[Translated article] Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years

BACKGROUND AND OBJECTIVE

Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years.

PATIENTS AND METHODS

RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years.

RESULTS

Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30⁺ lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]).

CONCLUSION

The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years

BACKGROUND AND OBJECTIVE

Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years.

PATIENTS AND METHODS

RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years.

RESULTS

Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]).

CONCLUSION

The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

FRI0244 EOSINOPHILIC FASCIITIS-LIKE SECONDARY TO CHRONIC GRAFT-VERSUS-HOST DISEASE: CLINICAL DESCRIPTION OF 28 PATIENTS

Background:

Eosinophilic fasciitis (EF) is an uncommon chronic inflammatory disease characterized by myalgia, soft tissue hardening, peripheral eosinophilia and increased acute phase reactants, often triggered after strenuous physical exercise. Its appearance has been described as a rare complication after allogeneic transplantation of hematopoietic progenitors in the context of chronic graft-versus-host disease (cGVHD). Its etiopathogenesis is not well known and usually the treatment with systemic corticosteroids is effective

Objectives:

Describe the clinical and transplant-related characteristics of a cohort of patients with eosinophilic fasciitis-like in the context of cGVHD

Methods:

Observational, retrospective and descriptive study of the clinical characteristics of 28 patients affected by EF-like followed in a multidisciplinary consultation of cGVHD, started in March, 2014. Regular demographic variables, clinical characteristics related to the transplant and with the cGVHD, laboratory parameters, rescue therapies and their response were collected. The statistical analysis was done with Microsoft Excel 2007.

Results:

Seventeen (60.7%) patients were male and 11 (39.35%) were women with a mean age of 48.75 years (range from 10 to 74). Acute myeloid leukemia was the most frequent cause of the transplant in 11 patients (39.3%). Transplant related characteristics are reflected in Table 1 and the clinical manifestations, therapies received and their response in Table 2. Four (14.2%) patients died during their follow-up, being the cause of death in 2 cases due to sepsis, and in 1 case attributable to GVHD.

Table 1.

Baseline and transplant related characteristics (N = 28).

.VariablesN (%)Donor Type (related / not related)13(46.4%)/15(53.6%)Type of conditioning (reduced intensity / myeloablative)18(64.25%)/10(35.7%)Source of cells (Peripheral blood / bone marrow)27(96.4%/1(3.6%)cGVHD type quiescent / de novo / progressive11(39.3%)/13(46.4%)/4(14.3%)Other affected organs (cGVHD score)-Mouth6(21.4%)-Eyes10(35.7%)-Lung2(7.1%)-Liver3(10.7%)-Gastrointestinal tract0(0%)-Genital2(7.1%)-Cutaneous16(57.14%)Global ScoreNIH1(mild / moderate / severe)4(14.2%)/14(50%)/10(35.7%)

1NIH: National Institute of Health.

Table 2.

Clinical manifestations and therapies (N = 28).

.VariablesN (%)/Median (range)Prodromic symptoms: yes / no20(71%)/8(29%)- Stiffness2(7.1%)- Artromyalgia17(60.7%)- Edema3(10.7%)Time until first visit31.3 months (range 9-73)Contracture Yes / No18(64.3%)/10(35.7%)Mobility limitation (mild / moderate)13(46.4%)/9(32.1%)ECOG1affected11(39.2%)Eosinophilia17(60.7%)Positive autoantibodies8(28.5%)First line therapies (corticosteroids)28(100%)Extracorporeal photoapheresis19(67.9%)Therapies of 2nd line/ 3rd or more6(21.4%)/12 (42.8%)Physiotherapy14 (50%)Response: complete / sequels10(35.7%)/18(64.2%)

1ECOG: Eastern Cooperative Oncology Group scale to assess the quality of life

Conclusion:

Nonspecific joint symptoms such as stiffness, edema or arthromyalgia in patients undergoing allogeneic transplantation of hematopoietic progenitors may be factors that predict the development of sclerotic GVHD type eosinophilic fasciitis-like and should be closely monitored in order to be able to perform early stage diagnoses of the disease. It is necessary to deepen the pathogenesis of this entity and the multidisciplinary approach to improve the prognosis of patients with GVHD

References:

[1]Inamoto Y. Arthritis Rheumatol. 2014;66(4):1044–52.

Disclosure of Interests:

None declared

THU0347 CLINICAL DESCRIPTION OF A COHORT OF PATIENTS WITH SCLEROTIC-TYPE CHRONIC GRAFT-VERSUS-HOST DISEASE TREATED IN A MULTIDISCIPLINARY PRACTICE

Background:

Graft versus host disease is the most frequent complication after allogeneic transplantation of hematopoietic progenitors. Its chronic form usually involves a multisystemic syndrome that reflects a complex immune response with varying degrees of inflammation, immune dysregulation and fibrosis, responsible for the characteristic clinical manifestations of the disease. Joint, muscular and fascial involvement represents one of the areas, often unnoticed or poorly evaluated, that negatively impacts the physical function and quality of life of these patients.

Objectives:

Describe the presence of musculoskeletal manifestations and their clinical characteristics in patients with chronic GVHD (cGVHD) evaluated in a multidisciplinary consultation

Methods:

Descriptive and retrospective observational study to detail the initial presence and during the follow-up of diagnostic and nonspecific musculoskeletal manifestations of cGVHD in a cohort of 103 patients included in the database. The clinical characteristics of 68 patients with a defined diagnosis of sclerotic cGVHD are described. Demographic variables are collected along with clinical conditions about transplant and in a systematic way the assessment according to diagnostic criteria of the American National Institute of Health 2015 highlighting: range of motion scale and photographic range of motion (P-ROM) scale in shoulders, elbows, hands and ankles; and laboratory data: presence of eosinophilia and autoantibodies. Descriptive and frequency statistical analysis was done using Microsoft Office Excel 2007.

Results:

Sixty-eight(66%)patients meet diagnostic criteria for sclerotic cGVHD during follow-up. Forty-five(66.2%) women and 23(33.8%) men, with a mean age of 54.5 years (range 10-78), Acute myeloid leukemia was the reason for transplant in 20(29, 4%) followed by non-Hodgkin lymphoma in 15 (16.2%). In 40(58.7%) patients it was performed from a related donor and with reduced intensity conditioning in 43(63.2%). Only in one patient the source of hematopoietic progenitors was bone marrow (rest peripheral blood). The average time from transplant to the first visit was 29.5 months (range 4 -168). Twelve(17.64%) patients presented isolated joint/fascial involvement without objective skin involvement (Table 1)

Table 1.

Clinical features of the sclerotic joint/fascial chronic GVHD cohort (N= 68)

Unspecific musculoskeletal symptoms:46 (67.6%)-Artromyalgia39(57.3%)-Edema13(19%)-Stiffness 4(5.8%)Fasciitis/contractures28(41.2%)/43(63,2%)Restricted ROM1-Mild/Moderate/Severe34(50%)/14(20.2%)/4(5.8%)Impaired mobility-Shoulders26(38.2%)-Elbows21(30.8%)-Wrist/fingers29(42.6%)-Ankles21(30.6%)Sclerodermatous involvement-Superficial /deep 6(8.8%)/7(10.3%)-Mixed (sclerodermiform + lichenoid)20(29.4%)-Overlapping skin sclerosis13(19.2)NIH1Global Score-Mild/Moderate/Severe25(36.7%)/7(10.3%)/1(1.5%)Eosinophilia21 (30.8%)Autoantibodies14 (20.6%)

1ROM (range of motion)2NIH: National Institute of Health

Conclusion:

Joint involvement secondary to sclerosis is very common in our cohort, mainly of the dorsal wrist flexion with deleterious repercussion on physical function. It needs to be recognized and evaluated early with validated scales. The search for new biomarkers associated with fibrosis, the use of advanced imaging techniques and the multidisciplinary approach can help improve the prognosis of patients with cGVHD.

References:

[1]Jagasia MH,Blood Marrow Transplant. 2015;21(3):389–40

Disclosure of Interests:

None declared

Prognostic factors in patients with primary cutaneous anaplastic large cell lymphoma: a multicentric, retrospective analysis of the Spanish Group of Cutaneous Lymphoma

BACKGROUND

Reliable prognostic factors for patients with primary cutaneous anaplastic large cell lymphoma (PCALCL) are lacking.

OBJECTIVE

To identify prognostic factors for specific survival in patients with PCALCL.

METHODS

Using the convenience sampling method, patients with PCALCL diagnosed from May 1986 to August 2017 in 16 University Departments were retrospectively reviewed.

RESULTS

One hundred eight patients were included (57 males). Median age at diagnosis was 58 years. All of them showed T1-3N0M0 stages. Seventy per cent of the cases presented with a solitary lesion, mostly at the limbs. Complete response rate after first-line treatment was 87%, and no advantage was observed for any of them (surgery, radiotherapy, chemotherapy or other approaches). Nodal and visceral progression rate was 11% and 2%, respectively. 5-year specific survival (SSV) reached 93%; 97% for T1 patients and 84% for T2/T3 patients (P = 0.031). Five-year SSV for patients developing early cutaneous relapse was 64%; for those with late or no relapse, 96% (P = 0.001). Estimated median SSV for patients showing nodal progression was 103 months (95% CI: 51-155 months); for patients without nodal progression, estimated SSV did not reach the median (P < 0.001). Nodal progression was an independent predictive parameter for shorter survival (P = 0.011).

CONCLUSION

Multiple cutaneous lesions at presentation, early skin relapse and nodal progression portrait worse prognosis in patients with PCALCL.

A major fish stranding caused by a natural hypoxic event in a shallow bay of the eastern South Pacific Ocean

A massive beaching and mortality of fishes occurred in Coliumo Bay, a shallow bay located along the coast of the eastern South Pacific Ocean on 3 January 2008. This stranding was a consequence of an abrupt decrease in the dissolved oxygen concentration throughout the whole water column, due to the effect of intense upwelling along the coast off central-southern Chile. The main objectives of this study were: (1) to characterize taxonomically and biologically the fish species assemblage present in this beaching; (2) to evaluate several physiological indicators for the condition of the beached species at the time of their death; and (3) to assess the possible cause-effect mechanisms involved in the fishes death and the changes that took place in the fish community throughout the time. In this beaching, 26 fish species were identified: 23 teleosts, one myxiniform and two elasmobranchs. Most beached specimens were juveniles. Haematological and histological evidence indicate that severe hypoxia that lasted for at least 48 h was the most plausible cause of death. The main conclusion of this study is that the presence of oxygen-poor equatorial sub-surface water in the shallow coastal zone due to intense regional-scale upwelling caused the fish stranding. Although the effect of the hypoxic event was severe for the fish assemblage of Coliumo Bay, the rapid recuperation observed suggests that hypoxic events at the local spatial scale can be buffered by migration processes from the fish community inhabiting close by areas non-affected by low oxygen conditions. The effect that severe hypoxic events may have on larger spatial scales remains unknown.

Impact of education, income and chronic disease risk factors on mortality of adults: does 'a pauper-rich paradox' exist in Latin American societies?

OBJECTIVES

To test the hypothesis that an inverse association exists between socio-economic position and all-cause mortality in a developing country in Latin America.

STUDY DESIGN

Prospective cohort study carried out in Chile using data from a simple random sample of 920 apparently healthy subjects (weighted population 11,600 aged 30-89 years) followed for 8 years.

METHODS

Education level (0-8 years, 9-12 years and > or = 13 years) and income quartiles were established at the outset of the study, along with behavioural and biological risk factors for chronic diseases: smoking, alcohol use, obesity, diabetes, hypertension, lipids and family history of death by cardiovascular disease. Relative risks of all-cause mortality were estimated using age-adjusted Cox regression models.

RESULTS

During the follow-up period, 46 deaths were observed. Adjusting for age, gender, and behavioural and biological risk factors, the mortality risk for increasing categories of education after controlling for income was 1.0, 0.76 and 0.33 (P for trend<0.01). In contrast, the relative risk for increasing levels of income after controlling for education was 1.0, 0.98, 1.33 and 1.17 (P for trend=0.07).

CONCLUSION

While education level had a protective effect on mortality risk of Chilean adults, income had a slightly unfavourable effect on survival. This finding is described as suggestive of a 'pauper-rich paradox', since the higher income quantiles in this study correspond with the lower income levels in most developed countries. Nevertheless, due to the small number of deaths, additional research is required to assess the validity of these findings.

Primary cutaneous T-cell lymphoproliferative disorder of donor origin after allogeneic haematopoietic stem-cell transplantation

A 56-year-old male patient had a history of mantle-cell lymphoma, which was treated with polychemotherapy and reduced-intensity conditioning allogeneic haematopoietic stem cell transplantation (ASCT) from his healthy sister with an identical human leucocyte antigen profile. Six years after transplantation, the patient developed asymptomatic eczema-like cutaneous lesions. Histologically the lesions contained a dense superficial lichenoid infiltrate, mainly consisting of CD4+ atypical medium to large lymphocytes showing indented hyperchromatic nuclei. In situ hybridization for Epstein-Barr virus was negative. PCR amplification of the T-cell receptor-gamma chain gene from several lesions revealed a monoclonal rearrangement without clonal variation. Two-colour fluorescence in situ hybridization (X and Y chromosomes) and microsatellite genotyping were used to compare samples from the patient (transplant recipient), his sister (donor) and the skin biopsy sample, which confirmed that the origin of the neoplastic cells was the donor graft. To our knowledge, this is the first case of post-transplant primary cutaneous T-cell lymphoproliferative disorder after ASCT.

Impact of parity on anthropometric measures of obesity controlling by multiple confounders: a cross-sectional study in Chilean women

AIM

To find out whether there is an association between parity and obesity, evaluated through body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in Chilean women after controlling for sociodemographic characteristics, health risk and gynaeco-obstetric factors.

DESIGN

Cross-sectional study, using baseline data of the San Francisco Project.

SETTING

San Francisco de Mostazal, located in the central region of Chile, 6512 Chilean-Hispanic women (Spanish heritage with a variable indigenous component).

METHODS

A weighted random sample of 508 women who had their first pregnancy inside the primary child-bearing ages. Data were collected between 1997 and 1999. Statistical associations between parity and different anthropometric measurements of adiposity in multiple linear (MLnR) and logistic regression models (MLtR) were evaluated.

RESULTS

In MLnR a modest parity-related increment in BMI and practically null increment in WC, WHR and WHtR was observed. Covariates that showed a statistically significant association with anthropometric measures of adiposity were age, low education, marital status, employment, smoking, smoking cessation, hypertension, diabetes, dyslipidaemia, parent's obesity, menarche and fetal macrosomia. Crude odds ratio (OR) showed a strong association between parity and anthropometric markers of obesity. Nevertheless, after adjustments in MLtR models, the association remained only for BMI. All the measures of abdominal obesity related to parous women showed OR smaller than 1 (95% confidence intervals 0.57 to 0.96).

CONCLUSIONS

Parity modestly influences BMI, but does not seem to be related to WC, WHR and WHtR after controlling by confounders. Parity can increase adiposity but not necessarily following an abdominal pattern.

Cutaneous lymphadenoma: an adnexal neoplasm with intralobular activated lymphoid cells

Cutaneous lymphadenoma is an uncommon epithelial neoplasm with a controverted adnexal differentiation. We report a typical case of cutaneous lymphadenoma that developed on the left cheek of a 18-year-old woman. Histologically, the neoplasm consisted of lobules of basaloid cells with a peripheral palisading array and filled with a lymphocyte-predmoninant mixed cellular population. Numerous intralobular cells with ample amphopilic cytoplasm, large vesicular nuclei, and prominent nucleoli also were noticed. Immunohistochemical study showed labeling of these Reed-Sternberg-like large cells by antibodies against CD30 antigen. Our findings suggest that cutaneous lymphadenoma is a poorly differentiated adnexal neoplasm, probably trichoblastoma-related, where a singular interaction with several immune cells is established, including activated large lymphocytes analogous to those malignantly proliferating in Hodgkin's disease.

Verrucous plaque on the back of a hand

We report the case of a 44-year-old slaughter-house operator with a skin lesion that had been present for two years on the back of his left hand. The lesion had increased progressively in size despite numerous topical treatments. Physical examination revealed an infiltrated erythematous-violet plaque with a verrucous surface featuring numerous orifices draining purulent material. Histologic study of the lesion disclosed tuberculoid granulomatous infiltrates at the dermoepidermal limit. Presence of Mycobacterium tuberculosis, together with other epidemiologic, clinical, histologic, and immunologic data, permitted a diagnosis of tuberculosis verrucosa cutis to be made. The excellent response of the patient to treatment confirmed this hypothesis. However, polychemotherapy withdrawal was temporarily needed due to analytical abnormalities.