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Lin EC, Liao JB, Fang YH, Hong CH. The pathophysiology and current treatments for the subcutaneous panniculitis-like T cell lymphoma: An updated review. Asia Pac J Clin Oncol 2023; 19:27-34. [PMID: 35509196 DOI: 10.1111/ajco.13787] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 01/20/2023]
Abstract
Subcutaneous panniculitis-like T cell lymphoma (SPTCL) is a rare cutaneous T cell lymphoma, which is indolent in nature but could claim life if not correctly diagnosed and promptly treated. SPTCL is usually presented clinically as painless subcutaneous and erythematous nodules over the trunk or extremities. Active clinical vigilance for these subcutaneous nodules or panniculitis-like lesions is warranted. A biopsy must be performed in order to make a correct diagnosis. Positron emission tomography scan is utilized for disease staging and treatment follow-up. Due to the rarity of this lymphoma, a standard treatment protocol is not established yet. However, most cases of SPTCL could be treated well under immunosuppressive or polychemotherapeutic drugs except in cases with hemophagocytic syndrome. Hematopoietic stem cell transplantation may be used in refractory or relapse cases. In this review, we presented a case of SPTCL with long-term complete remission. Meanwhile, since most clinical evidences and experiences of SPTCL are based mostly on case reports or small case series, and the understanding of the SPTCL pathophysiology is limited, we reviewed and updated the pathophysiology and treatments of SPTCL.
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Affiliation(s)
- En-Cheng Lin
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan (ROC)
| | - Jia-Bin Liao
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan (ROC)
| | - Yu-Han Fang
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan (ROC)
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan (ROC).,Department of Dermatology, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan (ROC)
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Duan Y, Gao H, Zhou C, Jin L, Yang J, Huang S, Zhang M, Zhang Y, Wang T. A retrospective study of 18 children with subcutaneous panniculitis-like T-cell lymphoma: multidrug combination chemotherapy or immunomodulatory therapy? Orphanet J Rare Dis 2022; 17:432. [PMID: 36503528 PMCID: PMC9743713 DOI: 10.1186/s13023-022-02575-4] [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: 07/19/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Subcutaneous panniculitis T-cell lymphoma (SPTCL) is a rare, cytotoxic T-cell lymphoma with which some patients have accompanying hemophagocytic syndrome (HPS). There is currently no standard treatment regimen. In the past, the most commonly used treatment was multidrug chemotherapy. In contrast, numerous case reports or small series suggest that immunosuppressive drugs could also be effective for some patients. Since this NHL subtype is extremely rare in children and adolescents, to improve the understanding of this disease and standardize its rational treatment, we retrospectively summarized the treatment regimens of 18 pathologically diagnosed children with SPTCL to compare the clinical efficacy of multidrug chemotherapy and immunomodulatory therapy. RESULTS The median age of onset was 11.1 years. Painless subcutaneous nodules or skin patchy lesions were found in all patients, most commonly involving the lower extremities and/or trunk. Before January 1, 2019, the treatment was mainly chemotherapy, and 10 patients were initially treated with chemotherapy, among whom was one patient who progressed during initial treatment, was voluntarily discharged and was subsequently lost to follow-up, one patient who died of disease progression, and the remaining 8 patients who all achieved sustained remission, with a complete remission (CR) rate of 80% (8/10). Corticosteroids combined with cyclosporine A or ruxolitinib were the most common initial immunosuppressive agents at our center after January 1, 2019 and had a CR rate of 71.4% (5/7). In addition, 1 patient achieved partial remission (PR) during follow-up, and one had autologous hematopoietic stem cell transplantation (AHSCT) after 4 months of drug withdrawal. There were 7 patients (38.9%, one case in chemotherapy group and six cases in immunotherapy group) with HPS and 4/5 screened patients (80%) with positive HAVCR2 gene mutations. The median follow-up was 17 months. CONCLUSION The prognosis of SPTCL is relatively good. Previous multi-drug and long-term chemotherapy treatment has clear efficacy, and recent immunomodulatory therapy as pre-chemotherapy therapy can also benefit patients.
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Affiliation(s)
- Yanlong Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Huixia Gao
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Chunju Zhou
- grid.411609.b0000 0004 1758 4735Pathology Department, National Center for Children’s Health, Beijing Children’s Hospital, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Ling Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Jing Yang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Shuang Huang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Meng Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Yonghong Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China
| | - Tianyou Wang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children’s Hospital, National Center for Children’s Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics, Capital Medical University, Beijing, 100045 People’s Republic of China ,grid.411609.b0000 0004 1758 4735Hematology Center, Beijing Children’s Hospital, Capital Medical University, Nanlishi Road No. 56, Xicheng District, Beijing, 100045 People’s Republic of China
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3
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[PD-1 monoclonal antibody combined with chemotherapy in the treatment of subcutaneous panniculitis-like T-cell lymphoma: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:959-961. [PMID: 35045660 PMCID: PMC8763599 DOI: 10.3760/cma.j.issn.0253-2727.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Case Report-Indurated Plaques and Recurrent Fevers in a 37-Year-Old Man: Answer. Am J Dermatopathol 2021; 43:754. [PMID: 34546991 DOI: 10.1097/dad.0000000000001942] [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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Sullivan C, Loghmani A, Thomas K, Jetly-Shridhar R, Chowdry RP. Hemophagocytic Lymphohistiocytosis as the Initial Presentation of Subcutaneous Panniculitis-Like T-Cell Lymphoma: A Rare Case Responding to Cyclosporine A and Steroids. J Investig Med High Impact Case Rep 2020; 8:2324709620981531. [PMID: 33331177 PMCID: PMC7750743 DOI: 10.1177/2324709620981531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare peripheral
cytotoxic T-cell lymphoma, clinically resembling panniculitis. Hemophagocytic
lymphohistiocytosis (HLH) is a life-threatening syndrome of immune
overactivation, triggered by underlying conditions. SPTCL presenting with HLH
may represent a severe and rapidly progressive disease course. Currently, there
is no standardized approach to treatment of HLH secondary to underlying SPTCL. A
34-year-old Asian male presented with a several months history of high fevers,
weight loss, and nonpruritic purple discoloration of the skin. He had a skin
biopsy showing atypical lymphohistiocytic panniculitis with dermal mucinosis and
erythrophagocytosis consistent with SPTCL. The patient was initiated on
treatment with dexamethasone and cyclosporine A. Almost immediate improvement of
his skin lesions was noted and laboratory abnormalities trended toward baseline
within 2 weeks. He noted complete symptom resolution after 3 months on therapy.
SPTCL may be treated effectively with cyclosporine A and steroids to achieve
rapid clinical and symptom management of this rare malignancy.
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Gru AA, McHargue C, Salavaggione AL. A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation. Arch Pathol Lab Med 2020; 143:958-979. [PMID: 31339758 DOI: 10.5858/arpa.2018-0294-ra] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The "tough" cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). OBJECTIVE.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. DATA SOURCES.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. CONCLUSIONS.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and "reactive" infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.
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Affiliation(s)
- Alejandro A Gru
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Chauncey McHargue
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
| | - Andrea L Salavaggione
- From the Departments of Pathology (Drs Gru and Salavaggione) and Dermatology (Dr Gru), University of Virginia, Charlottesville; and the Department of Dermatology (Dr McHargue), Henry Ford Health System, Detroit, Michigan
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Berth-Jones J, Exton LS, Ladoyanni E, Mohd Mustapa MF, Tebbs VM, Yesudian PD, Levell NJ. British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018. Br J Dermatol 2019; 180:1312-1338. [PMID: 30653672 DOI: 10.1111/bjd.17587] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Affiliation(s)
- J Berth-Jones
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - E Ladoyanni
- Department of Dermatology, Dudley Group NHS Foundation Trust, Dudley, DY1 2HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - V M Tebbs
- formerly of George Eliot Hospital, College Street, Nuneaton, CV10 7DJ, U.K
| | - P D Yesudian
- Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K
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8
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Xu L, Che Y, Ding X, Song J, Zhang X, Sun X. Successful treatment of a rare subcutaneous panniculitis-like T-cell lymphoma: An unusual case report and literature review. Dermatol Ther 2019; 32:e12878. [PMID: 30884048 DOI: 10.1111/dth.12878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/02/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Liye Xu
- Medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Liaoning Sheng, China
| | - Yuxuan Che
- Medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Liaoning Sheng, China
| | - Xiaolei Ding
- Medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Liaoning Sheng, China
| | - Jincheng Song
- Medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Liaoning Sheng, China
| | - Xian Zhang
- Medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Liaoning Sheng, China
| | - Xiuhua Sun
- Medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Liaoning Sheng, China
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10
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Abstract
There are a number of rare T-cell lymphoma subtypes that may be encountered in clinical practice. In recent years, improved immunohistochemical techniques and molecular tumor profiling have permitted refinement of some of the diagnostic categories in this group, as well as the recognition of distinct conditions not previously well elucidated. In this chapter, we cover the diagnostic and clinical features of some of the more common of these conditions, including subcutaneous panniculitis-like T-cell lymphoma, cutaneous gamma-delta T-cell lymphoma, enteropathy-associated T-cell lymphoma, monomorphic epitheliotropic intestinal T-cell lymphoma, primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma, CD4-positive small/medium T-cell lymphoproliferative disorder, and acral CD8-positive T-cell lymphoma. Given the rarity of these conditions, optimal treatments approaches are not always well established, not least as data from large-scale clinical trials are lacking. In this chapter, we aim to provide a summation of current thinking around best treatment, as well as highlighting some controversies in the management of these diagnoses.
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Affiliation(s)
- C van der Weyden
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - C McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
| | - S Lade
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Department of Anatomical Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R W Johnstone
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H M Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Oncology, Sir Peter MacCallum, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Melbourne, Australia
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11
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Hematopoietic stem cell transplantation for subcutaneous panniculitis-like T-cell lymphoma: single center experience in an Asian population. Int J Hematol 2018; 109:187-196. [PMID: 30547418 DOI: 10.1007/s12185-018-02568-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a rare form of cytotoxic T-cell lymphoma. It is believed that SPTL in patients without hemophagocytic syndrome (HPS) follows an indolent course; in contrast, SPTL in patients with HPS has been associated with unfavorable survival. To provide more clinical data on SPTL in Asian populations and to identify optimal therapeutic strategies for SPTL, we assessed the clinicopathological features and long-term follow-up data of 10 Taiwanese SPTL patients diagnosed at a single center. Our study demonstrates a group of patients with high incidence of HPS (50%), rather aggressive courses, and early progression. A total of eight patients underwent hematopoietic stem cell transplant (HSCT), including one autologous HSCT and seven allogeneic HSCT. Seven of eight patients receiving HSCT achieved durable remission and maintained in remission for over 30 months (range 30-132 months). There was no difference in 3-year survival of patients with HPS (80%) compared with patients without HPS (80%). Of long-term survivors in the HPS group, three of four received HSCT (autologous HSCT, n = 1; allogeneic HSCT, n = 2). Our study indicated that HSCT is a curative option for eligible SPTL patients with HPS.
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12
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Kheterpal M, Mehta-Shah N, Virmani P, Myskowski PL, Moskowitz A, Horwitz SM. Managing Patients with Cutaneous B-Cell and T-Cell Lymphomas Other Than Mycosis Fungoides. Curr Hematol Malig Rep 2017; 11:224-33. [PMID: 27101016 DOI: 10.1007/s11899-016-0322-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cutaneous lymphomas (CL) are a heterogeneous group of neoplasms characterized with clinical and histopathological variation, as well as overlap with benign dermatoses. Diagnosis and treatment of CLs is challenging and often requires a multidisciplinary approach. However, prognostic knowledge of these conditions and awareness of treatment options can help optimize appropriate use of available regimens, thereby improving care for patients. Here, we review the most recent literature and outline treatment themes for managing patients with cutaneous B-cell and T-cell lymphomas other than mycosis fungoides.
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Affiliation(s)
- Meenal Kheterpal
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, 500 Westchester Ave, West Harrison, NY, 10604, USA
| | - Neha Mehta-Shah
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Memorial Sloan Kettering Cancer Center, 1233 York Avenue, New York, NY, 10065, USA
| | - Pooja Virmani
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,, 16 E60th Street, New York, NY, 10022, USA
| | - Patricia L Myskowski
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,, 16 E60th Street, New York, NY, 10022, USA
| | - Alison Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,, 1275 York Avenue, New York, NY, 10065, USA
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Memorial Sloan Kettering Cancer Center, 1233 York Avenue, New York, NY, 10065, USA.
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Abstract
Peripheral T-cell lymphomas represent 10% to 15% of non-Hodgkin lymphomas and comprise more than 20 different entities. Treatment of very rare T-cell lymphomas can be challenging because there are no large or randomized studies to guide clinical decision making, and treatment paradigms are often based on small series or imperfect data. Although a strict algorithm cannot be written with certainty, through the literature that exists and clinical experience, themes and principles of approaches do emerge that when coupled with clinical judgment allow reasonable and logical decisions.
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Maliniemi P, Laukkanen K, Väkevä L, Dettmer K, Lipsanen T, Jeskanen L, Bessede A, Oefner PJ, Kadin ME, Ranki A. Biological and clinical significance of tryptophan-catabolizing enzymes in cutaneous T-cell lymphomas. Oncoimmunology 2017; 6:e1273310. [PMID: 28405495 PMCID: PMC5384345 DOI: 10.1080/2162402x.2016.1273310] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/30/2016] [Accepted: 12/10/2016] [Indexed: 12/17/2022] Open
Abstract
Indoleamine 2,3-deoxygenase 1 (IDO1) induces immune tolerance in the tumor microenvironment (TME) and is recognized as a potential therapeutic target. We studied the expression of both IDO1 and the related tryptophan 2,3-dioxygenase (TDO) in several different subtypes of cutaneous T-cell lymphoma (CTCL), and evaluated the kynurenine (KYN) pathway in the local TME and in patient sera. Specimens from the total of 90 CTCL patients, including mycosis fungoides (MF, n = 37), lymphomatoid papulosis (LyP, n = 36), primary cutaneous anaplastic large cell lymphoma (pcALCL, n = 4), subcutaneous panniculitis-like T-cell lymphoma (SPTCL n = 13), and 10 patients with inflammatory lichen ruber planus (LRP), were analyzed by immunohistochemistry (IHC), immunofluorescence (IF), quantitative PCR, and/or liquid chromatography-tandem mass spectrometry (LC-MS/MS). Three CTCL cell lines also were studied. Expression of both IDO1 and TDO was upregulated in CTCL. In MF specimens and in the MF cell line MyLa2000, IDO1 expression exceeded that of TDO, whereas the opposite was true for LyP, ALCL, and corresponding Mac1/2A cell lines. The spectrum of IDO1-expressing cell types differed among CTCL subtypes and was reflected in the clinical behavior. In MF, SPTCL, and LyP, IDO1 was expressed by malignant cells and by CD33+ myeloid-derived suppressor cells, whereas in SPTCL CD163+ tumor-associated macrophages also expressed IDO1. Significantly elevated serum KYN/Trp ratios were found in patients with advanced stages of MF. Epacadostat, an IDO1 inhibitor, induced a clear decrease in KYN concentration in cell culture. These results show the importance of IDO1/TDO-induced immunosuppression in CTCL and emphasize its role as a new therapeutic target.
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Affiliation(s)
- Pilvi Maliniemi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital , Helsinki, Finland
| | - Kirsi Laukkanen
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital , Helsinki, Finland
| | - Liisa Väkevä
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital , Helsinki, Finland
| | - Katja Dettmer
- Institute of Functional Genomics, University of Regensburg , Regensburg, Germany
| | - Tuomas Lipsanen
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital , Helsinki, Finland
| | - Leila Jeskanen
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital , Helsinki, Finland
| | | | - Peter J Oefner
- Institute of Functional Genomics, University of Regensburg , Regensburg, Germany
| | - Marshall E Kadin
- Department of Pathology, Rhode Island Hospital, Providence, RI, USA; Department of Dermatology, Boston University School of Medicine and Roger Williams Medical Center, Providence, RI, USA
| | - Annamari Ranki
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital , Helsinki, Finland
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15
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Chen CC, Teng CL, Yeh SP. Relapsed and refractory subcutaneous panniculitis-like T-cell lymphoma with excellent response to cyclosporine: a case report and literature review. Ann Hematol 2016; 95:837-40. [DOI: 10.1007/s00277-016-2615-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
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16
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Asati DP, Ingle V, Joshi D, Tiwari A. Subcutaneous panniculitis-like T-cell lymphoma with macrophage activation syndrome treated by cyclosporine and prednisolone. Indian Dermatol Online J 2016; 7:529-532. [PMID: 27990393 PMCID: PMC5134172 DOI: 10.4103/2229-5178.193909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL; α/β T-cell subtype) is a distinct variantof cutaneous T-cell lymphomas, which presents as inflammatory subcutaneous nodules. A 17-year-old male presented with recurrent fever with concomitant facial swelling, pedal edema, hepatosplenomegaly, and mildly tender subcutaneous plaques in generalized distribution along with patches of scarring alopecia on scalp. There were features of macrophage activation syndrome in the form of hemophagocytosis in the bone marrow, pancytopenia, high serum lactate dehydrogenase levels, low fibrinogen clotting activity, prolonged activated prothrombine time (aPTT), increased serum ferritin, hypoalbuminemia, and hypertriglyceridemia. Histopathology showed lobular panniculitis-like infiltration by atypical lymphocytes rimming the adipocytes. Immunohistochemistry revealed positive CD3 and CD8 markers, whereas CD4, CD56, and CD20 were negative, consistent with the diagnosis of α/β type of SPTCL. Treatment with oral prednisolone (1mg/kg/day) and cyclosporine (2mg/kg/day; 100 mg) led to rapid subsidence of fever, plaques, and abnormal hematological parameters within a few weeks.
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Affiliation(s)
- Dinesh P Asati
- Department of Dermatology, All Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vaibhav Ingle
- Department of General Medicine, All Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Deepti Joshi
- Department of Pathology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Anurag Tiwari
- Consultant Dermatologist, Centre for Skin Diseases and Laser Treatment, Bhopal, Madhya Pradesh, India
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Abstract
Abstract
Although all the peripheral T-cell lymphomas are uncommon, there are some entities that are truly rare. Subtypes, such as enteropathy-associated T-cell lymphoma, hepatosplenic T-cell lymphoma, extranodal NK/T-cell lymphoma, and subcutaneous panniculitis-like T-cell lymphoma, have an approximate annual incidence in United States of <500 each. In these very rare subtypes, there is limited data to guide clinical decision-making. As such, our treatment decisions are often based on extrapolation, case series, personal experience, and biases. We summarize the existing data regarding initial management of these entities and compare how that management follows paradigms established for the more common T-cell lymphomas.
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