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Izu-Belloso R, Gainza-Apraiz I, Ortiz-Romero P, Servitje-Bedate O, Fernández de Misa-Cabrera R, Peñate-Santana Y, Hernandez-Machin B, Estrach-Panella T, Llamas-Velasco M, Yanguas-Bayona JI, Morillo-Andujar M, Acebo-Mariñas E, Perez-Gala S, Armario-Hita JC, Sanchez-Sambucety P, Ortiz-Brugues A, Eguren-Michelena C, Bielsa-Marsol I, Lopez-Pestaña A, Blanes-Martinez M, Fernandez-Guarino M, Lopez-Lerma I. Experience With Bexarotene to Treat Cutaneous T-Cell Lymphomas: A Study of the Spanish Working Group of Cutaneous Lymphomas. Actas Dermosifiliogr 2024:S0001-7310(24)00358-2. [PMID: 38653368 DOI: 10.1016/j.ad.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/04/2023] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Bexarotene has been approved to treat advanced stage cutaneous T-cell lymphomas (CTCL) since 1999. However, very few data have been published on its long-term safety and efficacy profile. The aim of this study is to determine the tolerability to bexarotene and outcomes by collecting the 2nd largest case series to date on its long-term use vs CTCL. MATERIAL AND METHOD This was a multicenter retrospective review of 216 patients with mycosis fungoides (174), or Sézary syndrome (42) on a 10-year course of bexarotene alone or in combinationwith other therapies at 19 tertiary referral teaching hospitals. RESULTS A total of 133 men (62%) and 83 women (38%) were included, with a mean age of 63.5 year (27-95). A total of 45% were on bexarotene monotherapy for the entire study period, 22% started on bexarotene but eventually received an additional therapy, 13% were on another treatment but eventually received bexarotene while the remaining 20% received a combination therapy since the beginning. The median course of treatment was 20.78 months (1-114); and the overall response rate, 70.3%. Complete and partial response rates were achieved in 26% and 45% of the patients, respectively. Treatment was well tolerated, being the most common toxicities hypertriglyceridemia (79%), hypercholesterolemia (71%), and hypothyroidism (52%). No treatment-related grade 5 adverse events were reported. CONCLUSIONS Our study confirms bexarotene is a safe and effective therapy for the long-term treatment of CTCL.
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Affiliation(s)
| | | | | | | | | | - Y Peñate-Santana
- Hospital Universitario Basurto, Bilbao, Spain; Hospital 12 de Octubre, Madrid, Spain; Hospital de Bellvitge, Barcelona, Spain; Red Canaria de Linfomas, Spain; Hospital Clinic de Barcelona, Spain; Hospital La Princesa, Madrid, Spain; Complejo Hospitalario Navarra, Pamplona, Spain; Hospital Virgen del Rocío, Sevilla, Spain; Hospital Universitario Cruces, Barakaldo, Spain; Hospital Ramón y Cajal, Madrid, Spain; Hospital Universitario del Puerto Real, Cadiz, Spain; Hospital Universitario de León, Spain; Hospital Arnau y Vilanova, Lérida, Spain; Hospital Infanta Leonor, Madrid, Spain; Hospital German Trias y Pujol, Barcelona, Spain; Hospital Universitario Donostia, San Sebastián, Spain; Hospital de Alicante, Spain; Hospital Cruz Roja, Madrid, Spain; Hospital Vall D´Hebrón, Barcelona, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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3
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Chen JJ, Tokumori FC, Del Guzzo C, Kim J, Ruan J. Update on T-Cell Lymphoma Epidemiology. Curr Hematol Malig Rep 2024:10.1007/s11899-024-00727-w. [PMID: 38451372 DOI: 10.1007/s11899-024-00727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE OF REVIEW T-cell lymphomas (TCLs) are a group of rare subtypes of non-Hodgkin lymphoma derived from mature T-lymphocytes. Recent updates in lymphoma classification based on the cell-of-origin pathogenesis have shed new light on TCL epidemiology and outcomes. Contemporary regional consortia and international studies, including those conducted recently in Asia and South America, have provided an updated delineation of the major subtypes across various global regions. RECENT FINDINGS Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), remains the most common subtype globally except in Asia, where extra-nodal NK-T cell lymphoma (ENKTL) has emerged as the most prevalent. Angioimmunoblastic T-cell lymphoma (AITL) is the second most common subtype globally except in South America where its incidence falls behind adult T-cell leukemia/lymphoma (ATLL) and ENKTL. ALK-negative anaplastic large cell lymphoma (ALCL) has been recognized as the second most common subtype in some parts of South America. Studies on the newly classified breast implant-associated ALCL (BIA-ALCL) are beginning to reveal its distribution and risk factors. Deciphering the epidemiology of TCLs is a challenging endeavor due to the rarity of these entities and ongoing refinement in classification. Collaborative efforts on prospective registries based on the most current WHO classifications will help capture the true epidemiology of TCL subtypes to better focus resources for diagnostic, prognostic, and therapeutic efforts.
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Affiliation(s)
- Jane J Chen
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Franco Castillo Tokumori
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10065, USA
| | | | - Jeanyoung Kim
- Division of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Jia Ruan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10065, USA.
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Izu-Belloso R, Gainza-Apraiz I, Ortiz-Romero P, Servitje-Bedate O, Fernández de Misa-Cabrera R, Peñate Y, Hernandez-Machin B, Estrach-Panella T, Llamas-Velasco M, Yanguas-Bayona JI, Morillo-Andujar M, Acebo-Mariñas E, Perez-Gala S, Armario-Hita JC, Sanchez-Sambucety P, Ortiz-Brugues A, Eguren-Michelena C, Bielsa-Marsol I, Lopez-Pestaña A, Blanes-Martinez M, Fernandez-Guarino M, Lopez-Lerma I. Experience With Bexarotene to Treat Cutaneous T-Cell Lymphomas: A Study of the Spanish Working Group of Cutaneous Lymphomas. Actas Dermosifiliogr 2024:S0001-7310(24)00160-1. [PMID: 38395224 DOI: 10.1016/j.ad.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Bexarotene has been approved to treat advanced stage cutaneous T-cell lymphomas (CTCL) since 1999. However, very few data have been published on its long-term safety and efficacy profile. The aim of this study is to determine the tolerability to bexarotene and outcomes by collecting the 2nd largest case series to date on its long-term use vs CTCL. MATERIAL AND METHOD This was a multicenter retrospective review of 216 patients with mycosis fungoides (174), or Sézary syndrome (42) on a 10-year course of bexarotene alone or in combination with other therapies at 19 tertiary referral teaching hospitals. RESULTS A total of 133 men (62%) and 83 women (38%) were included, with a mean age of 63.5 year (27-95). A total of 45% were on bexarotene monotherapy for the entire study period, 22% started on bexarotene but eventually received an additional therapy, 13% were on another treatment but eventually received bexarotene while the remaining 20% received a combination therapy since the beginning. The median course of treatment was 20.78 months (1-114); and the overall response rate, 70.3%. Complete and partial response rates were achieved in 26% and 45% of the patients, respectively. Treatment was well tolerated, being the most common toxicities hypertriglyceridemia (79%), hypercholesterolemia (71%), and hypothyroidism (52%). No treatment-related grade 5 adverse events were reported. CONCLUSIONS Our study confirms bexarotene is a safe and effective therapy for the long-term treatment of CTCL.
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Affiliation(s)
| | | | | | | | | | - Y Peñate
- Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Spain
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Shih BB, Ma C, Cortes JR, Reglero C, Miller H, Quinn SA, Albero R, Laurent AP, Mackey A, Ferrando AA, Geskin L, Palomero T. Romidepsin and Afatinib Abrogate Jak-Signal Transducer and Activator of Transcription Signaling and Elicit Synergistic Antitumor Effects in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2024:S0022-202X(23)03210-4. [PMID: 38219917 DOI: 10.1016/j.jid.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024]
Abstract
Cutaneous T-cell lymphomas are mature lymphoid neoplasias resulting from the malignant transformation of skin-resident T-cells. A distinctive clinical feature of cutaneous T-cell lymphomas is their sensitivity to treatment with histone deacetylase inhibitors. However, responses to histone deacetylase inhibitor therapy are universally transient and noncurative, highlighting the need for effective and durable drug combinations. In this study, we demonstrate that the combination of romidepsin, a selective class I histone deacetylase inhibitor, with afatinib, an EGFR family inhibitor, induces strongly synergistic antitumor effects in cutaneous T-cell lymphoma models in vitro and in vivo through abrogation of Jak-signal transducer and activator of transcription signaling. These results support a previously unrecognized potential role for histone deacetylase inhibitor plus afatinib combination in the treatment of cutaneous T-cell lymphomas.
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Affiliation(s)
- Bobby B Shih
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Cindy Ma
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Jose R Cortes
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Regeneron Pharmaceuticals, Tarrytown, New York, USA
| | - Clara Reglero
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Hannah Miller
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - S Aidan Quinn
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Robert Albero
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Biomedical Research Institute August Pi y Sunyer (IDIBAPS), Barcelona, Spain
| | - Anouchka P Laurent
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Adam Mackey
- Institute for Cancer Genetics, Columbia University, New York, New York, USA
| | - Adolfo A Ferrando
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Regeneron Pharmaceuticals, Tarrytown, New York, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA; Department of Pediatrics, Columbia University Medical Center, New York, New York, USA; Department of Systems Biology, Columbia University Medical Center, New York, New York, USA
| | - Larisa Geskin
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Teresa Palomero
- Institute for Cancer Genetics, Columbia University, New York, New York, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, USA.
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Hu J, Zhang X, Zhao L, Zhao Q, Geng S. Decrease of 5-hydroxymethylcytosine in primary cutaneous CD4 + small/medium sized pleomorphic T-cell lymphoproliferative disorder. An Bras Dermatol 2024; 99:27-33. [PMID: 37657958 DOI: 10.1016/j.abd.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Primary cutaneous CD4+ small/medium-sized pleomorphic T-Cell lymphoproliferative disorder (PC-SMTLD) has been considered as a controversial dermatological disease that has been included in cutaneous T-cell lymphoma group, presenting most commonly as a solitary nodule and/or plaque with a specific and characteristic head and neck predilection. Due to the considerable overlap between PC-SMTLD and pseudolymphoma (PL), the differential diagnosis is often challenging. Methylation of DNA at position 5 of cytosine, and the subsequent reduction in intracellular 5-hydroxymethylcytosine (5-hmC) levels, is a key epigenetic event in several cancers, including systemic lymphomas. However, it has rarely been studied in cutaneous lymphomas. OBJECTIVES The authors aimed to explore the role of differential 5-hmC immunostaining as a useful marker to distinguish PC-SMTLD from PL. METHODS Retrospective case series study with immunohistochemical and immunofluorescence analysis of 5-hmC was performed in PL and PC-SMTLD. RESULTS Significant decrease of 5-hmC nuclear staining was observed in PC-SMTLD when compared with PL (p < 0.0001). By semi-quantitative grade integration, there were statistical differences in the final 5-hmC scores in the two study groups. The IF co-staining of 5-hmC with CD4 revealed a decrease of 5-hmC in CD4+ lymphocytes of PC-SMTLD. STUDY LIMITATIONS The small clinical sample size of the study. CONCLUSIONS The immunorreactivity of 5-hmC in CD4+ lymphocytes was highly suggestive of a benign process as PL. Furthermore, the decrease of 5-hmC nuclear staining in PC-SMTLD indicated its lymphoproliferative status and helped to make the differential diagnosis with PL.
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Affiliation(s)
- Jiahui Hu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xian Jiaotong University, Xian, China
| | - Xinyue Zhang
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xian Jiaotong University, Xian, China
| | - Lihong Zhao
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xian Jiaotong University, Xian, China
| | - Qiang Zhao
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xian Jiaotong University, Xian, China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xian Jiaotong University, Xian, China.
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Joshi TP, Kunta N, Gupta R. Risk of subsequent malignancies in primary cutaneous anaplastic large cell lymphoma: a national database study. Arch Dermatol Res 2023; 316:57. [PMID: 38141099 DOI: 10.1007/s00403-023-02801-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Tejas P Joshi
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Niharika Kunta
- School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Rohit Gupta
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Titou H, Bouhamidi A. Epidemiology and prognostic factors of 114 patients with mycosis fungoides in a Moroccan cohort: a 29-year review. Clin Exp Med 2023; 23:3751-3758. [PMID: 37029872 DOI: 10.1007/s10238-023-01056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023]
Abstract
Limited data regarding survival of Moroccan patients with mycosis fungoides (MF). To evaluate the clinical profile and long-term outcomes of these patients. A retrospective review of 114 MF cases diagnosed from 1993 to 2022 who were followed up for more than 6 months of diagnosis was performed. Of 114 patients, 71.9% were male and the median age at diagnosis was 56 years. Approximately 64 and 36% of the patients had an early stage and advanced stage, respectively. Median follow-up duration was 56 months, and median duration of symptoms before diagnosis was 31 months. Various subtypes were observed, including mycosis fungoides folliculotropic (12.3%), poikilodermatous (11.4%), and palmaris et plantaris MF (5.3%). The 10-year overall survival was 89% in early-stage patients and 48.8% in advanced-stage patients. Complete response to treatment occurred in 45.6%, stable disease in 16.7% and disease progression in 7.9% of patients. Older age of > 60 years, higher T-stage (T3/T4) and advanced-stage MF were statistically significant in predicting poorer outcomes in MF. Despite delay in diagnosis, most cases of MF in Morocco were diagnosed in early stages. We observed a high proportion of classic MF and favorable prognosis.
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Affiliation(s)
- Hicham Titou
- Department of Dermatology-Venereology, Avicenne Military Hospital, Al Mouquaouama Avenue, 40000, Marrakech, Morocco.
| | - Ahmed Bouhamidi
- Department of Dermatology-Venereology, Avicenne Military Hospital, Al Mouquaouama Avenue, 40000, Marrakech, Morocco
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Lehman JS, Erickson LA. Emerging concepts in dermatopathology: a special issue of neoplastic, inflammatory, and special-site dermatopathology and important practice considerations. Hum Pathol 2023; 140:1-4. [PMID: 37562500 DOI: 10.1016/j.humpath.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
This special issue of Human Pathology, highlighting updates in dermatopathology, represents a carefully curated collection of articles written by authors invited for their respective areas of expertise. This issue covers a range of important topics in neoplastic, inflammatory, or special-site dermatopathology, with an emphasis on "high-stakes" or emerging diagnoses or those that would be otherwise encountered infrequently by most practicing pathologists. In addition, topics important in clinical practice, including considerations relating to skin of color and cognitive bias in dermatopathology, are addressed. Throughout this issue, authors have incorporated scientific advances and recent literature to help pathologists tackle these difficult areas in dermatopathology.
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Affiliation(s)
- Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Lebas E, Collins P, Somja J, Nikkels AF. Causes of Death in Cutaneous T-Cell Lymphoma Patients. Dermatology 2023; 239:860-867. [PMID: 37611553 DOI: 10.1159/000531979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 07/06/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The advancing evolution toward a Th2 immune environment confers a progressive immunosuppression in patients with longstanding cutaneous T-cell lymphoma (CTCL). The conjunction of the disease-related immunosuppression as well as the immunosuppressive character of some CTCL treatments increase the risk of infectious and neoplastic diseases, sometimes with fatal outcomes. OBJECTIVES The aim of the study was to prospectively study the causes of death in a cohort of CTCL patients, in a tertiary university skin cancer center. METHODS All CTCL patients who died between 2008 and 2020 were included. The cause of the death was classified as directly or indirectly related or unrelated to CTCL. RESULTS Over the study period, 31 (13F/18m) patients with CTCL died (mean age: 75.2 years), mean delay between diagnosis and death: 3.2 years (min: 1, max: 12 years), 58.1% of death causes were classified as indirect (infection), 12.9% directly related (blastic transformation), 22.5% unrelated, and 6.5% of unknown cause. 51.6% of mycosis fungoides (MF) patients who died had early-stage disease (1A-2A) or were on remission. 45.2% of dead patients had advanced-stage MF (2B-4B). Mean CRP level is increased in patients who died from infection whereas LDH level increased in patients with blastosis. A tertiary center is expected to manage of a higher proportion of CTCL patients with advanced-stage disease. CONCLUSIONS As infection represented more than 50% of the causes of death in CTCL patients, particular attention should be given to preventive measures such as anti-infective vaccination. Regular surveillance of CRP and LDH levels could be helpful for follow-up of MF patients, respectively, with regards to infection and blastosis.
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Affiliation(s)
- Eve Lebas
- Departments of Dermatology, Liège, Belgium
| | - Patrick Collins
- Dermatopathology, Liège University Hospital, CHU Du Sart Tilman, Liège, Belgium
| | - Joan Somja
- Dermatopathology, Liège University Hospital, CHU Du Sart Tilman, Liège, Belgium
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Adeeb M, Therachiyil L, Moton S, Buddenkotte J, Alam MA, Uddin S, Steinhoff M, Ahmad A. Non-coding RNAs in the epigenetic landscape of cutaneous T-cell lymphoma. Int Rev Cell Mol Biol 2023; 380:149-171. [PMID: 37657857 DOI: 10.1016/bs.ircmb.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Cutaneous T-cell lymphoma (CTCL) is a type of cancer that affects skin, and is characterized by abnormal T-cells in the skin. Epigenetic changes have been found to play a significant role in the development and progression of CTCL. Recently, non-coding RNAs (ncRNAs), such as microRNAs and long non-coding RNAs, have been identified as key players in the regulation of gene expression in CTCL. These ncRNAs can alter the expression of genes involved in cell growth, differentiation, and apoptosis, leading to the development and progression of CTCL. In this review, we summarize the current understanding of the role of ncRNAs in CTCL, including their involvement in DNA methylation, and other biological processes. We also discuss the types of ncRNAs, their role as oncogenic or tumor suppressive, and their putative use as diagnostic and prognostic biomarkers, based on the emerging evidence from laboratory-based as well as patients-based studies. Moreover, we also present the potential targets and pathways affected by ncRNAs. A better understanding of the complex epigenetic landscape of CTCL, including the role of ncRNAs, has the potential to lead to the development of novel targeted therapies for this disease.
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Affiliation(s)
- Monaza Adeeb
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Lubna Therachiyil
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar
| | - Safwan Moton
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Joerg Buddenkotte
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Majid Ali Alam
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shahab Uddin
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Laboratory Animal Research Center, Qatar University, Doha, Qatar
| | - Martin Steinhoff
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Medical School, Doha, Qatar; Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Aamir Ahmad
- Translational Research Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha, Qatar; Department of Dermatology and Venereology, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar.
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Abstract
Skin cancer is often associated with greater morbidity and mortality in skin of color patients because most medical literature and research on skin cancer to date has been predominantly focused on lighter skin types. It is crucial that dermatologic providers be able to recognize different presentations of skin cancer in skin of color patients to optimize the early detection of these tumors and ensure equitable outcomes. This article details the epidemiology, risk factors, clinical features, and disparities in the treatment of melanoma, squamous cell carcinoma, basal cell carcinoma, and mycosis fungoides subtype of cutaneous T-cell lymphoma in skin of color patients.
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Affiliation(s)
- Ananya Munjal
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Nkanyezi Ferguson
- University of Missouri Department of Dermatology, Missouri, Columbia, MO, USA.
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13
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Lavender V, Duarte J, Lusted C. Comprehensive evaluation of a cutaneous T-cell lymphoma education webinar. Br J Nurs 2023; 32:S10-S16. [PMID: 37219985 DOI: 10.12968/bjon.2023.32.10.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Effective and timely referral, treatment and care of people with cutaneous T-cell lymphoma (CTCL) depend on clinical staff possessing highly specialised knowledge and skills. Because of the fragmented nature of the CTCL workforce, specialist education was delivered via a webinar. AIM The study aimed to comprehensively evaluate the webinar and test the validity of using an evaluation model for a one-off education event. METHODS The webinar was evaluated using Moore et al's conceptual model for evaluation of education. Data were collected using polling questions and post-webinar questionnaires and analysed using descriptive summaries and content analysis. FINDINGS Respondents agreed or strongly agreed that the webinar was an effective way to learn, enjoyable, relevant to their role and interesting. Learners also reported improvements in awareness, knowledge and understanding of CTCL, its referral and treatment. CONCLUSION Evaluating one-off education events using a conceptual model of evaluation for continuous medical education is recommended, with some adaptations to overcome limitations.
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Affiliation(s)
- Verna Lavender
- Head of Nursing for Research and Education, Cancer and Surgery Clinical Group, and Head of Guy's Cancer Academy, Guy's and St Thomas' NHS Foundation Trust
| | - Joao Duarte
- Clinical Nurse Specialist in Acute Oncology, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust
| | - Claire Lusted
- Lymphoma/Melanoma Advanced Nurse Practitioner, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust
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14
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Elsea D, Savage KJ, Lilley C, Lisano J, Liu J, Yu KS. Cost-Effectiveness of Brentuximab Vedotin Versus Physician's Choice of Methotrexate or Bexarotene for the Treatment of Cutaneous T-cell Lymphoma in Canada. Adv Ther 2023; 40:2326-2338. [PMID: 36920744 PMCID: PMC10129955 DOI: 10.1007/s12325-023-02470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Brentuximab vedotin versus physician's choice of methotrexate (MTX) or bexarotene (BEX) significantly improved progression-free survival (PFS) (median PFS, 16.7 vs. 3.5 months) and delayed time to subsequent treatment (8.4 vs. 3.7 months), with similar overall survival in patients with CD30-expressing mycosis fungoides (MF) or primary cutaneous anaplastic large cell lymphoma (pcALCL), two types of cutaneous T-cell lymphomas. We assessed the cost-effectiveness of brentuximab vedotin versus MTX or BEX from a Canadian healthcare payer perspective in the indicated population. METHODS A 5-state partitioned survival model [pre-progression, non-stem cell transplant (SCT) post-progression, SCT, SCT relapse, death] with a weekly cycle length and 45-year lifetime horizon has been developed. Health-state occupancies, utility estimates, and treatment duration were informed by ALCANZA. Other inputs and costs came from the literature or clinician experts. Scenario analyses varied key parameters and tested assumptions. RESULTS Brentuximab vedotin versus MTX or BEX was cost-effective; the incremental cost-effectiveness ratio was CAN$43,790 per quality-adjusted life year (QALY) gained. Brentuximab vedotin was more effective (incremental life years: 0.15; QALYs: 0.25) and total treatment costs were slightly higher (incremental costs: $11,105) than MTX or BEX. Key model drivers included end-stage care duration, SCT eligibility, and brentuximab vedotin retreatment rates. CONCLUSION Brentuximab vedotin compared with MTX or BEX was cost-effective for CD30-expressing MF and pcALCL. Brentuximab vedotin's higher drug costs versus MTX or BEX were offset by decreased post-progression and end-stage management costs, and showed a 0.25 QALY gain versus MTX or BEX, and increased the proportion of patients eligible for potentially curative SCT.
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Affiliation(s)
- David Elsea
- Lumanity, Sheffield, UK
- Curta, Inc., Seattle, WA, USA
| | - Kerry J Savage
- Center for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Julie Lisano
- Global Medical Affairs, Seagen Inc., Bothell, WA, USA
| | - Jingmin Liu
- Biostatistics, Seagen Inc., Bothell, WA, USA
| | - Kristina S Yu
- Health Economics and Outcomes Research, Seagen Inc., 21823 30th Drive SE, Bothell, WA, 98021, USA.
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15
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Lee H. Mycosis fungoides and Sézary syndrome. Blood Res 2023; 58:66-82. [PMID: 37105561 PMCID: PMC10133849 DOI: 10.5045/br.2023.2023023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are a distinct disease entity of cutaneous T-cell lymphoma with heterogenous clinical features and prognosis. MF mainly involves skin and usually shows an indolent and favorable clinical course. In patients with advanced-stage disease, extracutaneous involvement including lymph nodes, viscera, and blood, or large cell transformation may be observed. SS is a leukemic form of advanced-stage MF, characterized by generalized erythroderma. Early-stage MF can be treated with skin-directed therapy. However, patients with refractory or advanced-stage disease are associated with severe symptoms or poor prognosis, requiring systemic therapy. Recent progress in understanding the pathogenesis of MF/SS has contributed to advances in the management of these rare diseases. This review aims to describe the clinical manifestations, diagnosis, risk stratification, and treatment strategy of MF/SS, focusing on the recent updates in the management of these diseases.
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Affiliation(s)
- Hyewon Lee
- Division of Hemato-Oncology, Department of Internal Medicine, and Center for Hematologic Malignancy, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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16
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Krishna S, Ravina M, Kashyap Y, Dasgupta S, Kote R. 18F-Labeled Fluoro-2-Deoxyglucose Positron Emission Tomography and Computed Tomography Findings in a Case of Atypical Presentation of Adult Cutaneous T-cell Lymphoma. Indian J Nucl Med 2023; 38:167-169. [PMID: 37456180 PMCID: PMC10348491 DOI: 10.4103/ijnm.ijnm_128_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 07/18/2023] Open
Abstract
Adult cutaneous T-cell lymphoma is an uncommon malignancy with poor prognosis and is usually seen in association with human T-cell lymphotropic virus type 1. We present the case of a 25-year-old female who gave a history of extensive whole-body polypoidal cutaneous and bilateral orbital and breast swellings. Biopsy was suggestive of cutaneous T-cell lymphoma and the patient was evaluated with 18F-labeled fluoro-2-deoxyglucose positron emission tomography and computed tomography for initial staging of the disease.
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Affiliation(s)
- Sarin Krishna
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Mudalsha Ravina
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Yashwant Kashyap
- Department of Medical Oncology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Subhajit Dasgupta
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Rutuja Kote
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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17
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Stokke J, Tann A, El-Mallawany NK, Oschlies I. Diagnosis and management of cutaneous lymphomas and lymphoid proliferations in children, adolescents and young adults (CAYA). Best Pract Res Clin Haematol 2023; 36:101448. [PMID: 36907638 DOI: 10.1016/j.beha.2023.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
Cutaneous lymphomas and lymphoid proliferations (LPD) in children, adolescents, and young adults (CAYA) are a heterogeneous group of lymphoid neoplasms that present formidable diagnostic challenges to clinicians and pathologists alike. Although rare overall, cutaneous lymphomas/LPD occur in real-world settings and awareness of the differential diagnosis, potential complications, and various therapeutic approaches will help ensure the optimal diagnostic work-up and clinical management. Lymphomas/LPD involving the skin can occur as primary cutaneous disease in a patient that characteristically has lymphoma/LPD confined to the skin, or as secondary involvement in patients with systemic disease. This review will comprehensively summarize both primary cutaneous lymphomas/LPD that occur in the CAYA population as well as those CAYA systemic lymphomas/LPD with propensity for secondary cutaneous involvement. Focus on the most common primary entities occurring in CAYA will include lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, mycosis fungoides, subcutaneous panniculitis-like T-cell lymphoma, and hydroa vacciniforme lymphoproliferative disorder.
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18
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Fahmy LM, Kwinta BD, Schreidah CM, Ferris LK, Geskin LJ. Topical Mechlorethamine for the Treatment of Psoriasis: A Report of Two Cases and Literature Review. Dermatol Ther (Heidelb) 2023; 13:617-627. [PMID: 36543971 PMCID: PMC9884718 DOI: 10.1007/s13555-022-00871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Psoriasis is a common inflammatory skin disease that significantly impacts patients' psychosocial wellbeing. Despite increasingly effective treatment options, the recurrence of plaques after discontinuation of therapy in many patients highlights the need for additional therapies. METHODS We report two cases of patients with concurrent psoriasis and mycosis fungoides who were treated with topical mechlorethamine (MCH). A literature review was performed by searching PubMed using the keywords psoriasis, mechlorethamine, chlormethine, and nitrogen mustard. RESULTS Both patients had significant improvement in their psoriasis following treatment with topical MCH gel, which was well tolerated and maintained clearance after 1 and 3 years of follow-up. Seven prospective cohort studies investigating the use of topical MCH were identified through literature review. Out of five studies reporting clinical outcomes by patient, 68 of 77 patients (88%) experienced an improvement in their psoriasis, with 47 of 77 (61%) achieving complete or near-complete clearance. The remaining two studies reported clinical outcomes by lesion, demonstrating improvement in 40 of 45 lesions (88%) and complete or near-complete clearance in 32 of 42 lesions (76%). Contact dermatitis was the most frequent adverse effect, observed in 56 of 125 patients (45%). CONCLUSIONS Topical MCH may be an option for patients with psoriasis who fail or have incomplete responses to other treatments. Published studies are limited by lack of standardized treatment regimens and well-defined outcome measures, highlighting the need for prospective clinical trials to better understand the utility of this topical agent in psoriasis.
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Affiliation(s)
- Lauren M Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Bradley D Kwinta
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Celine M Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA.
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19
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Horino T, Okada D, Inotani S, Nakajima H, Komori M, Terada Y. Denileukin diftitox-induced systemic capillary leak syndrome with acute kidney injury. CEN Case Rep 2023; 12:63-67. [PMID: 35870043 PMCID: PMC9892406 DOI: 10.1007/s13730-022-00720-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023] Open
Abstract
Systemic capillary leak syndrome is a rare and life-threatening disorder, characterized by recurrent episodes of unexplained hypotension, hemoconcentration, and hypoalbuminemia. This condition is caused by leakage of plasma and proteins into the extravascular space and can be classified as either idiopathic or secondary. Secondary systemic capillary leak syndrome can result from cancer, infections, medications, or surgery. Systemic capillary leak syndrome frequently develops as a side effect of denileukin diftitox treatment of refractory cutaneous T-cell lymphoma. However, the pathophysiology of this disease is not well understood. Herein, we report a case of denileukin diftitox-induced systemic capillary leak syndrome.
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Affiliation(s)
- Taro Horino
- Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Daiki Okada
- Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Satoshi Inotani
- Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hideki Nakajima
- Department of Dermatology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masahiro Komori
- Department of Otolaryngology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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20
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Prince HM, Hutchings M, Domingo-Domenech E, Eichenauer DA, Advani R. Anti-CD30 antibody-drug conjugate therapy in lymphoma: current knowledge, remaining controversies, and future perspectives. Ann Hematol 2023; 102:13-29. [PMID: 36512081 DOI: 10.1007/s00277-022-05054-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
CD30 is overexpressed in several lymphoma types, including classic Hodgkin lymphoma (cHL), some peripheral T-cell lymphomas (PTCL), and some cutaneous T-cell lymphomas. The antibody-drug conjugate brentuximab vedotin targets CD30-positive cells and has been evaluated for the treatment of various lymphoma entities. This narrative review summarizes 10 years of experience with brentuximab vedotin for the treatment of CD30-positive lymphomas, discusses novel therapies targeting CD30 in development, and highlights remaining controversies relating to CD30-targeted therapy across lymphoma types. The collective body of evidence for brentuximab vedotin demonstrates that exploitation of CD30 can provide sustained benefits across a range of different CD30-positive lymphomas, in both clinical trials and real-world settings. Preliminary experience with brentuximab vedotin in combination with immune checkpoint inhibitors for relapsed/refractory cHL is encouraging, but further exploration is required. The optimal use of brentuximab vedotin for first-line therapy of PTCL remains to be determined. Further research is required on brentuximab vedotin treatment in high-risk patient populations, and in rare lymphoma subtypes, for which no standard of care exists. Novel therapies targeting CD30 include chimeric antigen receptor therapies and bispecific antibody T-cell engagers, which may be expected to further improve outcomes for patients with CD30-positive lymphomas in the coming years.
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21
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Alexander-Savino C, Boye-Doe A, Bowers E, Beaven A. Oral Mycosis Fungoides: Report of 2 Cases and Review of the Literature. Case Rep Dermatol 2023; 15:1. [PMID: 37497305 PMCID: PMC10368101 DOI: 10.1159/000530935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/20/2023] [Indexed: 07/28/2023] Open
Abstract
Oral and laryngeal cutaneous T-cell lymphoma (CTCL) is rare and usually associated with poor prognosis. Here, we discuss 2 cases of oral CTCL that developed in heavily pretreated patients and provide a review of the literature. The first case is of a 46-year-old African American male with rapidly progressive disease, presenting with a lesion on his hard palate 6 months after being diagnosed with a CD4+CD8+ CTCL. His cutaneous disease was widespread with tumors on >80% of his body surface area. Unfortunately, the patient died 2 ½ years after his CTCL diagnosis and 7 months after developing the oral CTCL lesion. The second case is of a 38-year-old African American male with stage IIb CD3+CD4+CD30+ mycosis fungoides (MF), who developed a tumor on the hard palate 6 months after diagnosis. He received palliative radiation to the oral lesion and multiple lines of systemic therapy for pulmonary, laryngeal, esophageal, and gastric involvement. Biopsy of the gastric lesions showed a CD30+ T-cell lymphoma with the same clonal peak as in his skin but with large cell transformation. Brentuximab vendoin was started, and the patient is now in complete remission, 30 months later. From the 76 cases of oral CTCL that have been reported in the English language, six were of transformed MF. The most common sites affected were the tongue and palate, and the most common presentation were erythematous or ulcerated tumors, plaques, or nodules associated with dysphagia and pain. Oral CTCL typically occurs years after the initial diagnosis of CTCL and portend a poor prognosis with an average survival of just over 1 year after development of oral lesions.
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Affiliation(s)
- Carolina Alexander-Savino
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alexandra Boye-Doe
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edith Bowers
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anne Beaven
- Division of Hematology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Marín-Hernández E, De-Las-Fuentes-García AD, Siordia-Reyes GA. Blistering and aggressive paniculite cutaneous T-cell lymphoma. Bol Med Hosp Infant Mex 2023; 80:58-63. [PMID: 37490681 DOI: 10.24875/bmhim.22000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/02/2022] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is characterized by atypical T-cells expressing the α/β T-cell receptor in the subcutaneous fat. Although it is usually indolent, some cases can show an aggressive course. It is usually a disease of the middle-aged, but can rarely affect children. CASE REPORT We describe the case of a 12-year-old male, previously healthy, who presented a dermatosis disseminated to the four segments consisting of vesicles, blisters, erythematous and hematonecrotic plaques, atrophic scars, associated with edema. The biopsy confirmed limited cutaneous panniculitic T-cell lymphoma with extensive epidermal necrosis. CONCLUSIONS We report the case of a SPTCL in a child. Although rare in this age group, the diagnosis should be considered in children who present similar conditions and who do not respond to treatment. Diagnosis is made on clinical suspicion and confirmed by histology. We discuss the challenges in its management and how timely diagnosis influences patient survival.
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Affiliation(s)
- Eduardo Marín-Hernández
- Servicio de Dermatología Pediátrica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | | | - Georgina A Siordia-Reyes
- Servicio de Anatomía Patológica Pediátrica, Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social. Ciudad de México, México
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23
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Stuver R, Lewis N, Dogan A, Horwitz SM. Moving towards biologically informed treatment strategies for T-cell lymphomas. Int J Hematol 2022; 117:492-503. [PMID: 36574170 PMCID: PMC10395754 DOI: 10.1007/s12185-022-03524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
The rarity and biological heterogeneity of the peripheral T-cell lymphomas has made subtype- and biomarker-driven approaches challenging to realize and even more challenging to evaluate in clinical practice. Out of necessity, treatment of T-cell lymphomas has historically been derivative of other aggressive lymphomas, utilizing intensive combination chemotherapy programs in the upfront setting and non-overlapping cytotoxic regimens upon relapse. However, due to tremendous work in understanding the oncogenic basis of these varied diseases, an increasing exploration of rational, targeted therapies is underway. Still, clinical successes have at times lagged behind pathobiological realizations, and there is an evolving need for biologically based, subtype-specific strategies in the clinic. Herein we propose a framework for future success that relies upon optimizing standard therapy in populations known to benefit from combination chemotherapy, building upon CHOP (or CHOP-like) induction with the CHOP + X model, exploring the use of targeted platforms in the relapsed and refractory setting, and designing biomarker-informed clinical trials that target-specific subhistologies and unique molecular subsets.
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Affiliation(s)
- Robert Stuver
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Natasha Lewis
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmet Dogan
- Hematopathology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.,Cellular Therapy Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Chen YH. Ichthyosis with superimposed mycosis fungoides, a rare case of generalized erythema with malaise. J Family Med Prim Care 2022; 11:6514-6517. [PMID: 36618246 PMCID: PMC9810917 DOI: 10.4103/jfmpc.jfmpc_111_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022] Open
Abstract
Ichthyosiform eruption of mycosis fungoides is rare, and ichthyosis with superimposed mycosis fungoides is scarcely ever seen; only a few cases have been documented in the medical literature. Furthermore, the patients with ichthyosiform lesions may indicate the presence of an underlying systemic disease, paraneoplastic syndrome, or an atypical manifestation of cutaneous T-cell lymphoma. Thus, determining the accurate etiology is important to establish the correct diagnosis and subsequently facilitate its management. They should be evaluated thoroughly, and a skin biopsy is essential to rule out the possibility of ichthyosiform mycosis fungoides.
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Affiliation(s)
- Yu-Hsun Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Address for correspondence: Dr. Yu-Hsun Chen, No. 100, Tzyou 1st Rd., Sanmin Dist., Kaohsiung City 80756, Taiwan. E-mail:
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25
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Rodrigues-Fernandes CI, Vargas PA, de Aquino IG, Lopes MA, Santos-Silva AR. Sézary syndrome: Report of a rare case with perioral manifestation and review of the literature. Oral Oncol 2022; 134:106134. [PMID: 36183500 DOI: 10.1016/j.oraloncology.2022.106134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/09/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022]
Abstract
This report aimed to describe a rare case of Sézary syndrome (SS) diagnosed in an Oral Medicine service. A 54-year-old female presented a generalized pruritus and erythema of the skin of 2 years in duration, which had been treated with antihistamines, corticosteroids, and hydrating creams, without resolution. Extra-oral examination showed a painful lymphadenopathy on the right supraclavicular region. Ultrasound-guided fine-needle aspirationbiopsy did not detect any abnormalities. The patient's skin was remarkably dry and thickened, with erythroderma, fissures, and ulcerations. The perioral region exhibited extreme peeling and angular cheilitis. Immunophenotyping of peripheral blood revealed proliferation of undifferentiated T-cells and a massive proportion of TCD4+ cells relative to TCD8+ cells. PET/CT examination demonstrated multiple lymphadenopathies, and bone marrow biopsy was negative for neoplastic cell infiltration. A diagnosis of SS was established, and the patient is currently being treated with UVB phototherapy, methotrexate, doxepin, and folic acid, with mostly complete regression of signs and symptoms.
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Affiliation(s)
- Carla Isabelly Rodrigues-Fernandes
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil; Department of Oral Biology and Oral Pathology, University of Pretoria, Pretoria, South Africa
| | - Iara Gonçalves de Aquino
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Department of Oral Diagnosis, Semiology and Pathology Areas, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Kondratjeva J, Julien F, Coutelier C, Humeau L, Moog F, Combarros D, Fourquaux I, Pressanti C, Delverdier M, Moore PF, Cadiergues MC. Cutaneous epitheliotropic T-cell lymphoma in a donkey - a case report. BMC Vet Res 2022; 18:267. [PMID: 35821128 PMCID: PMC9275177 DOI: 10.1186/s12917-022-03365-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/28/2022] [Indexed: 05/31/2023] Open
Abstract
Background Cutaneous epitheliotropic T-cell lymphoma is a malignant tumour of the skin already reported in humans, dogs, cats, horses, and other species, but not previously in donkeys. The standard diagnosis is based on clinical, morphological and immunophenotypic data. Differentiation of malignant versus benign proliferation of lymphocytes is crucial; in ambiguous cases T-cell receptor gamma (TRG) molecular clonality should be tested. In the present paper, we report a case of mycosis fungoides diagnosed in a donkey whose diagnosis was based on clinical, histological and immunohistochemical aspects and a positive TRG clonality test. Case presentation A twenty-five-year-old donkey gelding was referred with a mildly pruritic, generalised and severe exfoliative dermatosis. Otherwise, the animal was clinically healthy, though mildly underweight. Dermatological examination revealed severe generalised alopecic and exfoliative dermatitis, occasionally eroded, with high number of large, thin, greyish scales. All mucocutaneous junctions except the hoofs were affected. Ectoparasites and dermatophytes were ruled out. The complete blood count and blood smear evaluation revealed mild normocytic normochromic anemia. The biochemistry panel showed mild hyperproteinemia with albumin within the normal range. Protein electrophoresis showed moderate polyclonal hypergammaglobulinemia. Histological findings were characterised by interface dermatitis with massive exocytosis in the epidermis of a homogenous population of lymphoid cells showing atypia. Clusters of neoplastic cells were present within the epidermis forming Pautrier “microabscesses”. These findings are consistent with cutaneous epitheliotropic lymphoma. Immunohistochemical staining revealed uniform labelling of the neoplastic cells for CD3, and lack of expression of CD20 (a B cell lineage associated marker). Molecular clonality PCR (PARR) was performed using equine TRG primers; this revealed a clonal rearrangement in a heavy polyclonal background. Transmission electronic microscopy showed multiple lymphocytes with convoluted or cerebriform nuclei. Conclusions This case report provides the first evidence of clinical, histopathological, immunophenotypic features, electron microscopy findings and molecular analysis of a cutaneous epitheliotropic T-cell lymphoma (mycosis fungoides) in a donkey. Our observations suggest that cutaneous T-cell lymphoma should be included in the differential diagnoses of exfoliative dermatitis, even those progressing in a chronic pattern and/or with few or no pruritus.
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Affiliation(s)
| | | | - Céline Coutelier
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France
| | - Louis Humeau
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France
| | - Fabien Moog
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France
| | - Daniel Combarros
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France.,INFINITy, Université de Toulouse, CNRS, UPS, InsermToulouse, France
| | - Isabelle Fourquaux
- Centre de Microscopie Electronique Appliquée À La Biologie, Université de Toulouse, Toulouse, France
| | - Charline Pressanti
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France.,INFINITy, Université de Toulouse, CNRS, UPS, InsermToulouse, France
| | - Maxence Delverdier
- Basic Sciences Department, Université de Toulouse, ENVT, Toulouse, France.,IHAP, Université de Toulouse, INRAE, ENVT, Toulouse, France
| | - Peter F Moore
- Leukocyte Antigen Biology Laboratory, UC Davis, VM PMI, Davis, CA, USA
| | - Marie Christine Cadiergues
- Small Animal and Equine Hospital, ENVT, Université de Toulouse, Toulouse, France. .,INFINITy, Université de Toulouse, CNRS, UPS, InsermToulouse, France.
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Jung JM, Lee MY, Won CH, Chang SE, Park CS, Lee MW, Lee WJ. Clinicopathological Factors Associated with the Prognosis and Chronicity of Lymphomatoid Papulosis: A Retrospective Cohort Study. Clin Lymphoma Myeloma Leuk 2022; 22:e541-e548. [PMID: 35307318 DOI: 10.1016/j.clml.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The clinical and pathological features of lymphomatoid papulosis (LYP) are diverse. The objective of this study is to evaluate the clinical and pathological features associated with the prognosis and clinical course of LYP. PATIENTS AND METHODS The clinical and pathological features of LYP in a medical center database were retrospectively retrieved. RESULTS Overall, 58 LYP patients were included in the study. The mean age at diagnosis was 39.1 years and the female-to-male ratio was 1:1.2. More than two-thirds (40/58, 69.0%) of the patients showed a chronic and recurrent disease course. A longer pre-diagnosis duration (odds ratio (OR), 1.01; 95% confidence interval (CI), 1.00-1.03) was significantly associated with secondary lymphoma development. Lower extremity involvement (OR, 10.40; 95% CI, 1.17-92.28) and the absence of eosinophils in the lesions (OR, 11.28; 95% CI, 1.01-126.24) were found to be significantly associated with the chronic and recurrent course of LYP. CONCLUSION A longer pre-diagnosis duration is associated with secondary lymphoma, while a lower extremity involvement and the absence of lesional eosinophil infiltration are associated with the chronicity of LYP.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Mi Young Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea.
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Songpa-gu, Seoul, Korea.
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Huang S, Liao M, Chen S, Zhang P, Xu F, Zhang H. Immune signatures of CD4 and CD68 predicts disease progression in cutaneous T cell lymphoma. Am J Transl Res 2022; 14:3037-3051. [PMID: 35702080 PMCID: PMC9185059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL) is highly heterogeneous, and its prognosis is closely related to the disease stage. The tumor microenvironment (TME) is an important component of tumor tissue, driving cancer cell growth, progression, and metastasis. However, the diagnostic value of TME in CTCL has not yet been studied in-depth. To date, no study has performed a comprehensive evaluation of the significance of the TME in CTCL. METHODS Using xCell methods based on bulk RNA sequencing data, we inferred immune cell fraction in the TME in 126 patients and assessed the prognostic importance of immune cells. Consensus clustering was performed to determine the TME subtypes and characterize the transcriptome of each subtype. Based on the TME subtypes, we established the disease progression model using random forest algorithms and logistic regression. The efficacy of the model was examined using an additional 49-patient cohort. Finally, we validated our finding at the protein level using immunochemistry in a 16-patient cohort. RESULTS Patients with advanced CTCL presented with a more active immunity overall than those with early stage. Random forest algorithms revealed that the immune cells CD4, macrophages, and dendritic cells (DCs) were the most effective prognosis predictors. Therefore, we constructed a risk model using logistic regression based on these immune cells. The TME score could be used to effectively predict disease conditions in three datasets with the AUC of 0.9414, 0.7912, and 0.7665, respectively. Immunochemistry at the protein level revealed that helper T cells and the macrophage markers CD4 and CD68 could successfully distinguish different CTCL stages in patients, whereas the DC marker langerin showed no change with disease progression. CONCLUSION We found advanced-stage CTCL was associated with an active immune microenvironment, and the immune signatures CD4 and CD68 showed a relatively high accuracy in predicting CTCL disease progression.
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Affiliation(s)
- Sanling Huang
- Department of Hematology, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
| | - Mengying Liao
- Department of Pathology, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
| | - Siliang Chen
- Department of Hematology, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
| | - Ping Zhang
- Department of Hematology, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
| | - Fangzhou Xu
- Department of Hematology, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
- The Clinical Trail Institute, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
| | - Hongyu Zhang
- Department of Hematology, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
- The Clinical Trail Institute, Peking University Shenzhen HospitalShenzhen 518000, Guangdong, P. R. China
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Krishnasamy S, Correia E, Kartan S, Wang X, Porcu P, Cha J, Nikbakht N. Application of the Current Diagnostic Algorithm for Early Mycosis Fungoides to a single center cohort: Identification of challenges and suggestions to modify. J Cutan Pathol 2022; 49:772-779. [PMID: 35445764 DOI: 10.1111/cup.14243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosing early-stage Mycosis fungoides (MF) remains a significant challenge. The International Society for Cutaneous Lymphomas (ISCL) proposed an algorithm for diagnosing early MF incorporating clinical and histopathologic characteristics, as well as immunohistochemistry and molecular studies. Here we aim to examine the diagnostic utility of the ISCL algorithm. METHODS In this single-center retrospective review, the ISCL algorithm was applied to 28 patients diagnosed with early-stage MF. Immunohistochemistry and molecular studies were not performed for all patients, so a subgroup analysis was conducted including 18 patients in whom both studies had been performed. We calculated the diagnostic sensitivity of the algorithm. Subsequently, we examined how modifying the algorithm's histopathologic criterion from epidermotropism without spongiosis to epidermotropism influenced its sensitivity. RESULTS 43% (12/28) of the cohort and 50% (9/18) of the subgroup met the algorithm's diagnostic threshold. When the algorithm was modified, 71% of the cohort and 89% of the subgroup met the algorithm's threshold. CONCLUSION While the ISCL algorithm is useful in diagnosing early-stage MF, its sensitivity remains suboptimal. Further refinement of the algorithm to capture spongiotic subtypes of MF may improve its diagnostic value.
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Affiliation(s)
- Shalini Krishnasamy
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA.,Department of Hematology & Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Emily Correia
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA
| | | | - Xuejun Wang
- Department of Hematology & Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Pierluigi Porcu
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA.,Department of Hematology & Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Jisun Cha
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA
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Toi N, Kurajoh M, Miyaoka D, Nagata Y, Yamada S, Imanishi Y, Hayashi D, Tateishi C, Inaba M, Tsuruta D, Morita A, Emoto M. Bexarotene-induced central hypothyroidism assessed by TRH stimulation test in cutaneous T-cell lymphoma patients. Endocr J 2022; 69:101-105. [PMID: 34433736 DOI: 10.1507/endocrj.ej21-0313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bexarotene-induced central hypothyroidism (CH), for which levothyroxine (LT4) replacement is recommended, has been shown to be caused by pituitary but not hypothalamic disorder experimentally, though the underlying mechanism in humans remains unclear. Here, the pathophysiology of bexarotene-induced CH was examined using a TRH stimulation test in cutaneous T-cell lymphoma (CTCL) patients. In this retrospective longitudinal observational study, serum TSH and free T4 (F-T4) levels were measured in 10 euthyroid patients with CTCL during 24 weeks of bexarotene treatment. TRH stimulation testing was performed following CH diagnosis, with LT4 replacement dosage adjusted to maintain F-T4 at the pre-treatment level. After one week of bexarotene administration, all 10 patients developed CH, based on combined findings of low or low-normal F-T4 with low or normal TSH levels. TSH peak response after a stimulation test at one week was reached at 30 minutes. However, that was <4 μIU/mL in all patients, indicating a blunted though not exaggerated and delayed TSH response. In eight who continued bexarotene for 24 weeks, median LT4 replacement dosage was 125 (range, 75-150) μg/day. TSH level at 30 as well as 15, 60, 90, and 120 minutes after TRH stimulation was significantly correlated with LT4 replacement dosage (ρ = -0.913, p = 0.002), whereas TSH and F-T4 basal levels at one week were not. These results suggest that pituitary hypothyroidism is responsible for bexarotene-induced CH, while TSH levels after TRH stimulation precisely reflect residual pituitary-thyroid function in patients receiving bexarotene.
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Affiliation(s)
- Norikazu Toi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Daichi Miyaoka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Yuki Nagata
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Yasuo Imanishi
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Daisuke Hayashi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Chiharu Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
- Department of Internal Medicine, Ohno Memorial Hospital, Osaka 550-0015, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Morita A, Tateishi C, Ikumi K, Hayashi D, Nakada A, Nishihara H, Torii K, Nishida E, Tsuruta D. Comparison of the Efficacy and Safety of Bexarotene and Photo(Chemo)Therapy Combination Therapy and Bexarotene Monotherapy for Cutaneous T-Cell Lymphoma. Dermatol Ther (Heidelb) 2022; 12:615-629. [PMID: 35084694 PMCID: PMC8941067 DOI: 10.1007/s13555-021-00655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Cutaneous T-cell lymphoma (CTCL) is a chronic condition with low malignancy. The combined use of therapeutic agents and photo(chemo)therapy is widely applied for the treatment of CTCL. The efficacy and safety of bexarotene and photo(chemo)therapy combination therapy were previously confirmed in Japanese patients with CTCL. The efficacy and safety of the bexarotene and photo(chemo)therapy combination therapy was compared with bexarotene monotherapy in Japanese patients with CTCL. Methods This was a randomized, open-label, two-parallel-group, active-control specified clinical study in Japanese patients diagnosed with CTCL carried out over 8 weeks with a study extension conducted at two institutions. This study was registered in Japan Registry of Clinical Trials (jRCTs041180094). Results In the combination therapy group, 22 subjects received oral bexarotene (300 mg/m2 body surface area) once daily, followed by bath-psoralen and ultraviolet (UV) A or narrowband UVB. In the monotherapy group, 24 subjects received oral bexarotene (300 mg/m2) once daily. The efficacy analysis using the modified Severity-Weighted Assessment Tool, which included 39 patients, showed a response rate of 81.0% (17/21) in the combination therapy group and 83.3% (15/18) in the monotherapy group. No statistically significant difference was detected between groups. In the combination therapy group, four subjects showed a complete clinical response or complete response, and subjects with a partial response exhibited a high rate of skin lesion resolution, significantly better than in the monotherapy group. In the safety analysis, which included 46 treated subjects (22 in the combination therapy group and 24 in the monotherapy group), no adverse events or adverse drug reactions were reported in either group. Conclusion Both bexarotene and photo(chemo)therapy combination therapy and bexarotene monotherapy were therapeutically effective in Japanese patients with CTCL and well tolerated. Combination therapy led to a higher skin lesion resolution rate and greater therapeutic effects compared with monotherapy. Trial Registration jRCTs041180094. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00655-0. This study evaluated the efficacy and safety of bexarotene monotherapy compared with bexarotene and photo(chemo)therapy combination therapy in Japanese patients with cutaneous T-cell lymphoma (CTCL). The study was a randomized, open-label, two-parallel-group, active-control specified clinical study in patients diagnosed with CTCL performed over an 8-week period with a study extension conducted in two institutions. In the combination therapy group, bexarotene (300 mg/m2 body surface area) was administered orally once daily to 22 subjects, followed by treatment with bath-psoralen and ultraviolet A (bath-PUVA) or narrowband UVB. In the bexarotene monotherapy group, bexarotene (300 mg/m2) was administered orally once daily to 24 subjects. Efficacy was assessed using the modified Severity-Weighted Assessment Tool. Among the 39 subjects analyzed for treatment efficacy, the response rate of the combination therapy group was 81.0% (17/21) and that of the monotherapy group was 83.3% (15/18). Differences between the two treatment groups were not statistically significant. Of the 21 subjects in the combination therapy group, 4 had a complete clinical response or complete response, and those with a partial response showed a higher skin lesion resolution rate than in the monotherapy group. The safety analysis revealed no reports of adverse events or adverse drug reactions among the 46 treated subjects (combination therapy group = 22; monotherapy group = 24). Thus, both bexarotene and photo(chemo)therapy combination therapy and bexarotene monotherapy were therapeutically effective and well tolerated in Japanese patients with CTCL. Patients receiving the combined therapy, however, showed a higher rate of skin lesion resolution.
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Affiliation(s)
- Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
| | - Chiharu Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kyoko Ikumi
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Daisuke Hayashi
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Aya Nakada
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Haruna Nishihara
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kan Torii
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Emi Nishida
- Department of Dermatology, Okazaki City Hospital, 3-1 Goshoai, Kouryuji-cho, Okazaki City, Aichi, 444-8553, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
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Zhang Y, Seminario-Vidal L, Varnadoe C, Lu Y, Dong N, Salamanca C, Whiddon S, Bennett J, Hargis R, Liu H, Montejo M, Hussaini M, Harro C, Messina J, Benson K, Pinilla-Ibarz J, Conejo-Garcia J, Sokol L. Clinical characteristics and prognostic factors of 70 patients with Sézary syndrome: a single-institutional experience at Moffitt cancer center. Leuk Lymphoma 2022; 63:109-116. [PMID: 34467825 PMCID: PMC9167451 DOI: 10.1080/10428194.2021.1971218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sézary syndrome (SS) is a rare and aggressive leukemic variant of cutaneous T-cell lymphoma, with a median overall survival (OS) rate of 2-4 years. Few studies have described the clinical outcome of SS patients since 2012. We retrospectively analyzed 70 patients diagnosed with SS treated at a high-volume tertiary cancer center between 2000 and 2018. Overall survival at 1 and 5 years was 84.1% and 50.7%, respectively. Univariate analyses identified older age (>65 years) and male sex as poor prognostic factors. Five patients presented with circulating large granular lymphocytic proliferation and had a favorable prognosis. Targeted therapies were effective in treating refractory/relapsed SS patients with a durable response. Therapeutic advancements and the comprehensive treatments used in a multidisciplinary clinic improved OS rates.
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Affiliation(s)
- Yumeng Zhang
- Department of Medicine, University of South Florida& H. Lee Moffitt Cancer Center and Research Institute, FL, USA, USA
| | - Lucia Seminario-Vidal
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Yuanyuan Lu
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ning Dong
- Department of Medicine, University of South Florida& H. Lee Moffitt Cancer Center and Research Institute, FL, USA, USA
| | - Christopher Salamanca
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Shannen Whiddon
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Janice Bennett
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Rebecca Hargis
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hien Liu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael Montejo
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mohammad Hussaini
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Carly Harro
- Department of Cancer Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jane Messina
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kaaron Benson
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Javier Pinilla-Ibarz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jose Conejo-Garcia
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Liu Z, Wu X, Hwang ST, Liu J. The Role of Tumor Microenvironment in Mycosis Fungoides and Sézary Syndrome. Ann Dermatol 2021; 33:487-496. [PMID: 34858000 PMCID: PMC8577908 DOI: 10.5021/ad.2021.33.6.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/21/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphomas (CTCLs). Most cases of MF display an indolent course during its early stage. However, in some patients, it can progress to the tumor stage with potential systematic involvement and a poor prognosis. SS is defined as an erythrodermic CTCL with leukemic involvements. The pathogenesis of MF and SS is still not fully understood, but recent data have found that the development of MF and SS is related to genetic alterations and possibly to environmental influences. In CTCL, many components interacting with tumor cells, such as tumor-associated macrophages, fibroblasts, dendritic cells, mast cells, and myeloid-derived suppressor cells, as well as with chemokines, cytokines and other key players, establish the tumor microenvironment (TME). In turn, the TME regulates tumor cell migration and proliferation directly and indirectly and may play a critical role in the progression of MF and SS. The TME of MF and SS appear to show features of a Th2 phenotype, thus dampening tumor-related immune responses. Recently, several studies have been published on the immunological characteristics of MF and SS, but a full understanding of the CTCL-related TME remains to be determined. This review focuses on the role of the TME in MF and SS, aiming to further demonstrate the pathogenesis of the disease and to provide new ideas for potential treatments targeted at the microenvironment components of the tumor.
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Affiliation(s)
- Zhaorui Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xuesong Wu
- Department of Dermatology, School of Medicine, University of California Davis, Sacramento, CA, United States
| | - Sam T Hwang
- Department of Dermatology, School of Medicine, University of California Davis, Sacramento, CA, United States
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Musiek ACM, Rieger KE, Bagot M, Choi JN, Fisher DC, Guitart J, Haun PL, Horwitz SM, Huen AOL, Kwong BY, Lacouture ME, Noor SJ, Rook AH, Seminario-Vidal L, Vermeer MH, Kim YH. Dermatologic Events Associated with the Anti-CCR4 Antibody Mogamulizumab: Characterization and Management. Dermatol Ther (Heidelb) 2021; 12:29-40. [PMID: 34816383 PMCID: PMC8776934 DOI: 10.1007/s13555-021-00624-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 11/30/2022] Open
Abstract
The CCR4-directed monoclonal antibody mogamulizumab has been shown to significantly improve progression-free survival and overall response rate compared with vorinostat in adults with relapsed/refractory mycosis fungoides (MF) and Sézary syndrome (SS). One of the most common adverse events seen with mogamulizumab in MF/SS patients is rash. Because of the protean nature of MF/SS and the variable clinical and histopathological features of mogamulizumab-associated rash, healthcare providers may have difficulty distinguishing rash from disease, and may not be aware of appropriate treatment strategies for this generally manageable adverse event. The objective of this report was to combine results from published literature with experiences and recommendations from multiple investigators and institutions into clinical best practice recommendations to assist healthcare providers in identifying and managing mogamulizumab-associated rash. Optimal management, which includes biopsy confirmation and steroid treatment, requires a multidisciplinary approach among oncology, dermatology, and pathology practitioners.
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Affiliation(s)
- Amy C M Musiek
- Division of Dermatology, Washington University School of Medicine, 4901 Forest Park, Suite 502, Saint Louis, MO, 63108, USA.
| | | | - Martine Bagot
- Hôpital Saint Louis, APHP, Inserm U976, Université de Paris, Paris, France
| | | | | | | | - Paul L Haun
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Sarah J Noor
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alain H Rook
- University of Pennsylvania, Philadelphia, PA, USA
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Blazejak C, Stranzenbach R, Gosman J, Gambichler T, Wehkamp U, Stendel S, Klemke CD, Wobser M, Olk J, Nicolay JP, Weyermann M, Stadler R, Assaf C. Clinical Outcomes of Advanced-Stage Cutaneous Lymphoma under Low-Dose Gemcitabine Treatment: Real-Life Data from the German Cutaneous Lymphoma Network. Dermatology 2021; 238:498-506. [PMID: 34474414 DOI: 10.1159/000517830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gemcitabine is an effective single-agent chemotherapy used in advanced stages of cutaneous T-cell lymphoma (CTCL). However, gemcitabine used in the current standard regimen is frequently associated with adverse events (AE), such as an increased risk for myelosuppression and severe infections. OBJECTIVES We investigated in this retrospective study the effect of low-dose gemcitabine in pretreated advanced-stage CTCL and in blastic plasmacytoid dendritic cell neoplasia (BPDCN) regarding overall response (OR), progression-free survival (PFS), and AE. MATERIAL AND METHODS A retrospective, multicenter study was conducted on 64 CTCL and BPDCN patients treated with gemcitabine in average absolute dosage of 1,800 mg/m2 per cycle, which is 50% lower compared to standard dosage of 3,600 mg/m2 per cycle (1,200 mg/m2 day 1, 8, 15). Evaluation of response to therapy and AE was done 4-6 weeks after the sixth cycle. RESULTS OR was 62% with 11% demonstrating a complete response. The median time of PFS was 12 months and median time to next treatment was 7 months. Only 3/63 patients showed serious side effects, e.g., port infection or acute renal failure. Almost 73% of the patients experienced minor to moderate side effects (CTCAE grade 0-2). Fatigue (27.2%), fever (22.7%), and mild blood count alteration (18.2%) were the most common AE. CONCLUSIONS This retrospective analysis supports the use of low-dose gemcitabine therapy in CTCL, demonstrating with 62% OR and PFS of 12 months an almost identical response rate and survival as compared to the standard dose therapy reported in previous studies but with a significantly improved safety profile and tolerability.
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Affiliation(s)
- Christoph Blazejak
- Department of Dermatology HELIOS Klinikum Krefeld, Academic Teaching Hospital of the University of Aachen, Aachen, Germany
| | - Rene Stranzenbach
- Universitätsklinik für Dermatologie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Janika Gosman
- Universitätsklinik für Dermatologie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Thilo Gambichler
- Department of Dermatology, Universitätsklinikum Bochum, Bochum, Germany
| | - Ulrike Wehkamp
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sarja Stendel
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claus-Detlev Klemke
- Department of Dermatology, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg, Karlsruhe, Germany
| | - Marion Wobser
- Department of Dermatology, Universitätsklinik Würzburg, Würzburg, Germany
| | - Joanna Olk
- Department of Dermatology, Universitätsklinik Würzburg, Würzburg, Germany
| | - Jan P Nicolay
- Department of Dermatology Universitätsmedizin Mannheim, Mannheim, Germany
| | - Maria Weyermann
- Niederrhein University of Applied Sciences, Faculty of Health Care, Krefeld, Germany
| | - Rudolf Stadler
- Universitätsklinik für Dermatologie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Chalid Assaf
- Department of Dermatology HELIOS Klinikum Krefeld, Academic Teaching Hospital of the University of Aachen, Aachen, Germany.,Department of Dermatology, Charité -Universitätsmedizin Berlin, Berlin, Germany
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Montes-Torres A, Lezcano-Biosca V, de la Fuente-Meira S, Prieto-Torres L. [Papular mycosis fungoides in elderly: Report of two cases]. Rev Esp Geriatr Gerontol 2021; 56:308-310. [PMID: 34116802 DOI: 10.1016/j.regg.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/02/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
Papular mycosis fungoides (MF) is an uncommon clinical variant of early MF without prognostic implications that follows an indolent course over years. It is characterized by the presence of multiple, small, pruritic, flat-topped, erythematous papules, often presenting as a nonspecific papular eruption which makes early diagnosis difficult. We describe two cases of elderly patients with papular MF, a probably underdiagnosed entity, which causes a significant deterioration in quality of life of patients who may benefit from specific treatments such as phototherapy.
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Affiliation(s)
- Andrea Montes-Torres
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | | | - Lucía Prieto-Torres
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Costa FB, Baptista PL, Duquia RP. A cross-sectional questionnaire study in a phototherapy unit during COVID-19. Photochem Photobiol Sci 2021; 20:1239-1242. [PMID: 34449079 PMCID: PMC8393778 DOI: 10.1007/s43630-021-00093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
Background In March 2020, social isolation measures were imposed in Brazil to contain the spread of the novel coronavirus (SARS-CoV-2), requiring health services to implement contingency plans. The main objective of the study was to verify the status of the disease, self-reported by patients who discontinued phototherapy, during a period of social isolation. Methods All patients receiving phototherapy at the Santa Casa de Porto Alegre, Brazil, prior to the implementation of social distancing measures were eligible for inclusion in the study. 86 patients answered a questionnaire during a medical evaluation. Results 95% of patients who stopped phototherapy reported a worsening of disease status. Only 19% of patients continued to attend phototherapy sessions during the social isolation period. Conclusion The COVID-19 pandemic led most patients to stop phototherapy, resulting in the perception of increased disease severity in an outpatient sample in southern Brazil.
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Affiliation(s)
- Francine Batista Costa
- Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, 135, Annes Dias St., Porto Alegre, Rio Grande Do Sul, RS, 90040-001, Brazil.
| | - Patrícia Lima Baptista
- Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, 135, Annes Dias St., Porto Alegre, Rio Grande Do Sul, RS, 90040-001, Brazil
| | - Rodrigo Pereira Duquia
- Department of Dermatology, Santa Casa de Misericórdia de Porto Alegre, 135, Annes Dias St., Porto Alegre, Rio Grande Do Sul, RS, 90040-001, Brazil
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Bichon A, Brue A, Godefroy R, Sallee M, Daniel L, Farnarier C, Gobin N, Abed S, Richard MA, Villani P, Malissen N, Daumas A. [Minimal change nephropathy and IgA deposits associated with a Sezary syndrome]. Rev Med Interne 2021; 43:48-53. [PMID: 34419323 DOI: 10.1016/j.revmed.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/19/2021] [Accepted: 08/01/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The Sézary syndrome (SS) is an aggressive form of cutaneous T-cell lymphoma (CTCL) requiring a rapid diagnosis due to its poor prognosis. CASE REPORT We report the first case of an eighty-nine-year-old woman who presented with concomitant Sezary syndrome and anasarca, revealing a nephrotic syndrome caused by a minimal change nephropathy associated with immunoglobulin A (IgA) deposits. Scarce literature described rare cases associating these two entities (nephrotic syndrome and nephropathy). However, the nephrotic syndrome was delayed from disease onset, secondary to immunosuppressive treatment of SS, or due to the weaning of SS therapy. Thus, the direct link between the glomerular lesion and the cutaneous lymphoma was difficult to establish. However, the synchronous occurrence of both SS and glomerulopathy in our patient, along with Sezary cells in both urines (urinary cytology) and biopsy, and resolution of nephropathy after treatment of SS, support the likely attributability of SS in glomerulopathy. CONCLUSION Practitioners must acknowledge the possible occurrence of glomerular involvement in SS.
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Affiliation(s)
- A Bichon
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - A Brue
- Service de dermatologie et cancérologie cutanée, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - R Godefroy
- Service de néphrologie et de transplantation rénale, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - M Sallee
- Service de néphrologie et de transplantation rénale, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - L Daniel
- Laboratoire d'anatomie pathologique, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - C Farnarier
- Laboratoire d'immunologie, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - N Gobin
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Abed
- Laboratoire d'immunologie, Hôpital de la Conception, Aix-Marseille Université, AP-HM, Marseille, France
| | - M A Richard
- Service de dermatologie et cancérologie cutanée, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - P Villani
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - N Malissen
- Service de dermatologie et cancérologie cutanée, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - A Daumas
- Service de médecine interne, gériatrie et thérapeutique, Aix-Marseille Université, AP-HM, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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Abstract
The cutaneous lymphomas are malignancies of T-cell and B-cell lymphocytes in which the skin is the primary organ of involvement. The cutaneous T-cell lymphomas include variants that can mimic the presentation of common skin diseases or arthropod bites. Mycosis fungoides, the most common cutaneous T-cell lymphoma, usually presents as fixed asymptomatic patches or plaques in sun-protected areas. The cutaneous B-cell lymphomas have fewer variants that often present as papules or nodules that can mimic nonmelanoma skin cancers. Some therapies for cutaneous lymphoma have unique side effects such as central hypothyroidism, hyperlipidemia, and peripheral neuropathy.
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MESH Headings
- Aged
- Aged, 80 and over
- Animals
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents, Immunological/adverse effects
- Arthropods
- Bexarotene/adverse effects
- Bites and Stings/diagnosis
- Brentuximab Vedotin/adverse effects
- Diagnosis, Differential
- Humans
- Hyperlipidemias/chemically induced
- Hypothyroidism/chemically induced
- Lymphoma, Primary Cutaneous Anaplastic Large Cell/diagnosis
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/therapy
- Lymphomatoid Papulosis/diagnosis
- Mycosis Fungoides/diagnosis
- Peripheral Nervous System Diseases/chemically induced
- Prognosis
- Sezary Syndrome/diagnosis
- Skin Diseases/diagnosis
- Skin Diseases/pathology
- Skin Neoplasms/pathology
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Affiliation(s)
- John A Zic
- Department of Dermatology, VU Cutaneous Lymphoma Clinic, Vanderbilt University Medical Center, Vanderbilt Dermatology, One Hundred Oaks, 719 Thompson Lane, Suite 26300, Nashville, TN 37204-3609, USA.
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Vallecorsa P, Di Venosa G, Gola G, Sáenz D, Mamone L, MacRobert AJ, Ramírez J, Casas A. Photodynamic therapy of cutaneous T-cell lymphoma cell lines mediated by 5-aminolevulinic acid and derivatives. J Photochem Photobiol B 2021; 221:112244. [PMID: 34174487 DOI: 10.1016/j.jphotobiol.2021.112244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 01/10/2023]
Abstract
The delta-amino acid 5-aminolevulinic acid (ALA), is the precursor of the endogenous photosensitiser Protoporphyrin IX (PpIX), and is currently approved for Photodynamic Therapy (PDT) of certain superficial cancers. However, ALA-PDT is not very effective in diseases in which T-cells play a significant role. Cutaneous T-cell lymphomas (CTCL) is a group of non-Hodgkin malignant diseases, which includes mycosis fungoides (MF) and Sézary syndrome (SS). In previous work, we have designed new ALA esters synthesised by three-component Passerini reactions, and some of them showed higher performance as compared to ALA. This work aimed to determine the efficacy as pro-photosensitisers of five new ALA esters of 2-hydroxy-N-arylacetamides (1f, 1 g, 1 h, 1i and 1 k) of higher lipophilicity than ALA in Myla cells of MF and HuT-78 cells of SS. We have also tested its effectiveness against ALA and the already marketed ALA methyl ester (Me-ALA) and ALA hexyl ester (He-ALA). Both cell Myla and SS cells were effectively and equally photoinactivated by ALA-PDT. Besides, the concentration of ALA required to induce half the maximal porphyrin synthesis was 209 μM for Myla and 169 μM for HuT-78 cells. As a criterion of efficacy, we calculated the concentration of the ALA derivatives necessary to induce half the plateau porphyrin values obtained from ALA. These values were achieved at concentrations 4 and 12 times lower compared to ALA, according to the derivative used. For He-ALA, concentrations were 24 to 25 times lower than required for ALA for inducing comparable porphyrin synthesis in both CTCL cells. The light doses for inducing 50% of cell death (LD50) for He-ALA, 1f, 1 g, 1 h and 1i were around 18 and 25 J/cm2 for Myla and HuT-78 cells respectively, after exposure to 0.05 mM concentrations of the compounds. On the other hand, the LD50s for the compound 1 k were 40 and 57 J/cm2 for Myla and HuT-78, respectively. In contrast, 0.05 mM of ALA and Me-ALA did not provoke photokilling since the concentration employed was far below the porphyrin saturation point for these compounds. Our results suggest the potential use of ALA derivatives for topical application in PDT treatment of MF and extracorporeal PDT for the depletion of activated T-cells in SS.
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Affiliation(s)
- Pablo Vallecorsa
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET-Hospital de Clínicas Gral, José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Di Venosa
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET-Hospital de Clínicas Gral, José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Gola
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Orgánica, Buenos Aires, Argentina; Universidad de Buenos Aires, CONICET, Unidad de Microanálisis y Métodos Físicos Aplicados a Química Orgánica (UMYMFOR), Buenos Aires, Argentina
| | - Daniel Sáenz
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET-Hospital de Clínicas Gral, José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
| | - Leandro Mamone
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET-Hospital de Clínicas Gral, José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alexander J MacRobert
- Centre for Nanomedicine and Surgical Theranostics, Unversity College London, UCL Medical School, Rowland Hill St, London NW32PF, UK
| | - Javier Ramírez
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Química Orgánica, Buenos Aires, Argentina; Universidad de Buenos Aires, CONICET, Unidad de Microanálisis y Métodos Físicos Aplicados a Química Orgánica (UMYMFOR), Buenos Aires, Argentina
| | - Adriana Casas
- Centro de Investigaciones sobre Porfirinas y Porfirias (CIPYP), CONICET-Hospital de Clínicas Gral, José de San Martín, Ciudad Autónoma de Buenos Aires, Argentina.
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Querfeld C, Scarisbrick JJ, Assaf C, Guenova E, Bagot M, Ortiz-Romero PL, Quaglino P, Bonizzoni E, Hodak E. Post hoc Analysis of a Randomized, Controlled, Phase 2 Study to Assess Response Rates with Chlormethine/Mechlorethamine Gel in Patients with Stage IA-IIA Mycosis Fungoides. Dermatology 2021; 238:347-357. [PMID: 34091453 DOI: 10.1159/000516138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma. Patients can be treated using chlormethine gel, a skin-directed therapy developed and approved for MF. In the randomized, controlled 201 trial, chlormethine gel was found to be noninferior to equal-strength chlormethine ointment. However, there remains a need to gain more insight into outcome measures after treatment. OBJECTIVE The aim of this study was to further investigate the potential of chlormethine gel treatment through a novel post hoc analysis of the 201 trial data (NCT00168064). METHODS Patients were randomized to chlormethine gel or ointment; response assessments included Composite Assessment of Index Lesion Severity (CAILS) and total body surface area (BSA). In this post hoc analysis, additional subgroup response analyses were performed for stage IA/IB-IIA MF. Very good partial response (75 to <100% improvement) was included as an additional response category. Time to response and overall response trends were determined. Finally, multivariate time-to-event analyses were performed to determine whether associations were observed between treatment frequency, response, and adverse events. RESULTS Response rates were significantly higher for patients with stage IA MF for CAILS (intent-to-treat [p = 0.0014] and efficacy-evaluable [EE; p = 0.0036] populations) and BSA (EE population [p = 0.0488]) treated with gel versus ointment. Time to first CAILS response and response trends were better for all-stage gel-treated patients overall. No association was seen between treatment frequency and response or occurrence of adverse events at the following visit. An association was observed between the occurrence of contact dermatitis and improved clinical response at the next visit (p = 0.0001). CONCLUSION This post hoc analysis shows that treatment with chlormethine gel may result in higher and faster response rates compared with chlormethine ointment, which confirms and expands results reported in the original analysis. The incidence of contact dermatitis may potentially be a prognostic indicator for clinical response; this needs to be confirmed in a larger population.
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Affiliation(s)
| | | | - Chalid Assaf
- Department of Dermatology and Venereology, Helios Klinikum Krefeld, Krefeld, Germany.,Academic Teaching Hospital of the University of Aachen, Aachen, Germany
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Martine Bagot
- Department of Dermatology, AP-HP, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Pablo Luis Ortiz-Romero
- Hospital 12 de Octubre, Institute I+12, CIBERONC, Medical School, Universidad Complutense, Madrid, Spain
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Erminio Bonizzoni
- Department of Clinical Sciences and Community, Section of Medical Statistics, Biometry and Epidemiology, University of Milan, Milan, Italy
| | - Emmilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lampadaki K, Koumourtzis M, Karagianni F, Marinos L, Papadavid E. Chlormethine Gel in Combination with Other Therapies in the Treatment of Patients with Mycosis Fungoides Cutaneous T Cell Lymphoma: Three Case Reports. Adv Ther 2021; 38:3455-3464. [PMID: 33928511 PMCID: PMC8190003 DOI: 10.1007/s12325-021-01721-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022]
Abstract
Introduction Chlormethine gel is a skin-directed therapy recommended for patients with early-stage mycosis fungoides (MF) cutaneous T cell lymphoma. Methods Herein, we present three cases of patients with stage IB–IIB MF who were treated with chlormethine gel and concomitant therapies. Results All patients responded well to treatment with chlormethine gel; complete responses were observed with improvements in Modified Severity-Weighted Assessment Tool scores and severity of lesions; one patient reported an improvement in quality of life. While adverse events did occur after treatment initiation, they were skin related and could be effectively managed through reductions in treatment frequency and the addition of emollients and topical steroids. Conclusion The cases presented here illustrate that chlormethine gel is an effective and safe treatment option for patients with MF who had received prior therapies that had proved ineffective. Chlormethine gel could be combined with other skin-directed or systemic therapies for optimal benefit. Incidences of dermatitis were seen to be successfully managed and quality of life benefits were also reported.
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43
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Geskin LJ, Bagot M, Hodak E, Kim EJ. Chlormethine Gel for the Treatment of Skin Lesions in All Stages of Mycosis Fungoides Cutaneous T-Cell Lymphoma: A Narrative Review and International Experience. Dermatol Ther (Heidelb) 2021; 11:1085-1106. [PMID: 34021485 PMCID: PMC8322195 DOI: 10.1007/s13555-021-00539-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Indexed: 12/25/2022] Open
Abstract
Mycosis fungoides (MF), the most common form of primary cutaneous T-cell lymphoma, is a disease typically with an indolent course that is initially characterized by localized patches and plaques. In the early stages of the disease, treatment involves skin-directed therapies (SDTs) such as topical corticosteroids and retinoids. Chlormethine gel (also known as mechlorethamine) was the first SDT purposely developed to treat MF and is currently endorsed by international guidelines for the treatment of adult patients with MF as a first-line therapy. While chlormethine is an efficacious therapy, its usage may be complicated by the development of cutaneous reactions at the sites of application. Herein, we discuss the supportive guidelines for MF and the suitability of chlormethine as a therapeutic option in patients with MF. In addition, we present real-world experience on the use of chlormethine gel from clinics in the USA, Israel, and France with the aim of demonstrating the efficacy of chlormethine gel in routine clinical practice and outlining strategies that are being used to manage emergent cutaneous reactions.
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Affiliation(s)
- Larisa J Geskin
- Department of Dermatology, Columbia University, 161 Fort Washington Ave, 12th Floor, New York, NY, 10032, USA.
| | - Martine Bagot
- Department of Dermatology, AP-HP, Université de Paris, Hôpital Saint-Louis, Paris, France
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ellen J Kim
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Del Guzzo CA, Kojadinovic A, Vinnakota RR, Geskin LJ, Newman JC, Langhoff E, Park YHA, Bates SE, Dana AN. Antibiotics and Imiquimod for Cutaneous T-Cell Lymphoma in Veterans: A Patient Population with Agent Orange Exposure. Oncologist 2021; 26:727-e1488. [PMID: 33851477 DOI: 10.1002/onco.13785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/29/2021] [Indexed: 11/12/2022] Open
Abstract
LESSONS LEARNED Staphylococcus aureus infection in cutaneous T-cell lymphoma (CTCL) is thought to contribute to disease progression; thus, adjunctive treatment with antibiotics warrants further investigation. This trial of antibiotic therapy followed by imiquimod in early stage CTCL was not completed because of difficulties with patient accrual. BACKGROUND Cutaneous T-cell lymphoma (CTCL), a form of non-Hodgkin lymphoma, is a heterogeneous group of malignancies of mature memory T lymphocytes. It has an annual age-adjusted incidence of 7.5 per million persons in the U.S. population [1]. The etiology of CTCL is unknown, but epidemiological studies have reported potential associations with environmental and occupational factors, including Agent Orange exposure in Vietnam Veterans [2]. Both topical and systemic therapies have been identified as effective in CTCL; the choice of treatment is dependent on disease stage, with the overall goal of improving symptoms given the chronic and recurrent nature of the disease. Several studies have suggested that CTCL is exacerbated by the presence of Staphylococcus aureus in the skin and can be ameliorated by treatment with antibiotics [3]. METHODS Our study was designed to assess the effects of antibiotics and imiquimod on early stage CTCL. Patients between the ages of 30-89 years with stage I and II CTCL were eligible for enrollment. They could not be receiving concurrent therapy, and the study design included a 14-day washout period after discontinuation of CTCL therapy. The washout period was followed by doxycycline 100 mg p.o. b.i.d. for 14 days and then two packets (250 mg per packet) of imiquimod 5% cream topically to the most clinically active lesions 3 days a week (Monday, Wednesday, and Friday) for 28 days. Skin lesions were measured using the modified Severity Weighted Assessment Tool (mSWAT). RESULTS Our study enrolled only two patients with early stage CTCL because of difficulty locating patients with active CTCL able to discontinue all therapy. The two enrolled patients completed all therapy. One patient had a complete response after imiquimod, whereas the other patient had stable disease. CONCLUSION Antibiotics and imiquimod have reported activity as single agents in CTCL; we did not enroll enough patients to assess value in the sequence of antibiotic therapy followed by imiquimod.
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Affiliation(s)
- Christina A Del Guzzo
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arsenije Kojadinovic
- Hematology and Oncology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Ravi R Vinnakota
- Department of Dermatology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Larisa J Geskin
- Departments of Dermatology, Columbia University Medical Center, New York, New York, USA
| | - Jessica C Newman
- Department of Dermatology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Departments of Dermatology, Columbia University Medical Center, New York, New York, USA
| | - Erik Langhoff
- Department of Nephrology, Mt. Sinai School of Medicine, New York, New York, USA
| | - Yeun-Hee A Park
- Hematology and Oncology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Department of Hematology and Oncology, Columbia University Medical Center, New York, New York, USA
| | - Susan E Bates
- Department of Hematology and Oncology, Columbia University Medical Center, New York, New York, USA
| | - Ali N Dana
- Department of Dermatology, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.,Departments of Dermatology, Columbia University Medical Center, New York, New York, USA.,Bellaire Dermatology, Houston, Texas, USA
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Voruz S, de Leval L, Cairoli A. Successful salvage therapy for refractory primary cutaneous gamma-delta T-cell lymphoma with a combination of brentuximab vedotin and gemcitabine. Exp Hematol Oncol 2021; 10:32. [PMID: 33985594 DOI: 10.1186/s40164-021-00225-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
Primary cutaneous gamma-delta T-cell lymphoma (PCGD-TCL) is a very rare lymphoma with an aggressive clinical course and a dismal outcome. The prognosis is linked to a pronounced resistance to chemotherapy and radiotherapy. No standard treatment approach is defined due to the low frequency of the disease and lack of prospective studies. CD30 is expressed in almost half of the cases of PCGD-TCL, which offers a potential therapeutic option. We report the successful treatment of a 68-year-old man who suffered PCGD-TCL with a combination of Brentuximab Vedotin and Gemcitabine after the failure of two lines of previous chemotherapy. CD30 expression was only partial. The treatment was very well tolerated and allowed the patient to benefit from allogeneic hematopoietic stem cell transplantation.
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Semaan S, Abel MK, Raffi J, Murase JE. A clinician's guide to cutaneous T-cell lymphoma presenting as recalcitrant eczematous dermatitis in adults. Int J Womens Dermatol 2021; 7:422-427. [PMID: 34621954 PMCID: PMC8484943 DOI: 10.1016/j.ijwd.2021.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/16/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) encompasses a group of low-grade, non-Hodgkin lymphoma, including mycosis fungoides and Sézary syndrome. Diagnosis of CTCL can be challenging given the prolonged, gradual onset and shared characteristics with many benign inflammatory skin diseases. In this case series, we describe four unique cases of patients with chronic, recalcitrant eczematous dermatitis who presented for a patch-test consultation and were ultimately diagnosed with CTCL. In particular, we highlight clinical pearls to aid in distinguishing CTCL from inflammatory dermatoses and describe the diagnostic strategy to help dermatologists arrive at the diagnosis of CTCL at earlier stages of the disease.
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Affiliation(s)
- Sarah Semaan
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Mary Kathryn Abel
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Jodie Raffi
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Department of Dermatology, University of California, Los Angeles, Los Angeles, California
| | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, San Francisco, California.,Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California
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47
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Mehdi SJ, Moerman-Herzog A, Wong HK. Normal and cancer fibroblasts differentially regulate TWIST1, TOX and cytokine gene expression in cutaneous T-cell lymphoma. BMC Cancer 2021; 21:492. [PMID: 33941102 PMCID: PMC8091512 DOI: 10.1186/s12885-021-08142-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/02/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mycosis fungoides (MF) is a primary cutaneous T-cell lymphoma (CTCL) that transforms from mature, skin-homing T cells and progresses during the early stages in the skin. The role of the skin microenvironment in MF development is unclear, but recent findings in a variety of cancers have highlighted the role of stromal fibroblasts in promoting or inhibiting tumorigenesis. Stromal fibroblasts are an important part of the cutaneous tumor microenvironment (TME) in MF. Here we describe studies into the interaction of TME-fibroblasts and malignant T cells to gain insight into their role in CTCL. METHODS Skin from normal (n = 3) and MF patients (n = 3) were analyzed for FAPα by immunohistochemistry. MyLa is a CTCL cell line that retains expression of biomarkers TWIST1 and TOX that are frequently detected in CTCL patients. MyLa cells were cultured in the presence or absence of normal or MF skin derived fibroblasts for 5 days, trypsinized to detached MyL a cells, and gene expression analyzed by RT-PCR for MF biomarkers (TWIST1 and TOX), Th1 markers (IFNG, TBX21), Th2 markers (GATA3, IL16), and proliferation marker (MKI67). Purified fibroblasts were assayed for VIM and ACTA2 gene expression. Cellular senescence assay was performed to assess senescence. RESULTS MF skin fibroblast showed increased expression of FAP-α with increasing stage compared to normal. Normal fibroblasts co-cultured with MyLa cells suppressed expression of TWIST1 (p < 0.0006), and TOX (p < 0.03), GATA3 (p < 0.02) and IL16 (p < 0.03), and increased expression of IFNG (p < 0.03) and TBX21 (p < 0.03) in MyLa cells. In contrast, MyLa cells cultured with MF fibroblasts retained high expression of TWIST1, TOX and GATA3. MF fibroblasts co-culture with MyLa cells increased expression of IL16 (p < 0.01) and IL4 (p < 0.02), and suppressed IFNG and TBX21 in MyLa cells. Furthermore, expression of MKI67 in MyLa cells was suppressed by normal fibroblasts compared to MF fibroblasts. CONCLUSION Skin fibroblasts represent important components of the TME in MF. In co-culture model, normal and MF fibroblasts have differential influence on T-cell phenotype in modulating expression of Th1 cytokine and CTCL biomarker genes to reveal distinct roles with implications in MF progression.
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Affiliation(s)
- Syed Jafar Mehdi
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham St, #576, Little Rock, AR, 72205, USA
| | - Andrea Moerman-Herzog
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham St, #576, Little Rock, AR, 72205, USA
| | - Henry K Wong
- Department of Dermatology, University of Arkansas for Medical Sciences, 4301 West Markham St, #576, Little Rock, AR, 72205, USA.
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Freeman CM, Wright BL, Bauer CS, Rukasin CR, Chiang SC, Marsh RA, Taylor S, Jacobsen J, Miller HK, Badia P. Cutaneous T-cell lymphoma as a unique presenting malignancy in X-linked magnesium defect with EBV infection and neoplasia (XMEN) disease. Clin Immunol 2021; 226:108722. [PMID: 33831577 DOI: 10.1016/j.clim.2021.108722] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Catherine M Freeman
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, AZ, United States of America; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, United States of America.
| | - Benjamin L Wright
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, AZ, United States of America; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Cindy S Bauer
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, AZ, United States of America; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Christine R Rukasin
- Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, AZ, United States of America; Division of Allergy, Asthma and Clinical Immunology, Mayo Clinic, Scottsdale, AZ, United States of America
| | - Samuel C Chiang
- Cincinnati Children's Hospital Medical Center, Division of Bone Marrow Transplant and Immune Deficiencies and Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States of America
| | - Rebecca A Marsh
- Cincinnati Children's Hospital Medical Center, Division of Bone Marrow Transplant and Immune Deficiencies and Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States of America
| | - Steve Taylor
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Jeffrey Jacobsen
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, AZ, United States of America
| | - Holly K Miller
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, United States of America; Mayo Clinic College of Medicine and Science, Scottsdale, AZ, United States of America
| | - Priscila Badia
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ, United States of America; Mayo Clinic College of Medicine and Science, Scottsdale, AZ, United States of America
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Kim YH, Prince HM, Whittaker S, Horwitz SM, Duvic M, Bechter O, Sanches JA, Stadler R, Scarisbrick J, Quaglino P, Zinzani PL, Wolter P, Eradat H, Pinter-Brown LC, Ortiz-Romero PL, Akilov OE, Trotman J, Taylor K, Weichenthal M, Walewski J, Fisher D, McNeeley M, Gru AA, Brown L, Palanca-Wessels MC, Lisano J, Onsum M, Bunn V, Little M, Trepicchio WL, Dummer R. Response to brentuximab vedotin versus physician's choice by CD30 expression and large cell transformation status in patients with mycosis fungoides: An ALCANZA sub-analysis. Eur J Cancer 2021; 148:411-421. [PMID: 33794441 PMCID: PMC9347228 DOI: 10.1016/j.ejca.2021.01.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, can lead to disfiguring lesions, debilitating pruritus and frequent skin infections. This study assessed response to brentuximab vedotin in patients with MF in the phase III ALCANZA study. METHODS Baseline CD30 levels and large-cell transformation (LCT) status were centrally reviewed in patients with previously-treated CD30-positive MF using ≥2 skin biopsies obtained at screening; eligible patients required ≥1 biopsy with ≥10% CD30 expression. Patients were categorised as CD30min < 10% (≥1 biopsy with <10% CD30 expression), or CD30min ≥ 10% (all biopsies with ≥10% CD30 expression) and baseline LCT present or absent. Efficacy analyses were the proportion of patients with objective response lasting ≥4 months (ORR4) and progression-free survival (PFS). RESULTS Clinical activity with brentuximab vedotin was observed across all CD30 expression levels in patients with ≥1 biopsy showing ≥10% CD30 expression. Superior ORR4 was observed with brentuximab vedotin versus physician's choice in patients: with CD30min < 10% (40.9% versus 9.5%), with CD30min ≥ 10% (57.1% versus 10.3%), with LCT (64.7% versus 17.6%) and without LCT (38.7% versus 6.5%). Brentuximab vedotin improved median PFS versus physician's choice in patients: with CD30min < 10% (16.7 versus 2.3 months), with CD30min ≥ 10% (15.5 versus 3.9 months), with LCT (15.5 versus 2.8 months) and without LCT (16.1 versus 3.5 months). Safety profiles were generally comparable across subgroups. CONCLUSION These exploratory analyses demonstrated that brentuximab vedotin improved rates of ORR4 and PFS versus physician's choice in patients with CD30-positive MF and ≥1 biopsy showing ≥10% CD30 expression, regardless of LCT status. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT01578499.
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Affiliation(s)
- Youn H Kim
- Dermatology and Medicine, Stanford University School of Medicine and Cancer Institute, 780 Welch Road, CJ220D, 94305, Stanford, CA, USA.
| | - H Miles Prince
- Department of Haematology, University of Melbourne, 140 Clarendon Street, 3002, East Melbourne, Australia.
| | - Sean Whittaker
- St Johns Institute of Dermatology, Guys and St Thomas NHS Foundation Trust, St Thomas Street, SE1 7EL, London, UK.
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, NY, USA.
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1452, 77030, Houston, TX, USA.
| | - Oliver Bechter
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Jose A Sanches
- Department of Dermatology, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar 255, S. 3068, 05403-000, São Paulo, Brazil.
| | - Rudolf Stadler
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Hans-Nolte-Str. 1, D-32429, Minden, Germany.
| | - Julia Scarisbrick
- Department of Dermatology, Cutaneous Lymphoma Service, University Hospital Birmingham, Mindelsohn Way, B15 2TH, Birmingham, UK.
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Via Cherasco 23, 10126, Turin, Italy.
| | - Pier Luigi Zinzani
- Institute of Hematology 'Seràgnoli', University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Pascal Wolter
- Department of Internal Medicine/Medical Oncology, Klinik St. Josef, St Vith, Klosterstrasse 9, 4780, St Vith, Belgium.
| | - Herbert Eradat
- Department of Hematology-Oncology, David Geffen School of Medicine at UCLA, 2020 Santa Monica Blvd Suite 600, 90404, Los Angeles, CA, USA.
| | - Lauren C Pinter-Brown
- Internal Medicine, Division of Hematology-Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive, 92868, Irvine, CA, USA.
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre. Institute I+12. Medical School. University Complutense, Av Córdoba s/n, 28041, Madrid, Spain.
| | - Oleg E Akilov
- Department of Dermatology, University of Pittsburgh, 200 Lothrop Street, 15213, Pittsburgh, PA, USA.
| | - Judith Trotman
- Department of Hematology, Concord Repatriation General Hospital, University of Sydney, Hospital Road, 2139, Concord, Sydney, Australia.
| | - Kerry Taylor
- Department of Hematology, ICON Cancer Care, 293 Vulture Street, 4101, South Brisbane, Australia.
| | - Michael Weichenthal
- Department of Dermatology, University Hospital of Schleswig-Holstein, Arnold Heller Str.3, 24105, Kiel, Germany.
| | - Jan Walewski
- Department of Lymphoid Malignancies, Maria Sklodowska-Curie National Research Institute of Oncology, 5 W. K. Roentgen, 02-781, Warsaw, Poland.
| | - David Fisher
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, 02215, Boston, MA, USA.
| | - Marise McNeeley
- Department of Anatomic Pathology for Clinical Trials, Quest Diagnostics, 1 Malcolm Avenue, 07608, Teterboro, NJ, USA.
| | - Alejandro A Gru
- Department of Pathology, University of Virginia, School of Medicine, 2730 Hunt Country Ln, 22901, Charlottesville, VA, USA.
| | - Lisa Brown
- Seagen Inc, 21823 30th Drive Southeast, 98021, Bothell, WA, USA.
| | | | - Julie Lisano
- Seagen Inc, 21823 30th Drive Southeast, 98021, Bothell, WA, USA.
| | - Matthew Onsum
- Seagen Inc, 21823 30th Drive Southeast, 98021, Bothell, WA, USA.
| | - Veronica Bunn
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, 40 Landsdowne Street, 02139, Cambridge, MA, USA.
| | - Meredith Little
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, 40 Landsdowne Street, 02139, Cambridge, MA, USA.
| | - William L Trepicchio
- Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, 40 Landsdowne Street, 02139, Cambridge, MA, USA.
| | - Reinhard Dummer
- Department of Dermatology, Skin Cancer Center, University Hospital Zürich, Gloriastrasse 31, 8091, Zürich, Switzerland.
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Hong EH, Jang YJ, Cho EB, Park EJ, Kim KJ, Kim KH. A Rare Case of Cutaneous T-Cell Lymphoma Accompanied by Acute Monoblastic Leukemia and Diffuse Large B-Cell Lymphoma. Ann Dermatol 2021; 33:178-181. [PMID: 33935460 PMCID: PMC8082011 DOI: 10.5021/ad.2021.33.2.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 12/05/2022] Open
Abstract
A 70-year-old female was referred for brown-to-gray colored papules and nodules on her lower legs. She had been diagnosed with diffuse large B-cell lymphoma (DLBCL) in her stomach, and myelodysplastic syndrome (MDS) by bone marrow biopsy. Three years after complete remission of DLBCL, she experienced DLBCL recurrence in her small bowel and was hospitalized. MDS had been stationary, but during the treatment of DLBCL, her laboratory findings suggested signs of leukemia. Bone marrow biopsy was done, and acute monoblastic leukemia (AMoL) was diagnosed. After 1 cycle of chemotherapy for AMoL, skin lesions developed, and her skin biopsy showed cutaneous T-cell lymphoma (CTCL). Terminal deoxynucleotidyl transferase staining and CD123 staining were negative, and bone marrow re-biopsy conducted after the skin lesion developed still showed monoblastic proliferation. Whether the CTCL represented with an AMoL lineage switch could not be completely proved due to the absence of molecular or clonal marker evaluations, but the possibility of coexistence of three different malignancies was higher. During treatment, a neutropenic fever developed, and the patient died due to sepsis. We herein report a rare case of CTCL accompanied by AmoL and DLBCL.
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Affiliation(s)
- Eun Hye Hong
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ye Ji Jang
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Byul Cho
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
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