Outcomes and prognostic factors in African American and black patients with mycosis fungoides/Sézary syndrome: Retrospective analysis of 157 patients from a referral cancer center

BACKGROUND

The prevalence of mycosis fungoides/Sézary syndrome (MF/SS) is higher in the black population than in the white population in the United States and worse outcomes have been observed in black patients.

OBJECTIVE

To describe the outcomes and to identify prognostic factors in African American and black patients with MF/SS.

METHODS

Clinical features and follow-up data were analyzed in 157 self-identified African American or black patients seen during 1994-2018.

RESULTS

We included 122 patients with early stage MF and 35 patients with advanced-stage disease (median follow-up of 25 months). Overall, >80% of the patients who died from disease or progressed had erythema or hyperpigmentation without hypopigmentation. Patients with hypopigmentation, either as the sole manifestation or in combination with other lesions, had better overall survival (P = .002) and progression-free survival (P = .014). Clinical stage, TNMB classification, plaque disease, and elevated serum lactate dehydrogenase were also significantly associated with outcomes. Demographic and socioeconomic parameters were not associated with prognosis.

LIMITATIONS

A retrospective study at a single cancer center.

CONCLUSION

MF/SS manifestations and outcomes in African American and black patients are heterogeneous. Demographic and socioeconomic factors do not seem to have a prognostic role, while clinical characteristics might help in the stratification of risk of progression and shorter survival, allowing for individually tailored therapeutic interventions.

Survival, disease progression and prognostic factors in elderly patients with mycosis fungoides and Sézary syndrome: a retrospective analysis of 174 patients

BACKGROUND

Advanced age at diagnosis is considered a poor prognostic factor in mycosis fungoides (MF) and Sézary syndrome (SS).

OBJECTIVE

To evaluate the outcomes and prognostic factors in patients diagnosed at an advanced age (≥65 years) with MF/SS.

METHODS

Survival, progression rates and various clinical and histopathological variables were studied in a group of 174 elderly patients diagnosed with MF/SS between 1992 and 2015 at a single referral cancer center in the United States. Kaplan-Meier estimates were used to determine survival and progression and Cox proportional hazards regression univariate and multivariate models were used to identify prognostic factors.

RESULTS

Of 174 elderly patients, 76.4% were diagnosed with early-stage (clinical stages IA-IIA) and 23.6% with late-stage MF/SS (IIB-IV). Advanced age was associated with poor overall survival, but not with disease-specific survival (DSS) or progression-free survival (PFS). Gender, increasing clinical stage, T and B classifications, elevated lactate dehydrogenase (LDH) levels and development of large cell transformation (LCT) were significant predictors of poor survival or disease progression. Patients with early-stage MF and <10% total skin involvement (T1 classification) or patch-only disease (T1a/T2a) showed better PFS with no observed disease-specific mortality. Folliculotropic MF was associated with poor DSS in patients with early-stage disease.

CONCLUSIONS

Older age at diagnosis of MF/SS does not predict worse disease-specific outcomes. Elderly patients with early-stage disease, specifically involving less than 10% of the skin surface with patches but without plaques or folliculotropism, have an excellent prognosis. However, the development of LCT is a strong prognostic indicator of poor survival in elderly patients with MF/SS.

Giant cell arteritis in a 20-year-old black man: a cause of intermittent calf claudication

Giant cell arteritis in a young black man is an extremely unusual occurrence. A 20-year-old black man came for treatment of bilateral leg claudication that had been present for a 2-month period. His medical and angiographic evaluation led to an arterial biopsy that demonstrated giant cell arteritis. The patient was treated with corticosteroids and his condition has subsequently improved. Unusual variants of giant cell arteritis are discussed.

Airway compression by a right aortic arch in the absence of a vascular ring

This case describes the diagnosis and successful management of an unusual form of respiratory distress in an infant with tetralogy of Fallot. Severe compression of the airway resulted from a large right aortic arch in the absence of a vascular ring.

Thallium-201 for medical use. Part 3: Human distribution and physical imaging properties

Studies were undertaken to determine the biologic distribution of thallium-201 in man. The disappearance from the blood is extremely rapid and intracellular deposition is nearly immediate. The biologic half-time of thallium was measured by both the Brookhaven whole-body counter and the Donner whole-body scanner, with excellent agreement. The effective whole-body half-time of thallium-201 is about 57 hr. Concentration of activity was seen in the heart, kidneys, large bowel, and thyroid. The whole-body radiation dose is 0.21 rads/mCi.

Investigation of 125I as an isotopic source for mammography

An isotopic radiation source 125I was investigated for use in soft tissue radiaography, with particular attention to possible use in mammography for mass screening. Film sensitivities, exposure rates, absorbed doeses, contrast and resolution were determined, and compared to conventional x-ray units. It was found that contrast and resolution were comparable to 30 kVp x-rays (W anode) but that surface absorbed dose was reduced by a factor of two with 125I. These results experimentally verified the advantage to be obtained from monoenergetic radiations, which had been predicted from theoretical considerations by others. Duration of exposure was estimated to be between 4 and 12 sec with a 40 Ci source. The 60-day half life of 125I may necessitate its use in conjunction with an image intensification system or electron radiographic techniques, in order to preclude source replacement at inconveniently short intervals.

Thallium-201 for myocardial imaging. Relation of thallium-201 to regional myocardial perfusion

Following intravenous administration, the myocardial concentration of tracer thallium-201, potassium-43, and rubidium-81 were determined in mice; thallium was present in the greatest concentration in the myocardium (2.08% compared 1.25% for potassium and 1.15% for rubidium at 10 minutes). The regional myocardial distribution of thallium-201 was determined in dogs under conditions of normal flow, and total occlusion, and compared with potassium-43 (r=0.97). The regional distribution of thallium-201 was compared to microspheres under conditions of partial occlusion and reactive hyperemia (r=0.97). Thallium-201 was evaluated in a series of phantom scans, which demonstrated that the low energy X-ray of thallium was suitable for imaging. These results suggest that thallium-201 can be used for the evaluation of the distribution of regional myocardial perfusion.

Thallium-201 for medical use. II: Biologic behavior

Thallium-201 has been evaluated for myocardial imaging by determining its distribution and assessing its imaging properties. Organ distribution with time was studied in goats, chosen for their large size and easy operability. Myocardial imaging was performed in living and sacrificed goats and also in two anesthetized dogs, without infarction. Infarcts were made by ligature at open chest surgery on the goats and the infarcts subsequently confirmed histologically. The myocardium of normal and infarced, young and old goats was cut into blocks and the isotope distribution measured and compared with that in the lungs, liver, spleen, and kidney in normal goats. The renal medulla-to-cortex concentration ratio in goats was studied and is approximately five. The heart uptake exceeds 3% for 100 min whereas contiguous organs have less than one-half of the myocardial concentration, and blood clearance is rapid. One problem may prove to be inhomogeneity of uptake of thallium in the "normal" myocardium, showing a standard deviation of 1u% in a young goat and 29% in an old goat. In view of the good myocardial uptake, however, this work strongly suggests the trial 201Tl in patients.

Thallium-201 for medical use. I

Thallium-201 merits evaluation for myocardial visualization, kidney studies, and tumor diagnosis because of its physical and biologic properties. A method is described for preparation of this radiopharmaceutical for human use. A critical evaluation of 201Tl and other radiopharmaceuticals for myocardial visualization is given.