluate the efficacy and safety of repeated intra-lesional administrations of TG1042 (adenovirus-interferon-γ) in patients with relapsing primary cutaneous B-cell lymphomas (CBCL). Method Thirteen patients have been enrolled and received intralesional injections of TG1042 containing 5×1010 viral particles into up to six lesions simultaneously. Injections were performed on days 1, 8 and 15 of each of four consecutive 28 day cycles. Results Eleven (85%) out of 13 enrolled patients showed an objective response after injections of TG1042. Seven patients (54%) exhibited complete and four (31%) displayed partial response. The median time to disease progression in the study population was 23.5 months (range 6.25 to 26+). Most commonly observed adverse events were minor to moderate flu-like symptoms, fatigue and injection site reactions. Conclusions Our study showed that treatment with TG1042 was associated with a clinical benefit in the majority of the patients with relapsing CBCL, including tumor regression, a clinically meaningful duration of response and a good treatment tolerance. Trial Registration www.clinicaltrials.govNCT00394693
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Affiliation(s)
- Brigitte Dreno
- Department of Skin Cancer, University Hospital, Nantes, France
- * E-mail:
| | | | - Youn Kim
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Joan Guitart
- Northwestern University Medical School, Chicago, Illinois, United States of America
| | - Madeleine Duvic
- University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Olivier Dereure
- Department of Dermatology, Saint Eloi Hospital, Montpellier, France
| | - Amir Khammari
- Department of Skin Cancer, University Hospital, Nantes, France
| | | | | | | | | | | | | | | | | | | | | | - Reinhard Dummer
- Department of Dermatology, University Hospital, Zurich, Switzerland
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8
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Vandersee S, Terhorst D, Humme D, Beyer M. Treatment of indolent primary cutaneous B-cell lymphomas with subcutaneous interferon-alfa. J Am Acad Dermatol 2014; 70:709-715. [PMID: 24433874 DOI: 10.1016/j.jaad.2013.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/13/2013] [Accepted: 11/14/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Interferon-alfa is used in the treatment of primary cutaneous B-cell lymphoma (PCBCL). Therapy with interferon-alfa has thus far been reported solely in case reports and small case series, mostly describing intralesional use. OBJECTIVE We sought to evaluate efficacy, response rate, time to response, duration of response, and safety of subcutaneously administered interferon-alfa for the treatment of cutaneous B-cell lymphoma. METHODS We conducted a retrospective chart analysis of patients given the diagnosis of PCBCL and treated with interferon-alfa subcutaneously at a tertiary referral center. RESULTS Fifteen patients with indolent subtypes of PCBCL were identified. The overall response rate was 66.7%; all responding patients went into complete remission. Response was not significantly associated with the maximum tolerated dose. Within the median follow-up time of 40 months, 90% of the responders experienced a relapse; median duration of response was 15.5 months. Adverse events were predominantly mild and in no case led to cessation of therapy. LIMITATIONS Retrospective nature of the analysis and small number of patients because of scarcity of the disease are limitations. CONCLUSION Treatment of indolent PCBCL with subcutaneously injected interferon-alfa demonstrated good response rates and tolerability. Response was not dose dependent. Relapses were observed in nearly all responding patients raising the question of interferon-alfa maintenance therapy in PCBCL.
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MESH Headings
- Adult
- Aged
- Biopsy, Needle
- Cohort Studies
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Female
- Follow-Up Studies
- France
- Humans
- Immunohistochemistry
- Injections, Subcutaneous
- Interferon-alpha/adverse effects
- Interferon-alpha/therapeutic use
- Kaplan-Meier Estimate
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Male
- Middle Aged
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Retrospective Studies
- Risk Assessment
- Skin Neoplasms/drug therapy
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Statistics, Nonparametric
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Staffan Vandersee
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Dorothea Terhorst
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany; Centre d'Immunologie Marseille-Luminy, INSERM-CNRS-Université de la Mediterannée, Marseille, France
| | - Daniel Humme
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marc Beyer
- Skin Cancer Centre Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Brandenburg A, Humme D, Terhorst D, Gellrich S, Sterry W, Beyer M. Long-term outcome of intravenous therapy with rituximab in patients with primary cutaneous B-cell lymphomas. Br J Dermatol 2013; 169:1126-32. [DOI: 10.1111/bjd.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 12/01/2022]
Affiliation(s)
- A. Brandenburg
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
- Dermatologikum Hamburg; Hamburg Germany
| | - D. Humme
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| | - D. Terhorst
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
- Centre d'Immunologie Marseille-Luminy; INSERM - CNRS - Université de la Mediterannée; Marseille France
| | - S. Gellrich
- Medical practice for Dermatology and Allergy Sylke Gellrich; Berlin Germany
| | - W. Sterry
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| | - M. Beyer
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
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Current world literature. Curr Opin Oncol 2012; 24:587-95. [PMID: 22886074 DOI: 10.1097/cco.0b013e32835793f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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