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Foss F, Kim YH, Scarisbrick J, Akilov O, Ristuccia R, Dwyer K, Wu W, Bagot M. Insights into treatment of patients with mycosis fungoides or Sézary syndrome using mogamulizumab. J DERMATOL TREAT 2025; 36:2438794. [PMID: 39894454 DOI: 10.1080/09546634.2024.2438794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 11/29/2024] [Indexed: 02/04/2025]
Abstract
PURPOSE Mogamulizumab demonstrated improved outcomes vs. vorinostat across a range of disease and patient characteristics in patients with mycosis fungoides or Sézary syndrome in the MAVORIC trial. MATERIALS AND METHODS This post-hoc analysis further examined MAVORIC data to assess factors associated with long-term response (ORR >12 months), time to next treatment (TTNT), and impact of concomitant steroid use, lymphopenia, and mogamulizumab-associated rash (MAR) on patient response. RESULTS A higher proportion of patients achieved ORR lasting ≥4, 6, 8, or 12 months in the mogamulizumab vs. vorinostat arm. Long-term response was also observed in mogamulizumab-treated patients with more advanced disease (stage IVA1 [17/20], B2 blood involvement [18/20], and SS [14/20]). PFS was significantly longer (9.4 vs. 3.1 months; p < 0.0001) in mogamulizumab vs. vorinostat-treated patients taking concomitant steroids. Mogamulizumab-treated patients experienced longer TTNT vs. vorinostat. Lymphopenia and MAR were associated with response to mogamulizumab. CONCLUSIONS MAVORIC demonstrated greater efficacy with mogamulizumab vs. vorinostat in relapsed/refractory patients with CTCL, including those with more advanced disease. Concomitant steroid use improved ORR and PFS but did not impact vorinostat outcomes. Overall responses occurred more frequently in mogamulizumab-treated patients that developed lymphopenia than those that did not. A higher percentage of patients with MAR had an overall response than those without MAR.
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Affiliation(s)
- Francine Foss
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Julia Scarisbrick
- Institute of Immunology and Immunotherapy, University Hospitals Birmingham, University of Birmingham, Birmingham, UK
| | - Oleg Akilov
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Wende Wu
- Kyowa Kirin, Inc., Princeton, NJ, USA
| | - Martine Bagot
- Hôpital Saint Louis, APHP, Inserm U976, Université Paris Cité, Paris, France
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van der Weyden C, Bressel M, Khot A, Prince HM, Dickinson M. Assessment of the Tolerability and Optimal Dosing of the Combination of Brentuximab Vedotin and Lenalidomide in Patients With Relapsed or Refractory T-cell Lymphoma: Results of a Single-centre Phase 1 Dose-escalation Study. EJHAEM 2025; 6:e70033. [PMID: 40364805 PMCID: PMC12070942 DOI: 10.1002/jha2.70033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 03/02/2025] [Accepted: 03/05/2025] [Indexed: 05/15/2025]
Abstract
Objective We report the results of a pilot study investigating the combination of brentuximab vedotin (BV) and lenalidomide in patients with relapsed/ refractory T-cell lymphoma. Methods A dose escalation study design was utilized. Primary and secondary endpoints included maximum tolerated dose (MTD), adverse events, and response rates. Results Six patients were treated with BV and two dose levels of lenalidomide, in 21-day cycles. The protocol-determined MTD was BV 1.8 mg/kg and lenalidomide 25 mg, however, all patients required subsequent dose reductions with ongoing treatment. The most common adverse event was peripheral neuropathy in four of six patients. Two patients achieved complete responses and three achieved partial responses. Discussion The combination is deliverable with dose attenuation. Further study is needed to define clinical benefit. Clinical Trial Registration This trial was registered on ClinicalTrials.gov (NCT number 03302728).
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Affiliation(s)
- Carrie van der Weyden
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleAustralia
| | - Mathias Bressel
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleAustralia
- Department of Biostatistics and Clinical TrialsPeter MacCallum Cancer CentreMelbourneAustralia
| | - Amit Khot
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleAustralia
| | - Henry Miles Prince
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleAustralia
| | - Michael Dickinson
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneParkvilleAustralia
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Kersten JM, Ottevanger R, Doeleman T, Valkema PA, Schrader AMR, Jansen PM, Vermeer MH, Willemze R. Histopathologic Evaluation of Density and Depth of the Lymphoid Infiltrate in Clinically Defined Patches and Plaques in Early Stage Mycosis Fungoides. J Cutan Pathol 2025; 52:406-409. [PMID: 40197624 PMCID: PMC12061629 DOI: 10.1111/cup.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 02/14/2025] [Accepted: 03/30/2025] [Indexed: 04/10/2025]
Affiliation(s)
- Juliette M. Kersten
- Department of DermatologyLeiden University Medical CenterLeidenthe Netherlands
| | - Rosanne Ottevanger
- Department of DermatologyLeiden University Medical CenterLeidenthe Netherlands
| | - Thom Doeleman
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Pieter A. Valkema
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Anne M. R. Schrader
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Patty M. Jansen
- Department of PathologyLeiden University Medical CenterLeidenthe Netherlands
| | - Maarten H. Vermeer
- Department of DermatologyLeiden University Medical CenterLeidenthe Netherlands
| | - Rein Willemze
- Department of DermatologyLeiden University Medical CenterLeidenthe Netherlands
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Liu L, Zhang X. A comprehensive update of extracutaneous involvement of mycosis fungoides: A narrative review of literature. Medicine (Baltimore) 2025; 104:e42279. [PMID: 40355202 PMCID: PMC12074150 DOI: 10.1097/md.0000000000042279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 04/11/2025] [Indexed: 05/14/2025] Open
Abstract
Mycosis fungoides, the most prevalent subtype of cutaneous T-cell lymphoma, primarily targets areas of the skin that of not exposed to sunlight. Nevertheless, it can involve extracutaneous tissues at any disease stage, especially during its advanced phases. Research suggests that all extracutaneous organs might be susceptible, though such cases are more commonly reported in autopsy studies and less so in clinical setting. The most recent comprehensive review of such extracutaneous manifestations in mycosis fungoides occurred almost a decade ago. With the aim of enhancing clinicians' understanding of these extracutaneous manifestations to improve diagnostic accuracy and patient outcomes, this updated review provides a current synthesis of the rare instances of extracutaneous involvement in mycosis fungoides.
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Affiliation(s)
- Lingxi Liu
- Department of Dermatology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaoyan Zhang
- Department of Dermatology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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5
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Nguyen AJ, Link JL, Johnson EF, Todd A, Lehman JS, Comfere NI, Sokumbi O. Assessing the utility of incorporation of clinical and histopathologic features for risk stratification in plaque-stage folliculotropic mycosis fungoides: A retrospective validation study. J Am Acad Dermatol 2025:S0190-9622(25)00698-X. [PMID: 40334919 DOI: 10.1016/j.jaad.2025.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2024] [Revised: 04/23/2025] [Accepted: 04/30/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND A recently proposed staging system for folliculotropic mycosis fungoides (FMF) used clinical and histopathologic data to define 2 prognostic classes (ie early, advanced) for plaque-stage disease. OBJECTIVE In this external retrospective single-center cohort, we assessed the prognostic ability of the proposed re-classification system and high-risk histopathologic features overall. METHODS Patients with FMF were staged clinically. Skin biopsy specimens were reviewed for high-risk features. Patients with plaque-stage FMF were subcategorized as having early or advanced disease. RESULTS Of 81 patients with FMF (early-stage, n = 43; advanced-stage, n = 38), 40 had plaque-stage FMF (early plaque-stage, n = 24; advanced plaque-stage, n = 16). There was no difference in overall survival between early and advanced plaque-stage FMF. Of all cases, univariate analysis revealed associations between angioinvasion/angiodestruction and overall survival (hazard ratio, 6.04; 95% CI, 1.88-19.42; P = .003) and disease-specific survival (hazard ratio, 7.17; 95% CI, 1.76-29.33; P = .006), and between large cell transformation and disease-specific survival (hazard ratio, 4.91; 95% CI, 1.47-16.35; P = .010). LIMITATIONS Few disease-specific deaths in the plaque-stage subgroup precluded analysis of disease-specific survival. CONCLUSION In this cohort, addition of histopathologic data to subdivide plaque-stage FMF into early and advanced groups added no prognostic value. However, certain histopathologic features including angioinvasion/angiodestruction and large-cell transformation did offer prognostic power overall.
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Affiliation(s)
- Amanda J Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jenny L Link
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Emma F Johnson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Austin Todd
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Nneka I Comfere
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida.
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Kravitz D, Joffe E, Abraham A. Sonographic Demonstration of Myopathy in Mycosis Fungoides. JAMA Neurol 2025; 82:520-521. [PMID: 40126497 DOI: 10.1001/jamaneurol.2025.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2025]
Abstract
This case report describes a diagnosis of muscle infiltration of mycosis fungoides in a female aged 36 years with initial disease manifesting as pigmented skin patches.
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Affiliation(s)
- David Kravitz
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Erel Joffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Hematology and Cellular Therapy, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alon Abraham
- Neuromuscular Diseases Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Goodlad JR. Updated Classification of Cutaneous Lymphoma. Adv Anat Pathol 2025; 32:239-255. [PMID: 40066774 DOI: 10.1097/pap.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
The International Consensus Classification (ICC) of myeloid and lymphoid neoplasms follows the precedent set in the Revised European-American lymphoma classification for modern lymphoma classifications by defining specific diseases on the basis of all the available morphologic, immunophenotypic, genetic, and clinical findings. Primary cutaneous lymphomas exhibit a broad range of clinical behavior ranging from lesions which spontaneously regress to those which run an aggressive, often fatal course. Accurate separation of entities is therefore essential for prognostication and to ensure appropriate treatment is administered. However, despite marked differences in clinical course, many subtypes of primary cutaneous lymphoma exhibit remarkably similar, often overlapping, and sometimes indistinguishable pathologic features. While molecular analysis has furthered our understanding of some of these disease entities, it does not yet facilitate robust distinction. Thus, clinical correlation retains a central role in both the diagnosis and classification of primary cutaneous lymphoma. This review aims to draw attention to problem areas in differential diagnosis and hopefully offer some practical suggestions for resolving difficult cases. It will also highlight recent advances in the field and discuss how they reinforce the current classification system and how they might impact of future classifications and treatment strategies.
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Affiliation(s)
- John R Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Glasgow, Scotland
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Zengarini C, Tugnoli F, Natale A, Mussi M, Clarizio G, Agostinelli C, Sabattini E, Corrà A, Piraccini BM, Pileri A. Dermatoscopic Patterns in Mycosis Fungoides: Observations from a Case-Series Retrospective Analysis and a Review of the Literature. Diagnostics (Basel) 2025; 15:1136. [PMID: 40361954 PMCID: PMC12072082 DOI: 10.3390/diagnostics15091136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Revised: 04/02/2025] [Accepted: 04/21/2025] [Indexed: 05/15/2025] Open
Abstract
Background: Dermoscopy, a non-invasive diagnostic technique, is being increasingly used to evaluate cutaneous T-cell lymphomas such as mycosis fungoides (MF) and Sézary syndrome (SS). However, its diagnostic accuracy and role in staging remain underexplored. Objective: This study aimed to assess the dermoscopic patterns in MF and SS, correlating the findings with the disease stage and lesion type to evaluate dermoscopy's diagnostic utility. Methods: A retrospective, monocentric analysis was conducted on patients with histologically confirmed MF or SS. Dermoscopic images were evaluated for vascular patterns, pigmentation, scaling, and keratin plugs. The statistical analysis assessed the correlations between these dermoscopic features and the TNMB staging and lesion type. A literature review was also performed to contextualize the findings, focusing on studies describing dermoscopic features in MF based on retrospective, prospective, and cross-sectional data. Results: The study included 30 patients with histologically confirmed MF or SS (19 males and 11 females; mean age: 64.5 years). The dermoscopic evaluation revealed that all the lesions were pigment-free, with vascular structures as the predominant feature. Linear vessels (40%) and serpentine vessels (13.3%) were the most frequently observed, along with dotted vessels (36.7%) and clods (10%). The vessel distribution was diffuse (40%) or perifollicular (36.7%), with a predominant red (56.7%) or orange (40%) background. Scaling was present in 76.7% of cases, either diffuse (40%) or perifollicular (36.7%), and keratin plugs were detected in 40% of the lesions. No statistically significant correlations were found between dermoscopic features and the TNMB stage or lesion type (p > 0.05). A cluster analysis identified two patient groups with differing vascular and scaling features but no clear association with disease stage. The literature review identified studies that commonly reported features in MF dermoscopy, including fine, short linear vessels and an orange-yellow background, particularly in early-stage MF. Spermatozoa-like structures have been marked as highly specific for diagnosing MF. Some studies also suggested a transition in vascular morphology from linear vessels in early disease to branched vessels and ulceration in advanced stages. Conclusions: Our results showed some vascular patterns have some potential but lack sensitivity for staging MF and SS. The terminology used and the reproducibility of our results compared to those reported in the literature showed little consistency, with none of our cases showing spermatozoa-like structures. Moreover, the same issues with the use of non-reproducible terminology were noted across the studies because it is not standardized and due to different incongruent dermoscopic patterns. More significant prospective studies with standardized descriptors and larger groups are needed to refine its diagnostic and staging utility.
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Affiliation(s)
- Corrado Zengarini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Tugnoli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
| | - Alessio Natale
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Martina Mussi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giacomo Clarizio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Claudio Agostinelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Elena Sabattini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alberto Corrà
- Dermatology Unit, Ospedale San Bartolo, 36100 Vicenza, Italy
| | - Bianca Maria Piraccini
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro Pileri
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy (A.P.)
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Goyal A, O'Leary D, Dabaja B, Weng WK, Zain J, Cutler C, Guitart J, Kim YH, Geskin LJ, Hoppe RT, Wilson LD, Beaven AW, Horwitz S, Allen PB, Barta SK, Bohjanen K, Brammer JE, Carter JB, Comfere N, DeSimone JA, Dusenbery K, Duvic M, Huen A, Jagadeesh D, Kelsey CR, Khodadoust MS, Lechowicz MJ, Mehta-Shah N, Moskowitz AJ, Olsen EA, Poh C, Pro B, Querfeld C, Sauter C, Sokol L, Sokumbi O, Wilcox RA, Zic JA, Gru A, Hamadani M, Foss F. ASTCT and USCLC clinical practice recommendations for allogeneic stem cell transplant in mycosis fungoides and Sézary syndrome. J Am Acad Dermatol 2025:S0190-9622(25)00594-8. [PMID: 40199382 DOI: 10.1016/j.jaad.2025.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 03/30/2025] [Accepted: 04/02/2025] [Indexed: 04/10/2025]
Abstract
INTRODUCTION Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma. While MF generally follows an indolent course, a subset of patients will experience progressive and/or treatment-refractory disease. SS is an aggressive cutaneous T-cell lymphoma associated with high morbidity and mortality secondary to immune compromise and opportunistic infection. Although allogeneic hematopoietic cell transplant (allo-HCT) is currently the only available potentially curative treatment modality for MF/SS and is included in the National Comprehensive Cancer Network and the American Society for Transplantation and Cellular Therapy treatment guidelines, there is no published guidance regarding referral criteria, timing and allo-HCT approach to help guide clinicians caring for these patients. METHODS Delphi survey of 32 specialists in dermatology (n = 9), transplant hematology/oncology (n = 10), nontransplant hematology/oncology (n = 8), and radiation oncology (n = 5) from across the United States. Consensus required agreement of ≥75% of participants. RESULTS Sixteen consensus statements were generated on 4 topics: 1) criteria for referral for consideration for allo-HCT, 2) allo-HCT preparative regimens and procedures, 3) disease status at the time of allo-HCT, and 4) multidisciplinary management in the pre- and post-transplant settings. CONCLUSION These clinical practice guidelines provide a framework for decision-making regarding allo-HCT for MF/SS and highlight areas for future prospective investigation.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
| | - Daniel O'Leary
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Bouthaina Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen-Kai Weng
- Blood and Marrow Transplantation, and Cellular Therapy, Department of Medicine, Stanford University, Stanford, California
| | - Jasmine Zain
- Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Corey Cutler
- Division of Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joan Guitart
- Department of Dermatology, Northwestern Feinberg School of Medicine, Evanston, Illinois
| | - Youn H Kim
- Division of Oncology, Departments of Dermatology and Medicine, Stanford University, Stanford, California
| | - Larisa J Geskin
- Department of Dermatology, Columbia University, New York, New York
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Anne W Beaven
- Division of Hematology, University of North Carolina, Chapel Hill, North Carolina
| | - Steve Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela B Allen
- Department of Hematology & Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia
| | - Stefan K Barta
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly Bohjanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan E Brammer
- Division of Hematology, Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Joi B Carter
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nneka Comfere
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer A DeSimone
- Department of Dermatology, University of Virginia Schar Cancer Institute, Fairfax, Virginia
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auris Huen
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Michael S Khodadoust
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Neha Mehta-Shah
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Alison J Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elise A Olsen
- Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christina Poh
- Division of Hematology and Oncology, University of Washington, Seattle, Washington
| | - Barbara Pro
- Department of Hematology and Oncology, New York Presbyterian - Columbia University Irving Medical Center, New York, New York
| | - Christiane Querfeld
- Division of Dermatology, Department of Pathology, Beckman Research Institute, City of Hope National Medical Center, Duarte, California
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Lubomir Sokol
- Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, Florida
| | - Ryan A Wilcox
- Division of Internal Medicine, Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - John A Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alejandro Gru
- Department of Dermatology, Columbia University, New York, New York
| | - Mehdi Hamadani
- Division of Hematology & Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
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10
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Almoqati M, Althobaiti R, Zafer D, Alabbadi AS, Alluhaibi R, Al Hawsawi K. Lichen Planus Initially Presenting as Poikiloderma: A Challenging Case Report. Cureus 2025; 17:e81641. [PMID: 40322368 PMCID: PMC12049852 DOI: 10.7759/cureus.81641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2025] [Indexed: 05/08/2025] Open
Abstract
Lichen planus (LP) is a chronic inflammatory disorder that affects the skin, mucous membranes, nails, and hair. Cutaneous LP (CLP) is characterized by violaceous, polygonal, flat-topped papules and plaques that are intensely pruritic. Although it can develop on any part of the body, it most commonly affects the flexor surfaces of the wrists, lower back, and ankles. This report presents an atypical case of LP in a 33-year-old woman who initially exhibited poikilodermatous changes with bluish-gray patches, persisting for a decade. Due to the overlapping clinical and histopathological features, an extensive diagnostic workup including pan-computed tomography, lymph node biopsy, and immunohistochemistry was performed to exclude poikilodermatous mycosis fungoides. One year later, skin examination and histopathological evaluation revealed the classical features of LP, leading to a definitive diagnosis. This case highlights an unusual presentation in which poikiloderma preceded the classic clinical picture of LP. Our findings contribute to the existing knowledge of LP by emphasizing the importance of recognizing atypical presentations for accurate diagnosis and management.
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Affiliation(s)
| | | | - Dai Zafer
- General Medicine, King Abdulaziz Hospital, Makkah, SAU
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Foss FM, Kim YH, Prince HM, Akilov OE, Querfeld C, Seminario-Vidal L, Fisher DC, Kuzel TM, Yannakou CK, Geskin LJ, Feldman T, Sokol L, Allen PB, Dang NH, Cabanillas F, Wong HK, Ooi CE, Xing D, Sauter N, Singh P, Czuczman M, Duvic M. Efficacy and Safety of Denileukin Diftitox-Cxdl, an Improved Purity Formulation of Denileukin Diftitox, in Patients With Relapsed or Refractory Cutaneous T-Cell Lymphoma. J Clin Oncol 2025; 43:1198-1209. [PMID: 39700456 PMCID: PMC11949209 DOI: 10.1200/jco-24-01549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 10/16/2024] [Accepted: 11/12/2024] [Indexed: 12/21/2024] Open
Abstract
PURPOSE Denileukin diftitox (DD)-cxdl is a fusion protein comprising diphtheria toxin fragments A and B and human interleukin-2. This phase III, multicenter, open-label, single-arm registrational trial evaluated the efficacy and safety of DD-cxdl in patients with relapsed/refractory (R/R) cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS In the main study, which followed a dose-finding lead-in, DD-cxdl was administered intravenously daily (5 days; 9 µg/kg/d once daily) every 21 days for up to eight cycles. Patients in the primary efficacy analysis set (PEAS) were required to have stage IA-IIIB CTCL (mycosis fungoides and/or Sézary syndrome) and at least ≥one previous systemic therapy. The primary efficacy end point was objective response rate (ORR) using the Global Response Score. Secondary end points were duration of response (DOR), time to response (TTR), skin tumor burden, and safety and tolerability. RESULTS The PEAS included 69 patients (median age, 64.0 years). The ORR was 36.2% (95% CI, 25.0 to 48.7), including 8.7% with complete response. The median DOR was 8.9 months (95% CI, 5.0 to not estimable), and the median (Q1-Q3) TTR was 1.4 (0.7-2.1) months. A total of 84.4% of patients showed decreased skin tumor burden, with 48.4% showing a ≥50% decrease. Treatment-emergent adverse events (TEAEs) of special interest, most of which were grade 1 or 2, included infusion reaction (73.9%), hypersensitivity (68.1%), hepatotoxicity (36.2%), and capillary leak syndrome (20.3% [grade ≥3, 5.8%]). Other common TEAEs were nausea (43.5%) and fatigue (31.9%). CONCLUSION Efficacy and safety results show that DD-cxdl would potentially fulfill a serious, unmet medical need for patients with R/R CTCL.
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Affiliation(s)
| | - Youn H. Kim
- Departments of Dermatology & Medicine, Stanford Cancer Center, Stanford, CA
| | - H. Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Oleg E. Akilov
- University of Pittsburgh Medical Center-Presbyterian Shadyside, Pittsburgh, PA
| | | | - Lucia Seminario-Vidal
- Department of Dermatology, University of South Florida, Tampa, FL
- Eli Lilly and Company, Indianapolis, IN
| | | | - Timothy M. Kuzel
- Rush University Medical Center, Chicago, IL
- Department of Medicine, Northwestern University, Chicago, IL
| | - Costas K. Yannakou
- Epworth HealthCare, Melbourne, Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, Australia
| | | | - Tatyana Feldman
- John Theurer Cancer Center at Hackensack Meridian Health, Hackensack, NJ
| | - Lubomir Sokol
- H. Lee Moffit Cancer Center and Research Institute, Inc., Tampa, FL
| | | | - Nam Hoang Dang
- University of Florida Health Shands Hospital, Gainesville, FL
| | | | - Henry K. Wong
- University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | | | | | | | - Madeleine Duvic
- Department of Dermatology, The University of Texas—MD Anderson Cancer Center, Houston, TX
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12
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Hong JB, Hsieh TS, Tsai TF, Liau JY, Chiu HC, Lee TL, Huang TC. Preliminary assessment of the accuracy of cutaneous T-cell lymphoma diagnosis through deep sequencing of the TRG gene. Clin Exp Dermatol 2025; 50:788-794. [PMID: 39504536 DOI: 10.1093/ced/llae413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 08/20/2024] [Accepted: 09/27/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND The diagnostic challenges in early mycosis fungoides (MF) and other cutaneous T-cell lymphomas (CTCLs) persist despite advancements in molecular methods. OBJECTIVES To provide a preliminary assessment of next-generation sequencing (NGS) in analysing TRG (T-cell receptor gamma locus) sequences for distinguishing CTCLs from benign inflammatory skin disorders. METHODS NGS was used to assess TRG sequences in skin samples from clinicopathologically proven CTCLs and benign inflammatory skin disorders. RESULTS Our study analysed skin samples from a total of 36 participants, comprising 22 cases of CTCL, including 14 MF and 8 other CTCLs, alongside 14 cases of benign inflammatory skin disorders. According to LymphoTrack® criteria, monoclonality was detected in 16 (73%) of the 22 patients with CTCL. Specifically, in cases of MF, 10 of 14 (71%) were identified as monoclonal, with all 4 non-monoclonal cases being in the patch stage. For the other cases of CTCL, six of eight displayed monoclonality. Among the 22 patients with CTCL, 10 (45%) had multiple biopsies, with 8 (36%) displaying the same dominant clone across different sites. Among the 14 benign cases, only the case of erythrodermic psoriasis exhibited monoclonality. Our decision tree analysis suggests that a high frequency of the most abundant clone, its ratio to the third most abundant clone and TRG VγI segment usage are effective markers that can help in the diagnosis of CTCL. CONCLUSIONS A combination of the clone frequencies and TRG V segment usage may enhance diagnosis of MF and other CTCLs, helping to differentiate them from benign conditions. However, molecular diagnosis for patch-stage MF remains challenging.
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Affiliation(s)
- Jin-Bon Hong
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Tyng-Shiuan Hsieh
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Jau-Yu Liau
- Department of Pathology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Hsien-Ching Chiu
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Tung-Lung Lee
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Tai-Chung Huang
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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13
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Ta VA, Ram-Wolff C, Annabi E, Chauvel C, de Masson A, Beylot-Barry M, Soulier J, Bagot M, Vial JP, Veyrat-Masson R, Moins-Teisserenc H. Computational Free Flow Cytometry for Sézary Cells Identification and Quantification. J Invest Dermatol 2025:S0022-202X(25)00328-8. [PMID: 40113034 DOI: 10.1016/j.jid.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 02/28/2025] [Accepted: 03/03/2025] [Indexed: 03/22/2025]
Affiliation(s)
- Van Anh Ta
- INSERM U1342, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | | | - Elissa Annabi
- INSERM U1342, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Paris, France
| | | | - Adèle de Masson
- INSERM U1342, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Paris, France; Université Paris Cité, Paris, France; Department of Dermatology, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Jean Soulier
- INSERM U1342, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Paris, France; Université Paris Cité, Paris, France; Haematology Laboratory, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Martine Bagot
- INSERM U1342, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Paris, France; Université Paris Cité, Paris, France; Department of Dermatology, CHU de Bordeaux, Bordeaux, France
| | | | | | - Hélène Moins-Teisserenc
- INSERM U1342, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Paris, France; Université Paris Cité, Paris, France; Haematology Laboratory, Hôpital Saint-Louis, AP-HP, Paris, France.
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14
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Hedebo S, Pedersen MB, Lindahl LM, Drjlevic-Nielsen A, Johansen C, D'Amore F, Iversen L, Bech R. Systemic Targeted Therapies in Patients with Relapsed/Refractory Advanced Stage Cutaneous T-cell Lymphoma: A Real-world Single-centre Case Series. Acta Derm Venereol 2025; 105:adv40952. [PMID: 40079767 DOI: 10.2340/actadv.v105.40952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 01/28/2025] [Indexed: 03/15/2025] Open
Abstract
Cutaneous T-cell lymphomas are a heterogeneous group of non-Hodgkin lymphomas. Early stages are often controlled with skin-directed therapy, such as topical corticosteroids, topical chlormethine gel, or UV therapy, whereas advanced stages often warrant a more aggressive approach with systemic antibody targeted therapy including mogamulizumab, brentuximab vedotin, or alemtuzumab. A retrospective cohort case series of 27 patients from Aarhus University Hospital, Denmark is presented, evaluating real-world outcomes of patients with cutaneous T-cell lymphomas treated with intravenous systemic targeted therapies from 2013 to 2023. The median age was 72 and the majority had Sézary syndrome or mycosis fungoides. All patients had relapsed/refractory advanced stage cutaneous T-cell lymphoma. Six patients received mogamulizumab, 12 patients received brentuximab vedotin, and 15 patients received alemtuzumab. Six patients received more than 1 of the systemic targeted treatments. Overall response rates were 78% for mogamulizumab, 65% for brentuximab vedotin, and 61% for alemtuzumab. Median time to progression was 2.5, 4, and 11 months, respectively. In conclusion, this paper offers a unique perspective on the complexities of clinical practice when managing advanced-stage cutaneous T-cell lymphomas and demonstrates the effectiveness of the therapies described, with particular emphasis on the promising results observed with alemtuzumab administered in a low-dose protocol.
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MESH Headings
- Humans
- Male
- Aged
- Female
- Retrospective Studies
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
- Skin Neoplasms/mortality
- Middle Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Alemtuzumab/administration & dosage
- Alemtuzumab/adverse effects
- Alemtuzumab/therapeutic use
- Aged, 80 and over
- Brentuximab Vedotin/administration & dosage
- Brentuximab Vedotin/adverse effects
- Neoplasm Staging
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/administration & dosage
- Mycosis Fungoides/drug therapy
- Mycosis Fungoides/pathology
- Treatment Outcome
- Sezary Syndrome/drug therapy
- Sezary Syndrome/pathology
- Denmark
- Neoplasm Recurrence, Local/drug therapy
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/pathology
- Time Factors
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Affiliation(s)
- Signe Hedebo
- Department of Dermatology and Venereology Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark.
| | - Martin B Pedersen
- Aarhus University, Aarhus, Denmark; Department of Hematology Aarhus University Hospital, Aarhus, Denmark
| | | | - Aska Drjlevic-Nielsen
- Department of Dermatology and Venereology Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
| | - Claus Johansen
- Department of Dermatology and Venereology Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
| | - Francesco D'Amore
- Aarhus University, Aarhus, Denmark; Department of Hematology Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology and Venereology Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark; MC2 Therapeutics, Hoersholm, Denmark
| | - Rikke Bech
- 1Department of Dermatology and Venereology Aarhus University Hospital, Aarhus, Denmark; Aarhus University, Aarhus, Denmark
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15
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Cappelli L, Cappelli M, Haldar N, Paul T, Mandel J, Zhan T, Nikbakht N, Shi W. Condensed low-dose total skin electron beam therapy for mycosis fungoides: an institutional retrospective review and subgroup analysis of patients with large cell transformation. Arch Dermatol Res 2025; 317:531. [PMID: 40056226 PMCID: PMC11890398 DOI: 10.1007/s00403-025-04030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 02/03/2025] [Accepted: 02/12/2025] [Indexed: 03/10/2025]
Abstract
Low-dose total skin electron beam therapy (TSEBT) is an effective treatment option for mycosis fungoides (MF) with proven palliative effects and reduced toxicity. Presented is an institutional analysis of survival/response rate and quality of life for MF patients with subgroup analysis of those possessing pathologic large cell transformation (LCT). This is a single institutional retrospective review of patients with mycosis fungicides treated from 2014 to 2023 with low-dose TSEBT. All patients received 12 Gy in 6 fractions every other day with the modified Stanford technique, with boosts to shadowed sites between treatments, completed in 2 weeks. Outcomes evaluated included clinical response, duration of and time to response, patient-reported quality of life, and physician-scored disease burden. Forty-six patients were included in the study, 28 male and 18 female, with a median age 66.5 (range 32.7-90.6). Stage IB was most common at the time of TSEBT (41.3%). Median follow up was 44.5 months. The overall response rate was 91.3% (52.2% partial response, 19.6% complete and near complete response). The median duration of response was 8.2 months (range, 6.1-28.7), and the median time to best response was 3.5 months (range, 2.7-5.6). Quality of life (QOL) and disease burden continued to show significant benefit after TSEBT (p<0.001). In a subgroup analysis, 18 patients (39.1%) were found to have large cell transformation (LCT) at diagnosis. LCT was associated with higher presenting stage prior to TSEBT (p=0.016) and a better response to treatment (p=0.040). However, median duration of response was only 7.4 months in the patients with LCT vs. 39.4 months in the patients without (p=0.003). Condensed Low-dose TSEBT is a convenient treatment with favorable clinical outcomes and low toxicities in patients with mycosis fungoides. Patients with LCT may have shorter duration of treatment response. Further studies are warranted to validate this finding.
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Affiliation(s)
- Louis Cappelli
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Sidney Kimmel Cancer Center, 111 St 11th Street, Philadelphia, Pennsylvania, 19107, USA.
| | - Megan Cappelli
- Department of Dermatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Nilanjan Haldar
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tiara Paul
- Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jenna Mandel
- Department of Dermatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tingting Zhan
- Department of Pharmacology, Physiology and Cancer Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Neda Nikbakht
- Department of Dermatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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16
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Jung JM, Won CH, Chang SE, Lee MW, Lee WJ. Spatially Resolved Single-Cell Transcriptome Analysis of Mycosis Fungoides Reveals Distinct Biomarkers GNLY and FYB1 Compared With Psoriasis and Chronic Spongiotic Dermatitis. Mod Pathol 2025; 38:100681. [PMID: 39675427 DOI: 10.1016/j.modpat.2024.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 11/25/2024] [Accepted: 12/04/2024] [Indexed: 12/17/2024]
Abstract
Early mycosis fungoides (MF) and inflammatory dermatoses including psoriasis and chronic spongiotic dermatitis are often difficult to differentiate. We explored diagnostic markers differentiating MF from psoriasis and chronic spongiotic dermatitis via spatially resolved single-cell transcriptome analysis. Single-cell transcriptomics of intraepidermal T cells of MF patches, psoriasis, and chronic spongiotic dermatitis were analyzed using CosMx spatial molecular imager utilizing surface markers, including CD3 and CD4. An immunohistochemical study with potential markers was performed to verify clinical utility. Compared with psoriasis and chronic spongiotic dermatitis, 41 upregulated differentially expressed genes (DEGs) in MF were associated with the T-cell receptor (TCR) signaling pathway and apoptosis regulation. Protein-protein interaction network analysis of these DEGs revealed a main cluster associated with TCR signaling. Pathway enrichment analysis showed that apoptosis, Th17 cell differentiation, and TCR signaling pathways were enriched in MF. GNLY and FYB1, DEGs with the highest fold-change values, were selected as potential diagnostic biomarkers for MF. For immunohistochemistry, biopsy specimens from 150 patients diagnosed with patch MF with CD4+ immunophenotype (n = 56), psoriasis (n = 48), and chronic eczema (n = 46) were included. The sensitivity and specificity of granulysin (GNLY) for distinguishing MF and psoriasis/chronic spongiotic dermatitis were 67.9% and 93.6%, respectively. For FYN-binding protein 1 (FYB1), those values were 73.2% and 69.2%, respectively. The area under the receiver operating characteristic curve values of GNLY and FYB1 were 0.86 and 0.79, respectively. In conclusion, granulysin and FYB1 can be promising diagnostic biomarkers for differentiating early-stage MF from psoriasis and chronic spongiotic dermatitis.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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17
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Singh GK, Das P, Srivastava S, Singh K, Singh V, Barui S, Mulajkar D, Dubey IP. Mycosis fungoides and Sezary syndrome - Simplifying the approach for dermatologists. Part 2: Evaluation, staging, prognosis and treatment. Indian J Dermatol Venereol Leprol 2025; 91:180-187. [PMID: 39912186 DOI: 10.25259/ijdvl_754_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/19/2024] [Indexed: 02/07/2025]
Abstract
Cutaneous T-cell lymphoma is a heterogeneous group of T-cell neoplasms, of which mycosis fungoides and Sezary syndrome are the most common. The prognosis depends on the stage of the disease. The early stage follows a protracted course with a five-year disease-specific survival of greater than 95% and is treated with skin-directed topical therapies, phototherapy, and oral drugs like methotrexate. Advanced disease has a five-year overall survival of less than 25% and requires management by systemic chemotherapeutic agents. This review article is the second part out of the two covering the staging, prognosis, and treatment from a dermatologist's perspective.
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Affiliation(s)
- Gautam Kumar Singh
- Department of Dermatology, Bharati Vidyapeeth's Medical College, Pune, India
| | - Pankaj Das
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Shailendra Srivastava
- Department of Dermatology, Base Hospital Delhi Cantonment and Army College of Medical Sciences, Delhi Cantt, India
| | - Kanwaljeet Singh
- Department of Pathology, Army Hospital, Research and Referral, Kolkata, India
| | - Vikram Singh
- Department of Pathology, Armed Forces Medical College, Pune, India
| | - Sanghita Barui
- Department of Pathology, Base Hospital, Delhi Cantonment and Army College of Medical Sciences, Delhi Cantt, India
| | - Deepak Mulajkar
- Department of Medical Oncology, Army Hospital Research and Referral, Delhi, India
| | - Indra Prakash Dubey
- Department of Nuclear Imaging, Army Hospital Research and Referral, Delhi, India
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18
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Çerman AA, Cetinkaya PO, Kurt BÖ, Kırker A, Altunay İ. Comparison of the efficacy of treatment with clobetasol propionate or bexarotene in early-stage mycosis fungoides. An Bras Dermatol 2025; 100:237-242. [PMID: 39741016 PMCID: PMC11962818 DOI: 10.1016/j.abd.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 01/02/2025] Open
Abstract
BACKGROUND There are few studies in the literature comparing the effectiveness of topical treatments in early-stage mycosis fungoides (MF). OBJECTIVES It was aimed to evaluate the clinical efficacy, side effects and topical treatment compliance with bexarotene or clobetasol propionate in early-stage MF. METHODS A total of 40 patients with stage IA-IB MF were enrolled in the study. Twenty patients were treated with 1% bexarotene gel and 20 patients were treated with 0.05% clobetasol propionate ointment. RESULTS In the bexarotene group, 11 patients (55%) had complete clinical response (CCR) and 5 patients (25%) had partial response (PR) while in the clobetasol propionate group, 10 patients (50%) had CCR and 9 patients (45%) had PR. The median duration of remission was 10.5 months in the bexarotene group and 4 months in the clobetasol propionate group. The remission period was statistically significantly longer in the bexarotene group (p = 0.032). Irritation symptoms were statistically significantly more common in the bexarotene group (p = 0.001). STUDY LIMITATIONS The limitation of the study was its retrospective design. CONCLUSION Both topical bexarotene and topical clobetasol propionate were found to be effective in MF. Irritation symptoms were more common with topical bexarotene. Moreover, the remission period with topical bexarotene was significantly longer.
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Affiliation(s)
- Aslı Aksu Çerman
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Seyrantepe, İstanbul, Turkey.
| | - Pinar Ozdemir Cetinkaya
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Seyrantepe, İstanbul, Turkey
| | - Birgül Özkesici Kurt
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Seyrantepe, İstanbul, Turkey
| | - Artun Kırker
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Seyrantepe, İstanbul, Turkey
| | - İlknur Altunay
- Dermatology Department, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Seyrantepe, İstanbul, Turkey
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19
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Assaf C, Booken N, Dippel E, Dobos G, Eich H, Klemke C, Mitteldorf C, Nicolay JP, Theurich S, Wobser M, Stadler R. Practical recommendations for therapy and monitoring of mogamulizumab patients in Germany. J Dtsch Dermatol Ges 2025; 23:341-354. [PMID: 39723687 PMCID: PMC11887012 DOI: 10.1111/ddg.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 11/18/2024] [Indexed: 12/28/2024]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of the heterogeneous group of cutaneous T-cell lymphomas (CTCL). With the expansion of the biologic treatment landscape, new treatment options have become available in recent years, most notably the C-C chemokine receptor 4 (CCR4)-directed monoclonal antibody mogamulizumab. Based on the phase III pivotal trial, mogamulizumab is recommended by the German S2k guidelines for the second-line treatment of stage IB and above SS and MF, after at least one prior systemic therapy. Since then, new insights on safety and efficacy of mogamulizumab were generated by post hoc analyses and real-world evidence. A panel of CTCL-experts discussed available literature and own experiences and developed relevant recommendations on the use of mogamulizumab in clinical practice in Germany. The recommendations cover patient criteria, prior therapies, use of mogamulizumab as monotherapy or combination therapy, management of side effects, duration of therapy, and monitoring schedules. The aim of these clinical recommendations is to support healthcare professionals in their decision-making and use of mogamulizumab in daily practice.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology and VenereologyHelios Klinikum KrefeldKrefeldGermany
- Institute for Molecular MedicineMSH Medical School HamburgHamburgGermany
| | - Nina Booken
- Department of Dermatology and VenereologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Edgar Dippel
- Department of Dermatology and VenereologyKlinikum LudwigshafenLudwigshafenGermany
| | - Gabor Dobos
- Department of Dermatology, Venereology and AllergologyCharité – Universitätsmedizin BerlinBerlinGermany
| | - Hans‐Theodor Eich
- Department of Radiation OncologyMünster University HospitalMünsterGermany
| | - Claus‐Detlev Klemke
- Department of Dermatology and Skin Tumor CenterMunicipal Hospital KarlsruheAcademic Teaching Hospital of the University of FreiburgFreiburgGermany
| | - Christina Mitteldorf
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | - Jan P. Nicolay
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center MannheimMannheimGermany
| | - Sebastian Theurich
- Department of Medicine III, University Hospital LMULudwig‐Maximilians‐Universität MünchenMünchenGermany
| | - Marion Wobser
- Department of Dermatology, Venereology and AllergologyUniversity Hospital WürzburgWürzburgGermany
| | - Rudolf Stadler
- Department of Dermatology, Venereology, Allergology and PhlebologyJohannes Wesling ClinicUniversity Hospital of the Ruhr University BochumBochumGermany
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20
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Nenonen J, Winther AH, Jonsson P, Ivert LU, Brauner H. Identification of subgroups of early-stage mycosis fungoides patients with increased itch and impaired quality of life. Front Oncol 2025; 15:1524353. [PMID: 40094017 PMCID: PMC11906425 DOI: 10.3389/fonc.2025.1524353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 01/24/2025] [Indexed: 03/19/2025] Open
Abstract
Introduction Mycosis fungoides (MF), Sézary syndrome (SS) and other cutaneous T-cell lymphomas (CTCLs) can have a severe impact on quality of life (QoL) and itch, but early MF is insufficiently investigated despite representing most patients. This single center study investigated associations between QoL/itch/depressive symptoms and clinical phenotypes in patients with CTCL with particular focus on early MF-stages. Methods Patients were included during routine dermatological care. The primary outcomes included Dermatology Life Quality Index (DLQI), EuroQoL 5D (EQ-5D) index, Montgomery-Åsberg Depression Rating Scale - Self report (MADRS-S), and itch measured with a visual analogue scale (VAS-itch). Results In the total CTCL cohort (n=76), median EQ-5D index was impaired in female vs male patients (0.73 vs 0.85, p = 0.040). Among early MF patients (n=58), increased disease activity correlated with impaired DLQI (r = 0.413, p = 0.0014) and EQ-5D index (r = -0.317, p = 0.0161). Early MF patients with plaques vs only patches reported impaired EQ-5D index (median 0.725 vs 0.848, p = 0.0032) and increased itch (median VAS 3.27 vs 0.43, p = 0.0006). MF patients with stage IB vs IA reported impaired DLQI (median 5.00 vs 1.00, p = 0.0006), impaired EQ-5D index (median 0.725 vs 0.848, p = 0.0040) and increased itch (median VAS 3.37 vs 0.54, p = 0.0487). Discussion Although early MF patients reported generally a mild impact on QoL, this study highlights the need for disease management optimization for subgroups of early MF patients, including those with plaques, stage IB and higher disease activity.
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Affiliation(s)
- Julia Nenonen
- Division of Dermato-Venerology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna H Winther
- Division of Dermato-Venerology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Jonsson
- Division of Dermato-Venerology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lina U Ivert
- Division of Dermato-Venerology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Brauner
- Division of Dermato-Venerology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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21
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Wehkamp U, Pietzka S, Kotrová M, Jost M, Oschlies I, Schwarz A, Baldus C, Darzentas N, Brüggemann M. Mycosis fungoides: differentiation from inflammation and detection of circulating tumour cells with the EuroClonality next-generation sequencing assay. Br J Dermatol 2025; 192:492-500. [PMID: 39475451 DOI: 10.1093/bjd/ljae425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 02/19/2025]
Abstract
BACKGROUND Mycosis fungoides (MF) is a rare malignancy that is characterized by the presence of circulating tumour cells (CTCs) in a subgroup of patients. Reliably distinguishing MF from inflammatory skin conditions is challenging. OBJECTIVES To evaluate the potential benefits of next-generation sequencing (NGS)-based T-cell receptor rearrangement repertoire analysis in detecting clonal rearrangements in MF and inflammatory skin conditions. METHODS Skin biopsies and blood samples from 33 patients with MF and 10 patients with inflammatory skin conditions were analysed using TRB and TRG NGS. Twenty-seven patients had early-stage IA (n = 19) and IB (n = 8) MF, and six had advanced-stage disease (IIB, n = 5; IIIA, n = 1). RESULTS Analysis applying standard abundance thresholds identified at least one clonal rearrangement in the skin DNA of 97% (n = 32/33) of patients with MF and in 90% (n = 9/10) of those with inflammatory skin conditions. To enhance specificity, an abundance and distribution-based approach was applied, which considered only rearrangements that significantly stood out from the physiological background as clonal (MF, n = 29/33; inflammatory skin conditions, n = 1/10), allowing for highly sensitive (88%) and specific (90%) discrimination between MF and other inflammatory skin conditions. CTCs were detected in 46% (n = 11/24) of patients with early-stage MF and in 60% (n = 3/5) of those with late-stage MF. CONCLUSIONS NGS-based T-cell receptor repertoire analysis is a highly sensitive and specific method for the differential diagnosis of early-stage MF vs. inflammatory skin conditions, and for the sensitive molecular detection of CTCs.
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Affiliation(s)
- Ulrike Wehkamp
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Medical School Hamburg, Hamburg, Germany
| | - Sophie Pietzka
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michaela Kotrová
- Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marion Jost
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ilske Oschlies
- Department of Pathology, Hematopathology Section, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Agatha Schwarz
- Department of Dermatology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Claudia Baldus
- Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Nikos Darzentas
- Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Monika Brüggemann
- Department of Hematology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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22
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Valente M, Sanches JA, Nukui Y, Cury-Martins J, Souza BC, Pereira J, Miyashiro D. Characterization of adult T-cell leukemia/lymphoma patients with specific skin lesions in a tertiary dermatological service in Brazil. Front Med (Lausanne) 2025; 12:1505865. [PMID: 39991055 PMCID: PMC11842934 DOI: 10.3389/fmed.2025.1505865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 01/15/2025] [Indexed: 02/25/2025] Open
Abstract
Introduction Human T-lymphotropic virus type-1 (HTLV-1) is endemic in some countries, including Brazil. HTLV-1 is the etiological agent of adult T-cell leukemia-lymphoma (ATLL), a rare and aggressive CD4+ T-lymphocyte malignancy. ATLL affects 1-5% of virus carriers. Dermatological involvement occurs in 40-70%. Diagnosis is based on clinicopathologic correlation and HTLV-1 serology. There are few therapeutic options so far. Methods This is an observational retrospective cohort study with ATLL patients followed in a tertiary hospital in São Paulo, Brazil. Data were collected at diagnosis. Survival curves using the Kaplan-Meier method were analyzed with log-rank test, univariate and multivariate analyses were performed with the Cox proportional hazards model. Results Forty-four patients were studied, 24 females (54.5%), and 20 males (45.5%). The median age at diagnosis was 59.4 years. Classification at diagnosis was: 16 (36.4%) chronic (93.7% unfavorable, 6.2% favorable), 14 (31.8%) acute, 10 (22.7%) smoldering, four (9.1%) lymphoma, and none with primary cutaneous tumoral. Regarding skin lesions, 18 (40.9%) had plaques; 15 (34.1%) nodules/tumors; 11 (25.0%) papules; 10 (22.7%) erythroderma; seven (15.9%) patches; two (4.5%) ichthyosis; one (2.3%) purpuric lesions. Epidermotropism/exocytosis of lymphocytes was observed in 25 patients (62.5%), and Pautrier microabscesses in three (7.3%). Four patients (10.0%) had subcutaneous involvement, two (5.0%) folliculotropism, two (5.0%) angiocentrism, and one (2.5%) perineural involvement. Ten patients (25.0%) presented a lichenoid pattern. Thirty-four patients (79.1%) had increased lactate dehydrogenase; 20 (45.5%) lymphocytosis; six (13.6%) flower cells in peripheral blood; six (14.6%) hypercalcemia; five (12.2%) hypoalbuminemia. Beta-2 microglobulin was increased in all 24 cases investigated. Monoclonal T-lymphocytes were observed in the blood of 23 patients (76.7%) and the skin of 19 (76.0%). Thirty patients (68.2%) died. Median overall survival was 32.3 months. Acute and chronic unfavorable forms had worse prognoses, with median overall survival of 23.3 and 34.1 months, respectively (p = 0.0011). After multivariate analysis, Shimoyama classification (acute) and urea levels were associated with poorer prognoses. Conclusion We described a large Brazilian cohort of ATLL with cutaneous involvement. Description of clinical, pathology, laboratory, and follow-up data, and factors associated with poorer survival is essential to provide better care and to improve the quality of life of these patients.
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Affiliation(s)
- Mariana Valente
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
| | | | - Youko Nukui
- Discipline of Hematology, University of São Paulo, São Paulo, Brazil
| | - Jade Cury-Martins
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
| | | | - Juliana Pereira
- Discipline of Hematology, University of São Paulo, São Paulo, Brazil
| | - Denis Miyashiro
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
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23
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Bernardelli A, Visco C. Management of mycosis fungoides and Sézary syndrome with mogamulizumab in combination with psoralen plus UVA: two case reports. Ther Adv Hematol 2025; 16:20406207251317165. [PMID: 39906397 PMCID: PMC11792013 DOI: 10.1177/20406207251317165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 12/02/2024] [Indexed: 02/06/2025] Open
Abstract
This report describes the cases of two patients with mycosis fungoides and Sézary syndrome (MF/SS) who achieved clinical benefit with mogamulizumab combination therapies. Case 1 is a 56-year-old male with stage IIIB (T4NxM0B1) MF, which later progressed into SS, with ongoing skin symptoms (erythema, lichenified skin, and pruritis) and axillary and inguinal lymphadenomegaly. Skin-directed and systemic therapies failed to achieve a long-lasting response in this patient. Mogamulizumab (1 mg/kg once weekly for 4 weeks; once every 2 weeks thereafter) yielded temporary improvement in skin symptoms, but progression in the skin was confirmed after ~2 months. Subsequently, the combination of mogamulizumab with psoralen plus ultraviolet light A (PUVA) yielded a partial response; however, PUVA was discontinued due to phototoxicity and mogamulizumab was continued as monotherapy. At the latest evaluation, clinical improvement in the skin and reduced lymphadenomegaly were evident with ongoing mogamulizumab monotherapy; the patient is awaiting allogeneic hematopoietic stem cell transplantation. Case 2 is an 80-year-old male with stage IIIB (T4NxM0B1) granulomatous variant MF who presented with diffuse erythema with desquamation, ectropion, and inguinal lymphadenopathy. Treatment with oral prednisone and bexarotene failed to achieve adequate, long-lasting responses. Mogamulizumab (1 mg/kg once weekly for 4 weeks; once every 2 weeks thereafter) monotherapy yielded an initial improvement, characterized by less intense erythema, but the improvement was not sustained. Mogamulizumab was supplemented with oral prednisone and then PUVA; this combination resulted in improvement in the skin. PUVA was stopped due to unavailability, and methotrexate (10 mg once weekly) was initiated alongside continued mogamulizumab; this led to improvement in erythema. The patient continued mogamulizumab plus methotrexate with improving clinical status, prior to their death, which was deemed to be unlikely to be related to treatment. Our experience suggests that, in principle, mogamulizumab can be used in combination with other therapies; however, further research is needed.
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Affiliation(s)
- Andrea Bernardelli
- Hematology Unit, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Carlo Visco
- Section of Hematology, Department of Medicine, University of Verona, Piazzale L Scuro, 10, Verona 37134, Italy
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24
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Courtois A, Allaume P, Raby M, Pastoret C, Droitcourt C, Le Naourès C, Adamski H, Dupuy A, Le Gall F, Kammerer-Jacquet SF. Differential Expression of p53 in Mycosis Fungoides, Sezary Syndromes, and Their Transformed Forms. Am J Dermatopathol 2025; 47:95-104. [PMID: 39660957 DOI: 10.1097/dad.0000000000002898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024]
Abstract
ABSTRACT Mycosis fungoides (MF) and Sezary syndrome (SS) are common entities among primary cutaneous lymphomas. Large cell transformation is challenging for diagnosis and therapy. Molecular mechanisms by which these lymphomas undergo this transformation are poorly defined. We studied the immunohistochemical status of p53 in these entities and assessed whether p53 expression could be a useful tool for diagnosis and assessment of transformation. We extracted patients with transformed and untransformed SS or MF from the French Study Group on Cutaneous Lymphoma database between 2014 and 2021, followed in the Rennes University Hospital. An immunohistochemical study of p53 expression was performed on the biopsies sampled as part of routine care. We compared p53 overexpression in the different groups. We included 25 patients with MF, 7 patients with transformed MF (T-MF), 11 patients with SS, and 5 patients with transformed SS (T-SS). Using a cut-off set at 30% expression of neoplastic cells, we noted an overexpression of p53 in T-MF and T-SS compared with nontransformed forms (47% vs. 12%, respectively, P < 0.01) and in MF compared with SS (23% vs. 7%, respectively, P < 0.01). Overexpression of p53 with a cut-off at 30% therefore seems to be a discriminating tool in the differential diagnosis of MF/SS versus their transformed forms as well as the differential diagnosis between MF and SS.
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Affiliation(s)
- Anna Courtois
- Department of Pathology, Rennes University Hospital, France
| | - Pierre Allaume
- Department of Pathology, Rennes University Hospital, France
| | - Maxime Raby
- Department of Dermatology, Rennes University Hospital, France
| | - Cédric Pastoret
- Department of Hematology, Rennes University Hospital, France; and
| | | | | | - Henri Adamski
- Department of Dermatology, Rennes University Hospital, France
| | - Alain Dupuy
- Department of Dermatology, Rennes University Hospital, France
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25
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Aranha MFDAC, dos Santos MAL, Pires CAA, Dias LB, Pereira RG, Freire MLDF, da Cruz TT, de Oliveira LRR. Hypopigmented mycosis fungoides: an important differential diagnosis of hypochromias in childhood. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2025; 43:e2024181. [PMID: 39841700 PMCID: PMC11741227 DOI: 10.1590/1984-0462/2025/43/2024181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 10/06/2024] [Indexed: 01/24/2025]
Abstract
OBJECTIVE To highlight the importance of early recognition of hypopigmented mycosis fungoides (HMF) in cases of cutaneous hypochromia in children, with a view to an effective diagnostic and therapeutic approach. CASE DESCRIPTION Two cases of HMF in children are reported. The first case involves an eight-year-old boy with hypochromic macules on the trunk and root of the upper and lower limbs, while the second case is a six-year-old boy with widespread hypochromic patches. Both patients presented with prolonged evolution of hypopigmentation, leading to the suspicion of HMF after excluding other differential diagnoses. Histopathological and immunohistochemical tests were fundamental in confirming the diagnosis of HMF. COMMENTS HMF is a less prevalent and less publicized form of mycosis fungoides and is more common in children and people with a high phototype. Its diagnosis is challenging and often requires multiple biopsies for confirmation. Treatment includes phototherapy and immunosuppressive therapy, depending on the patient's age and extent of lesions. Early recognition of HMF is crucial for proper management and to avoid complications associated with malignant evolution.
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26
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Johansson A, Kalliara E, Belfrage E, Alling T, Pyl PT, Gerdtsson AS, Gullberg U, Porwit A, Drott K, Ek S. The Progression of Mycosis Fungoides During Treatment with Mogamulizumab: A BIO-MUSE Case Study of the Tumor and Immune Response in Peripheral Blood and Tissue. Biomedicines 2025; 13:186. [PMID: 39857770 PMCID: PMC11761615 DOI: 10.3390/biomedicines13010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 12/18/2024] [Accepted: 12/21/2024] [Indexed: 01/27/2025] Open
Abstract
Background/objectives: Mycosis fungoides (MF) is a rare malignancy, with an indolent course in the early stages of the disease. However, due to major molecular and clinical heterogeneity, patients at an advanced stage of the disease have variable responses to treatment and considerably reduced life expectancy. Today, there is a lack of specific markers for the progression from early to advanced stages of the disease. To address these challenges, the non-interventional BIO-MUSE trial was initiated. Here, we report on a case study involving one patient, where combined omics analysis of tissue and blood was used to reveal the unique molecular features associated with the progression of the disease. Methods: We applied 10× genomics-based single-cell RNA sequencing to CD3+ peripheral T-cells, combined with T-cell receptor sequencing, to samples collected at multiple timepoints during the progression of the disease. In addition, GeoMx-based digital spatial profiling of T-helper (CD3+/CD8-), T-cytotoxic (CD3+/CD8+), and CD163+ cells was performed on skin biopsies. Results. The results pinpoint targets, such as transforming growth factor β1, as some of the mechanisms underlying disease progression, which may have the potential to improve patient prognostication and the development of precision medicine efforts. Conclusions: We propose that in patients with MF, the evolution of the malignant clone and the associated immune response need to be studied jointly to define relevant strategies for intervention.
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Affiliation(s)
- Angelica Johansson
- Department of Immunotechnology, Faculty of Engineering (LTH), Lund University, 223 63 Lund, Sweden
| | - Eirini Kalliara
- Department of Immunotechnology, Faculty of Engineering (LTH), Lund University, 223 63 Lund, Sweden
| | - Emma Belfrage
- Department of Dermatology and Venereology, Skane University Hospital (SUS), 205 02 Lund, Sweden
| | - Teodor Alling
- Department of Immunotechnology, Faculty of Engineering (LTH), Lund University, 223 63 Lund, Sweden
| | - Paul Theodor Pyl
- Department of Laboratory Medicine, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Lund University, 221 00 Lund, Sweden
| | - Anna Sandström Gerdtsson
- Department of Immunotechnology, Faculty of Engineering (LTH), Lund University, 223 63 Lund, Sweden
| | - Urban Gullberg
- Department of Laboratory Medicine, Lund University, 221 00 Lund, Sweden
| | - Anna Porwit
- Division of Pathology, Department of Clinical Sciences, 221 00 Lund, Sweden
| | - Kristina Drott
- Division of Medical Oncology, Department of Clinical Sciences, 221 00 Lund, Sweden
| | - Sara Ek
- Department of Immunotechnology, Faculty of Engineering (LTH), Lund University, 223 63 Lund, Sweden
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27
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St. Thomas N, Christopher BN, Reyes L, Robinson RM, Golick L, Zhu X, Chapman E, Dolloff NG. Pharmacological Modulation of the Unfolded Protein Response as a Therapeutic Approach in Cutaneous T-Cell Lymphoma. Biomolecules 2025; 15:76. [PMID: 39858470 PMCID: PMC11763779 DOI: 10.3390/biom15010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/30/2024] [Accepted: 01/03/2025] [Indexed: 01/27/2025] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a rare T-cell malignancy characterized by inflamed and painful rash-like skin lesions that may affect large portions of the body's surface. Patients experience recurrent infections due to a compromised skin barrier and generalized immunodeficiency resulting from a dominant Th2 immune phenotype of CTCL cells. Given the role of the unfolded protein response (UPR) in normal and malignant T-cell development, we investigated the impact of UPR-inducing drugs on the viability, transcriptional networks, and Th2 phenotype of CTCL. We found that CTCL cells were >5-fold more sensitive to the proteasome inhibitor bortezomib (Btz) and exhibited a distinct signaling and transcriptional response compared to normal CD4+ cells. The CTCL response was dominated by the induction of the HSP70 family member HSPA6 (HSP70B') and, to a lesser extent, HSPA5 (BiP/GRP78). To understand the significance of these two factors, we used a novel isoform selective small-molecule inhibitor of HSPA5/6 (JG-023). JG-023 induced pro-apoptotic UPR signaling and enhanced the cytotoxic effects of proteasome inhibitors and other UPR-inducing drugs in CTCL but not normal T cells. Interestingly, JG-023 also selectively suppressed the production of Th2 cytokines in CTCL and normal CD4+ T cells. Conditioned media (CM) from CTCL were immunosuppressive to normal T cells through an IL-10-dependent mechanism. This immunosuppression could be reversed by JG-023, other HSP70 inhibitors, Btz, and combinations of these UPR-targeted drugs. Our study points to the importance of the UPR in the pathology of CTCL and demonstrates the potential of proteasome and targeted HSPA5/6 inhibitors for therapy.
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Affiliation(s)
- Nadia St. Thomas
- Department of Pharmacology and Immunology, Medical University of South Carolina, 173 Ashley Ave., MSC509, Charleston, SC 29425, USA; (N.S.T.); (B.N.C.); (L.R.); (R.M.R.); (L.G.)
| | - Benjamin N. Christopher
- Department of Pharmacology and Immunology, Medical University of South Carolina, 173 Ashley Ave., MSC509, Charleston, SC 29425, USA; (N.S.T.); (B.N.C.); (L.R.); (R.M.R.); (L.G.)
| | - Leticia Reyes
- Department of Pharmacology and Immunology, Medical University of South Carolina, 173 Ashley Ave., MSC509, Charleston, SC 29425, USA; (N.S.T.); (B.N.C.); (L.R.); (R.M.R.); (L.G.)
| | - Reeder M. Robinson
- Department of Pharmacology and Immunology, Medical University of South Carolina, 173 Ashley Ave., MSC509, Charleston, SC 29425, USA; (N.S.T.); (B.N.C.); (L.R.); (R.M.R.); (L.G.)
| | - Lena Golick
- Department of Pharmacology and Immunology, Medical University of South Carolina, 173 Ashley Ave., MSC509, Charleston, SC 29425, USA; (N.S.T.); (B.N.C.); (L.R.); (R.M.R.); (L.G.)
| | - Xiaoyi Zhu
- Department of Pharmacology and Therapeutics, Center for Inflammation Science and Systems Medicine, University of Florida Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL 33458, USA; (X.Z.); (E.C.)
| | - Eli Chapman
- Department of Pharmacology and Therapeutics, Center for Inflammation Science and Systems Medicine, University of Florida Scripps Institute for Biomedical Innovation and Technology, Jupiter, FL 33458, USA; (X.Z.); (E.C.)
| | - Nathan G. Dolloff
- Department of Pharmacology and Immunology, Medical University of South Carolina, 173 Ashley Ave., MSC509, Charleston, SC 29425, USA; (N.S.T.); (B.N.C.); (L.R.); (R.M.R.); (L.G.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
- Zucker Institute for Innovation Commercialization, Charleston, SC 29425, USA
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28
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Singh GK, Das P, Sharma P, Srivastava S, Singh V, Singh K, Barui S, Mulajkar D, Dubey IP. Mycosis fungoides and Sézary syndrome - Simplifying the approach for dermatologists. Part 1: Etiopathogenesis, clinical features and evaluation. Indian J Dermatol Venereol Leprol 2025; 91:40-48. [PMID: 39772314 DOI: 10.25259/ijdvl_737_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/19/2024] [Indexed: 01/12/2025]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of extranodal non-Hodgkin's lymphomas characterised by a cutaneous infiltration of malignant monoclonal T lymphocytes. While this broad spectrum of disease with its varied etiopathogenesis, clinical features and management options are well characterised, an approach from a dermatologist's perspective is lacking in the literature. We strive to elucidate the approach from a clinician's point of view, especially in respect of clinical examination, investigations, staging and management options that are available in the realm of the dermatologists. This review article is the first part out of the two, covering the etiopathogenesis, clinical features and evaluation.
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Affiliation(s)
- Gautam Kumar Singh
- Department of Dermatology, Bharati Vidyapeeth Medical College, Pune, India
| | - Pankaj Das
- Department of Dermatology, Armed Forces Medical College, Pune, India
| | - Pragya Sharma
- Department of Pathology, Armed Forces Medical College, Pune, India
| | - Shailendra Srivastava
- Department of Dermatology, Base Hospital Delhi Cantonment and Army College of Medical Sciences, New Delhi, India
| | - Vikram Singh
- Department of Pathology, Armed Forces Medical College, Pune, India
| | - Kanwaljeet Singh
- Department of Pathology, Army Hospital, Research and Referral, New Delhi, India
| | - Sanghita Barui
- Department of Pathology, Base Hospital, Delhi Cantonment and Army College of Medical Sciences, New Delhi, India
| | - Deepak Mulajkar
- Department of Oncomedicine, Army Hospital, Research and Referral, New Delhi, India
| | - Indra Prakash Dubey
- Department of Nuclear Medicine, Army Hospital Research and Referral, New Delhi, India
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29
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Campbell BA, Prince HM, Thursky K, Dabaja B, Hoppe R, Specht L, Morris S, Porceddu SV. Breaking Down the Barriers for Patients With Cutaneous T-Cell Lymphoma: Current Controversies and Challenges for Radiation Oncologists in 2024. Semin Radiat Oncol 2025; 35:110-125. [PMID: 39672636 DOI: 10.1016/j.semradonc.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2024]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a rare collection of diseases, frequently associated with diagnostic challenges and complex management dilemmas. The multidisciplinary team is vital for accurate clinico-pathological diagnoses and for collaborative therapeutic decisions throughout the management journey, which frequently involves multiple lines of therapy. Radiotherapy (RT) is a highly effective skin-directed therapy for CTCL, commonly delivered as localised fields or as total skin electron beam therapy (TSEBT). Mycosis fungoides (MF) is the most common of the CTCL, and patients typically experience high rates of morbidity and long natural histories of relapse and progression. Patients with MF typically present with incurable disease; in these patients, RT has an established role in symptom- and disease-control, achieving excellent response rates and proven therapeutic benefits. The role of RT continues to evolve, with modern practices favouring lower doses to reduce toxicity risks and allow for re-irradiation. Less commonly, there are situations where RT has an integral role in the potential cure of patients with MF: firstly, in the setting of unilesional MF where localised RT alone may be curative, and secondly, in the setting of preconditioning prior to curative-intent allogeneic hematopoietic stem cell transplant for patients with advanced MF/Sezary syndrome, where conventional-dose TSEBT is indicated as the most effective single agent for maximal debulking of skin disease. Radiotherapy also has an important role in the management of the less common CTCL, including the curative treatment of localised primary cutaneous anaplastic large cell lymphoma. Despite proven efficacy and quality of life benefits, disparity exists in access to RT and TSEBT. World-wide, stronger multidisciplinary collaborations and greater patient advocacy are required to increase access to RT and improve equity of care for our patients with CTCL.
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Affiliation(s)
- Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Pathology, The University of Melbourne, Parkville, Victoria, Australia.
| | - H Miles Prince
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia; Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia; Department of Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Bouthaina Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stephen Morris
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sandro V Porceddu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.; Department of Radiology, The University of Melbourne, Parkville, Victoria, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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30
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Cisoń H, Jankowska-Konsur A, Białynicki-Birula R. Could Residents Adequately Assess the Severity of Skin Lesions in Mycosis Fungoides/Sézary Syndrome? Evaluation of Interrater Agreement and Interrater Reliability of mSWAT. J Clin Med 2024; 14:75. [PMID: 39797157 PMCID: PMC11721865 DOI: 10.3390/jcm14010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/12/2024] [Accepted: 12/23/2024] [Indexed: 01/13/2025] Open
Abstract
Background/Objectives: Cutaneous T-cell lymphoma (CTCL), including Mycosis fungoides (MF) and Sézary syndrome (SS), is a challenging-to-diagnose lymphoproliferative malignancy characterized by T-cell dysfunction and progressive cutaneous and extra cutaneous involvement. Disease severity assessment in CTCL is crucial for guiding treatment. This study aims to evaluate the interrater agreement and interrater reliability of mSWAT among dermatology residents and identify lesion types most prone to scoring variability. Methods: Sixteen dermatology residents with varied experience levels assessed 14 patients with confirmed MF/SS diagnoses. Using mSWAT, residents independently scored lesions severity on a standardized set of patient's photos. The results were compared with reference mSWAT scores provided by an experienced clinician. Descriptive statistics and the Shapiro-Wilk test were applied to evaluate data distributions, while Student's t-test assessed score deviations from reference values. Furthemore, we conducted a pilot the high frequency ultrasound (HFUS) study on a single patient, whose mSWAT score and photographs are also presented in the manuscript. Results: Significant discrepancies were observed in 64.29% of cases (9/14), with tumors and infiltrative lesions in erythrodermic SS patients posing particular scoring challenges. Misclassification of tumors as patches or plaques was a frequent issue, leading to underestimations in mSWAT scores. Residents' assessments of infiltrative lesions were also notably inconsistent. Conclusions: This study highlights significant interobserver variability in mSWAT scoring among less experienced dermatology residents, particularly with tumor and erythrodermic lesions. Findings underscore the need for enhanced training and standardized scoring protocols to improve mSWAT reliability. Similar to other comparable indices, such as PASI, the mSWAT should be employed consistently by the same physician during each assessment to systematically monitor and evaluate the skin condition of a patient under observation. However, broader application requires the acquisition of sufficient experience. The study suggests the use of the HFUS as an objective method of assessment of the skin lesion infiltration in MF/SS patients.
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Affiliation(s)
- Hanna Cisoń
- University Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Alina Jankowska-Konsur
- University Centre of General Dermatology and Oncodermatology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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Fei F, Brar N, Herring MB, Menke JR, Oak J, Fernandez-Pol S. Quantification of the median fluorescence intensity of CD3 and CD4 in mycosis fungoides/Sezary syndrome versus non-neoplastic control cases in peripheral blood. J Hematop 2024; 17:191-199. [PMID: 39093388 DOI: 10.1007/s12308-024-00599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
Peripheral blood involvement by MF/SS has significant implications for prognosis and treatment. Flow cytometry is commonly used to assess MF/SS by analyzing the ratio of CD26- and/or CD7-CD4 + T cells and assessment of immunophenotypic abnormalities. However, distinguishing normal from abnormal cells is not always easy. In this study, we aimed to establish quantitative thresholds to better distinguish normal CD4 + T cells from neoplastic CD4 + T cells. A retrospective analysis of flow cytometry data was performed on 30 MF/SS patients with a detectable abnormal T cell population (positive), 63 patients with suspected or confirmed cutaneous involvement without a detectable abnormal T cell population (negative), and 60 healthy controls (control). CD3 and CD4 median fluorescence intensity (MFI) was normalized to internal control subsets. Among the positive cases, 50% had CD3 expression outside ± 2 SD from the mean of the negative and control group in the CD4 + CD26- subset. The corresponding specificity of this threshold was 94%. The ± 2 SD threshold showed a sensitivity of 57% and a specificity of 94% for the CD3 intensity among the CD7-negative subset. For CD4 intensity, the ± 2 SD threshold had a sensitivity of 33.3% and specificity of 95% for the CD26-negative subset and a sensitivity of 37% and specificity of 95% for the CD7-negative subset. In our study, although changes in CD3 and CD4 intensity greater than ± 2 SD were specific for MF/SS, more subtle differences in the intensity of CD3 and CD4 should not be used as the sole abnormality to make a diagnosis of circulating MF/SS.
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Affiliation(s)
- Fei Fei
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nivaz Brar
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Melissa Beth Herring
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jean Oak
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
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Song H, Hu Z, Zhang S, Yang L, Feng J, Lu L, Liu Y, Wang T. Effectiveness and safety of interferon α-2a combined with phototherapy for patients with early-stage mycosis fungoides - a single-arm prospective study in 13 patients. J DERMATOL TREAT 2024; 35:2350231. [PMID: 38754985 DOI: 10.1080/09546634.2024.2350231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Abstract
Background: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma. Objectives: This study was conducted to evaluate efficacy and safety of interferon (IFN) α-2a combined with phototherapy for early-stage MF. Methods: Thirteen patients with early-stage MF received subcutaneous injections of IFN α-2a at 3 million IU combined with phototherapy three times per week for 6 months. Treatment efficacy was measured by changes in body surface area (BSA) score and modified severity-weighted assessment tool (mSWAT) score at 1, 3, and 6 months after treatment. Histopathologic examinations of skin lesions were performed before and after treatment. Results: After 3 months of treatment, all 13 patients achieved a partial response, and BSA and mSWAT scores were significantly lower than those at baseline (p < 0.001). After 6 months, BSA and mSWAT scores were significantly lower than those at baseline (p < 0.001) and after 3 months (p < 0.05). Eleven patients achieved complete remission and two patients achieved a partial response (overall response rate, 100%). Histopathologic examination showed a significant decrease in the number of atypical lymphocytes in both epidermis and dermis. No severe adverse effects occurred. Conclusion: IFN α-2a in combination with phototherapy may be an effective and safe alternative modality for early-stage MF.
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Affiliation(s)
- Hongbin Song
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Department of Dermatology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China
| | - Zhonghui Hu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Shiyu Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lu Yang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Jindi Feng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Lu Lu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yuehua Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Tao Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Li R, Strobl J, Poyner EFM, Balbaa A, Torabi F, Mazin PV, Chipampe NJ, Stephenson E, Ramírez-Suástegi C, Shanmugiah VBM, Gardner L, Olabi B, Coulthard R, Botting RA, Zila N, Prigmore E, Gopee NH, Chroscik MA, Kritikaki E, Engelbert J, Goh I, Chan HM, Johnson HF, Ellis J, Rowe V, Tun W, Reynolds G, Yang D, Foster AR, Gambardella L, Winheim E, Admane C, Rumney B, Steele L, Jardine L, Nenonen J, Pickard K, Lumley J, Hampton P, Hu S, Liu F, Liu X, Horsfall D, Basurto-Lozada D, Grimble L, Bacon CM, Weatherhead SC, Brauner H, Wang Y, Bai F, Reynolds NJ, Allen JE, Jonak C, Brunner PM, Teichmann SA, Haniffa M. Cutaneous T cell lymphoma atlas reveals malignant T H2 cells supported by a B cell-rich tumor microenvironment. Nat Immunol 2024; 25:2320-2330. [PMID: 39558094 PMCID: PMC11588665 DOI: 10.1038/s41590-024-02018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/11/2024] [Indexed: 11/20/2024]
Abstract
Cutaneous T cell lymphoma (CTCL) is a potentially fatal clonal malignancy of T cells primarily affecting the skin. The most common form of CTCL, mycosis fungoides, can be difficult to diagnose, resulting in treatment delay. We performed single-cell and spatial transcriptomics analysis of skin from patients with mycosis fungoides-type CTCL and an integrated comparative analysis with human skin cell atlas datasets from healthy and inflamed skin. We revealed the co-optation of T helper 2 (TH2) cell-immune gene programs by malignant CTCL cells and modeling of the tumor microenvironment to support their survival. We identified MHC-II+ fibroblasts and dendritic cells that can maintain TH2 cell-like tumor cells. CTCL tumor cells are spatially associated with B cells, forming tertiary lymphoid structure-like aggregates. Finally, we validated the enrichment of B cells in CTCL and its association with disease progression across three independent patient cohorts. Our findings provide diagnostic aids, potential biomarkers for disease staging and therapeutic strategies for CTCL.
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Affiliation(s)
- Ruoyan Li
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.
| | - Johanna Strobl
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Elizabeth F M Poyner
- Biosciences Institute, Newcastle University, Newcastle, UK
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aya Balbaa
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | | | - Pavel V Mazin
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | | | - Emily Stephenson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | | | | | - Louis Gardner
- Biosciences Institute, Newcastle University, Newcastle, UK
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bayanne Olabi
- Biosciences Institute, Newcastle University, Newcastle, UK
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rowen Coulthard
- NovoPath, Department of Cellular Pathology, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rachel A Botting
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Nina Zila
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
- Section Biomedical Science, University of Applied Sciences FH Campus Wien, Vienna, Austria
| | - Elena Prigmore
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Nusayhah H Gopee
- Biosciences Institute, Newcastle University, Newcastle, UK
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marta A Chroscik
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Efpraxia Kritikaki
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Justin Engelbert
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Issac Goh
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Hon Man Chan
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | | | - Jasmine Ellis
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Victoria Rowe
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Win Tun
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Gary Reynolds
- Biosciences Institute, Newcastle University, Newcastle, UK
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Dexin Yang
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | | | | | - Elena Winheim
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Chloe Admane
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Benjamin Rumney
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Lloyd Steele
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Laura Jardine
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Julia Nenonen
- Division of Dermatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Keir Pickard
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Jennifer Lumley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Philip Hampton
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Simeng Hu
- Biomedical Pioneering Innovation Center and School of Life Sciences, Peking University, Beijing, China
| | - Fengjie Liu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
| | - Xiangjun Liu
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
| | - David Horsfall
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Daniela Basurto-Lozada
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Louise Grimble
- Biosciences Institute, Newcastle University, Newcastle, UK
| | - Chris M Bacon
- Wolfson Childhood Cancer Research Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sophie C Weatherhead
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hanna Brauner
- Division of Dermatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Yang Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
| | - Fan Bai
- Biomedical Pioneering Innovation Center and School of Life Sciences, Peking University, Beijing, China
| | - Nick J Reynolds
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith E Allen
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Patrick M Brunner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah A Teichmann
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
- Cambridge Stem Cell Institute, Jeffrey Cheah Biomedical Centre, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK.
- Department of Medicine, University of Cambridge, Cambridge, UK.
| | - Muzlifah Haniffa
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK.
- Biosciences Institute, Newcastle University, Newcastle, UK.
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Newcastle, Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Zvulunov A, Neale H, Stern J, Santaguida P, Stein AB, Koh M, Eichenfield LF, Guitart J, Goebeler M, Scarisbrick J, Willemze R, Coughlin CC, George R, Brazzelli V, Marschalkó M, Belousova I, Querfeld C, Bagot M, Szepietowski JC, Papadavid E, Quaglino P, Hoeger P, Ortiz-Romero PL, Nikolaou V, Dummer R, Aung PP, Lawley L, Morel KD, Ngan B, Wain M, Gameiro A, Lacy-Niebla RM, Pope E. Approach to Mycosis Fungoides in children: Consensus-based recommendations. J Am Acad Dermatol 2024; 91:1078-1085. [PMID: 39181404 DOI: 10.1016/j.jaad.2024.07.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/18/2024] [Accepted: 07/31/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Pediatric Mycosis fungoides (MF) management extrapolates from adult guidelines, despite differing clinical aspects. Recommendations are essential to address unique challenges in this distinct patient group. OBJECTIVE This project aims to derive consensus recommendations for pediatric MF management. METHODS Experts from pediatric dermatology, general dermatology, dermatopathology, and pediatric hematology-oncology (N = 83) were invited to contribute to consensus recommendations. The process involved 3 electronic Delphi rounds, concluding with a final consensus meeting using a modified Nominal Group Technique for unresolved items. RESULTS Consensus included more clinical severity measures than tumor-node-metastasis-blood staging: pruritus, functional or esthetic impairment (eg, palms, soles, genitalia), quality of life impact, and psychological aspects (eg, embarrassment, anxiety, depression), plus parental anxiety. Ten recommendations were made for managing early and advanced pediatric MF. Disagreement emerged in choosing therapies beyond stage I of the disease. DISCUSSION This multinational initiative aimed to standardize optimal pediatric MF management and successfully generated consensus recommendations. Additional work is needed for structured, prospective protocols in advanced-stage pediatric MF. LIMITATIONS Lack of pediatric hematologists-oncologists and patients' representatives. CONCLUSION Documentation of extended clinical severity and outcome measures is recommended. Addressing the need for structured protocols in advanced-stage pediatric MF and implementing systematic, prospective data collection is crucial.
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Affiliation(s)
- Alex Zvulunov
- Sheba Medical Center, Tel-Hashomer and Reichman University, Herzlia, Israel; Pediatric Dermatology Research Alliance, Portland, Oregon.
| | - Holly Neale
- Pediatric Dermatology Research Alliance, Portland, Oregon; Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jonah Stern
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Pasqualina Santaguida
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario
| | | | - Mark Koh
- Department of Dermatology, KK Women's and Children's Hospital, Singapore
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego, California
| | - Joan Guitart
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Ilinois
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Julia Scarisbrick
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rein Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Renu George
- Department of Dermatology, Venereology and Leprosy (Retired) Christian Medical College, Vellore, Tamil Nadu, India
| | - Valeria Brazzelli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Dermatologic Clinic, Universitàdegli Studi di Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Márta Marschalkó
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Irena Belousova
- Department of Dermatology, Medical Military Academy, Saint Petersburg, Russia
| | | | - Martine Bagot
- Service de Dermatologie, Université Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Evangelina Papadavid
- 2nd Department of Dermatology and Venereology, ATTIKON University Hospital, Athens, Greece
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Torino, Torino, Italy
| | - Peter Hoeger
- Department of Dermatology, University of Hamburg, and Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Pablo L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Institute i+12, CIBERONC, Medical School, University Complutense, Madrid, Spain
| | - Vasiliki Nikolaou
- 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens, University of Athens Medical School, "Andreas Sygros" Hospital for Skin Diseases, Athens, Greece
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Phyu P Aung
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Leslie Lawley
- Department of Dermatology, Emory University, Atlanta, Georgia
| | - Kimberly D Morel
- Departments of Dermatology and Pediatrics, Columbia University Medical Center, New York, New York
| | - Bo Ngan
- Division of Pathology, Department of Pediatric Laboratory Medicine, Hospital for Sick Children and Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mary Wain
- Guy's and St Thomas' NHS Trust, London, UK
| | - Ana Gameiro
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
| | - Rosa María Lacy-Niebla
- Department of Phototherapy, 'Dr. Manuel Gea González' General Hospital, Mexico City, Mexico
| | - Elena Pope
- Pediatric Dermatology Research Alliance, Portland, Oregon; Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Purnak S, Hosing C, Dabaja B, Bassett RL, Huen A, Duvic M. On the Way to Curing Advanced-Stage Mycosis Fungoides/Sézary Syndrome. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:827-836. [PMID: 39107202 DOI: 10.1016/j.clml.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION/BACKGROUND Advanced-stage mycosis fungoides (MF) and Sézary syndrome (SS) have poor prognosis with median survivals of less than 5 years. Although a variety of treatments are approved for MF/SS patients, durable complete remissions (CR) are rare. PATIENTS AND METHODS Advanced-stage MF or SS patients who achieved CR and maintained in CR or stage IA for more than 10 years were identified by a retrospective search of the principal investigator's database. RESULTS Of 2266 patients diagnosed with MF or SS, 23 patients with advanced-stage MF/SS (6 IIB, 1 IIIB, 5 IVA1, 3 IVA2, 8 IVB) who achieved CR and maintained in CR or stage IA for ≥ 10 years were identified. As final/curative treatment, 11 patients underwent allogeneic stem cell transplantation (SCT). Most patients presented at young age, underwent SCT with reduced intensity conditioning regimen, had matched related donors, and controllable post-transplant graft versus host disease. Eleven patients were treated with TSEB as part of combined modality protocol in 2 patients and debulking therapy before allogeneic SCT in 9 patients. Five stage IIB patients achieved CR with radiotherapy. Four patients with blood involvement were treated with extracorporeal photopheresis (ECP) in combination with long-term antibiotics and immunomodulatory agents. Long-term antibiotics were given to 14 patients. CONCLUSION TSEB followed by allogeneic SCT, radiotherapy, ECP plus long-term antibiotics and immunomodulatory agents were the most common curative/final treatments found in our patients. We are reporting the details of our long-term complete responders' treatment course in the hopes of obtaining more cure responses in the future.
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Affiliation(s)
- Seda Purnak
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Chitra Hosing
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Bouthaina Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Auris Huen
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Madeleine Duvic
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Licht P, Mailänder V. Multi-Omic Data Integration Suggests Putative Microbial Drivers of Aetiopathogenesis in Mycosis Fungoides. Cancers (Basel) 2024; 16:3947. [PMID: 39682136 DOI: 10.3390/cancers16233947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 11/16/2024] [Accepted: 11/21/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND Mycosis fungoides (MF) represents the most prevalent entity of cutaneous T cell lymphoma (CTCL). The MF aetiopathogenesis is incompletely understood, due to significant transcriptomic heterogeneity and conflicting views on whether oncologic transformation originates in early thymocytes or mature effector memory T cells. Recently, using clinical specimens, our group showed that the skin microbiome aggravates disease course, mainly driven by an outgrowing, pathogenic S. aureus strain carrying the virulence factor spa, which was shown by others to activate the T cell signalling pathway NF-κB. METHODS To explore the role of the skin microbiome in MF aetiopathogenesis, we here performed RNA sequencing, multi-omic data integration of the skin microbiome and skin transcriptome using Multi-Omic Factor Analysis (MOFA), virome profiling, and T cell receptor (TCR) sequencing in 10 MF patients from our previous study group. RESULTS We observed that inter-patient transcriptional heterogeneity may be largely attributed to differential activation of T cell signalling pathways. Notably, the MOFA model resolved the heterogenous activation pattern of T cell signalling after denoising the transcriptome from microbial influence. The MOFA model suggested that the outgrowing S. aureus strain evoked signalling by non-canonical NF-κB and IL-1B, which in turn may have fuelled the aggravated disease course. Further, the MOFA model indicated aberrant pathways of early thymopoiesis alongside enrichment of antiviral innate immunity. In line with this, viral prevalence, particularly of Epstein-Barr virus (EBV), trended higher in both lesional skin and the blood compared to nonlesional skin. Additionally, TCRs in both MF skin lesions and the blood were significantly more likely to recognize EBV peptides involved in latent infection. CONCLUSIONS First, our findings suggest that S. aureus with its virulence factor spa fuels MF progression through non-canonical NF-κB and IL-1B signalling. Second, our data provide insights into the potential role of viruses in MF aetiology. Last, we propose a model of microbiome-driven MF aetiopathogenesis: Thymocytes undergo initial oncologic transformation, potentially caused by viruses. After maturation and skin infiltration, an outgrowing, pathogenic S. aureus strain evokes activation and maturation into effector memory T cells, resulting in aggressive disease. Further studies are warranted to verify and extend our data, which are based on computational analyses.
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Affiliation(s)
- Philipp Licht
- Department of Dermatology, University Medical Centre Mainz, 55131 Mainz, Germany
| | - Volker Mailänder
- Department of Dermatology, University Medical Centre Mainz, 55131 Mainz, Germany
- Max Planck Institute for Polymer Research, 55128 Mainz, Germany
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Jung JM, Moon IJ, Lee WJ, Won CH, Chang SE, Lee MW. Clinically assessed mycosis fungoides tumor burden index as a prognostic marker in tumor-stage mycosis fungoides: a retrospective cohort study. Arch Dermatol Res 2024; 317:42. [PMID: 39576358 DOI: 10.1007/s00403-024-03496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 09/10/2024] [Accepted: 10/22/2024] [Indexed: 11/24/2024]
Abstract
Prognostic markers are needed for tumor-stage mycosis fungoides (MF) because of their variable prognosis. The objectives of this study were to explore prognostic markers for tumor-stage MF and assess the prognostic significance of clinically assessed MF tumor burden index (MTBI). MTBI was devised to consider the tumor size ≥ 2 cm, number ≥ 5, ulcers, and body surface area ≥ 50%. The prognostic value of MTBI and other potential markers derived from blood tests and skin biopsy were evaluated retrospectively using a tertiary medical center database. We included 38 cases of tumor-stage MF. The mean age was 52.1 years, and the male-to-female ratio was 2.5:1. In multivariable analysis, MTBI ≥ 3 (adjusted hazard ratio, 9.41; 95% confidence interval, 1.13-78.15) was significantly associated with worse disease-specific survival. Ulcers were the only MTBI constituent significantly associated with survival. Among other markers, elevated lactate dehydrogenase level was associated with a worse disease-specific survival. Neutrophil-lymphocyte-ratio, pan-inflammation-value, CD30 positivity, Ki-67 index, large cell transformation, and monoclonal T-cell receptor gene rearrangement were not associated with prognosis. In conclusion, MTBI is useful and promising prognostic marker for tumor-stage MF.
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Affiliation(s)
- Joon Min Jung
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea
| | - Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul, Songpa-gu, Korea.
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Şanlı H, Yıldızhan İ, Alızada M, Aydemir AT, Heper AO, Kırmızı A, Akay BN. A comprehensive study on aberrant CD20+ mycosis fungoides: clinical and prognostic insights. Clin Exp Dermatol 2024; 49:1651-1658. [PMID: 39078988 DOI: 10.1093/ced/llae297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/12/2024] [Accepted: 07/24/2024] [Indexed: 11/24/2024]
Abstract
BACKGROUND As the majority of T-cell lymphomas lack CD20 expression, cases of mycosis fungoides (MF) exhibiting aberrant CD20 expression are exceedingly uncommon. OBJECTIVES To comprehensively evaluate the clinical, histopathological and prognostic features of seven patients diagnosed with CD20+ MF. METHODS This retrospective study involved seven cases of MF with aberrant CD20 expression. The study provides details of demographics, clinical features, histopathology and treatment outcomes. Key timepoints include initial diagnosis of MF, detection of CD20 expression and follow-up, with a mean follow-up of 46 months. RESULTS Aberrant CD20+ MF was diagnosed at an average age of 58.6 years, approximately 5.6 years after the first MF diagnosis. Following CD20 detection, patients presented with advanced disease stages, requiring treatments such as chemotherapy, brentuximab vedotin and allogeneic haematopoietic stem cell transplantation. Four patients died from lymphoma, with an average survival time of 52 months. CONCLUSIONS Aberrant CD20 expression in MF is rare but indicates a progressive course associated with poor prognosis. This often requires systemic chemotherapy and, in certain instances, allogeneic haematopoietic stem cell transplantation. This study provides important insights into the clinical attributes, disease progression and treatment options for patients with MF with aberrant CD20 expression. Further research is necessary to validate the effectiveness of emerging therapies and enhance our understanding of the underlying mechanisms and prognostic determinants specific to this unique MF subgroup.
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Affiliation(s)
- Hatice Şanlı
- Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - İncilay Yıldızhan
- Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Alızada
- Mamak State Hospital, Department of Dermatology, Ankara, Turkey
| | - Ahmet Taha Aydemir
- Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aylin Okçu Heper
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayça Kırmızı
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Bengu Nisa Akay
- Department of Dermatology, Ankara University Faculty of Medicine, Ankara, Turkey
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Georgakopoulos I, Platoni K, Papadavid L, Kypraiou E, Patatoukas G, Kougioumtzopoulou A, Koumourtzis M, Kouloulias V. Radiation therapy for the management of T cell cutaneous lymphomas. Updated results of the role of low dose total skin electron beam (TSEB) therapy. Leuk Lymphoma 2024; 65:1740-1742. [PMID: 38972062 DOI: 10.1080/10428194.2024.2374049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Ioannis Georgakopoulos
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Kalliopi Platoni
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Lia Papadavid
- 2nd Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Efrosini Kypraiou
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - George Patatoukas
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Andromachi Kougioumtzopoulou
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Marios Koumourtzis
- 2nd Department of Dermatology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Vassilis Kouloulias
- 2nd Department of Radiology, Radiotherapy Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Hansen-Abeck I, Geidel G, Abeck F, Kött J, Cankaya R, Dobos G, Mitteldorf C, Nicolay JP, Albrecht JD, Menzer C, Livingstone E, Mengoni M, Braun AD, Wobser M, Klemke CD, Tratzmiller S, Assaf C, Terheyden P, Klespe KC, Schneider SW, Booken N. Pegylated interferon-α2a in cutaneous T-cell lymphoma - a multicenter retrospective data analysis with 70 patients. J Dtsch Dermatol Ges 2024; 22:1489-1497. [PMID: 39358932 DOI: 10.1111/ddg.15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/15/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Interferon-alpha is an important therapeutic option for the treatment of the cutaneous T-cell lymphomas (CTCL). Since the approved recombinant interferon-α-2a (IFN-α2a) has no longer been produced since January 2020, pegylated interferon-α2a (pegIFN-α2a) can be used as an alternative treatment, even though it is not approved for the treatment of CTCL. The aim of this multicentre study was to generate comprehensive data on the efficacy and tolerability of pegIFN-α2a in the treatment of CTCL. PATIENTS AND METHODS A multicenter retrospective study was conducted with 70 patients with CTCL from twelve German skin centers. RESULTS In total, 70 patients were included in the study, with 57.2% male and a mean age of 58.8 ± 14.9 years. Mycosis fungoides was present in 71.4% of cases and Sézary Syndrome in 28.6%. An overall response rate of 55.2% was observed with pegIFNα-2a therapy. In 50% of cases, therapy was discontinued after 63.6 ± 33.5 weeks. The most common reason for discontinuation was adverse events, which occurred in 68.6% of cases and which were classified as severe in 29.2%. Blood count changes, fatigue and liver toxicity occurred most frequently. CONCLUSIONS Our analysis provides comprehensive data on the efficacy and tolerability of pegIFNα-2a therapy in patients with CTCL. In terms of response rates and side effect profile, pegIFNα-2a appears to be comparable to IFN-α2a therapy.
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Affiliation(s)
- Inga Hansen-Abeck
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Glenn Geidel
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Finn Abeck
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Kött
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Rohat Cankaya
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabor Dobos
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
| | - Jana D Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Mannheim, Germany
| | - Christian Menzer
- Department of Dermatology, Section for DermatoOncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - Elisabeth Livingstone
- Department for Dermatology, Venereology and Allergology, Essen University Hospital, Essen, Germany
| | - Miriam Mengoni
- Department for Dermatology and Venereology, University Hospital Magdeburg, Magdeburg, Germany
| | - Andreas D Braun
- Department for Dermatology and Venereology, University Hospital Magdeburg, Magdeburg, Germany
| | - Marion Wobser
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Claus-Detlev Klemke
- Department of Dermatology and Skin Tumor Center, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Sabine Tratzmiller
- Department of Dermatology and Skin Tumor Center, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Chalid Assaf
- Department of Dermatology and Venereology, HELIOS Klinikum Krefeld and Institute for Molecular Medicine, Medical School Hamburg, Hamburg, Germany
| | - Patrick Terheyden
- Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein, Lübeck Campus, Lübeck, Germany
| | - Kai-Christian Klespe
- Department of Dermatology, Allergology and Venereology, Hannover Medical School, Hannover, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Booken
- Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Goyal A, O'Leary D, Dabaja B, Weng WK, Zain J, Cutler C, Guitart J, Kim YH, Geskin LJ, Hoppe RT, Wilson LD, Beaven AW, Horwitz S, Allen PB, Barta SK, Bohjanen K, Brammer JE, Carter JB, Comfere N, DeSimone JA, Dusenbery K, Duvic M, Huen A, Jagadeesh D, Kelsey CR, Khodadoust MS, Lechowicz MJ, Mehta-Shah N, Moskowitz AJ, Olsen EA, Poh C, Pro B, Querfeld C, Sauter C, Sokol L, Sokumbi O, Wilcox RA, Zic JA, Hamadani M, Foss F. ASTCT and USCLC Clinical Practice Recommendations for Allogeneic Stem Cell Transplant in Mycosis Fungoides and Sézary Syndrome. Transplant Cell Ther 2024; 30:1047-1060. [PMID: 39222792 DOI: 10.1016/j.jtct.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma (CTCL). While MF generally follows an indolent course, a subset of patients will experience progressive and/or treatment-refractory disease; Sézary syndrome is an aggressive lymphoma associated with high morbidity and mortality. Although allogeneic hematopoietic cell transplant (allo-HCT) is the only currently available potentially curative treatment modality for MF/SS there is no published guidance on referral criteria, transplant timing orallo-HCT approach. To develop consensus clinical practice recommendations, we performed a Delphi survey of 32 specialists in dermatology (n = 9), transplant hematology/oncology (n = 10), non-transplant hematology/oncology (n = 8), and radiation oncology (n = 5) from across the United States. Consensus required agreement of ≥75% of participants. Sixteen consensus statements were generated on four topics: (1) criteria for referral for consideration for allo-HCT, (2) allo-HCT preparative regimens and procedures (3) disease status at the time of allo-HCT, and (4) multidisciplinary management in the pre- and post-transplant settings. These clinical practice guidelines provide a framework for decision-making regarding allo-HCT for MF/SS and highlight areas for future prospective investigation.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
| | - Daniel O'Leary
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Bouthaina Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wen-Kai Weng
- Blood and Marrow Transplantation, and Cellular Therapy, Department of Medicine, Stanford University, Stanford, California
| | - Jasmine Zain
- Division of Lymphoma, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Corey Cutler
- Division of Transplantation and Cellular Therapy, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joan Guitart
- Department of Dermatology, Northwestern Feinberg School of Medicine, Evanston, Illinois
| | - Youn H Kim
- Departments of Dermatology and Medicine/Division of Oncology, Stanford University, Stanford, California
| | - Larisa J Geskin
- Department of Dermatology, Columbia University, New York, New York
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Anne W Beaven
- Division of Hematology, University of North Carolina, Chapel Hill, North Carolina
| | - Steve Horwitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pamela B Allen
- Department of Hematology & Medical Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia
| | - Stefan K Barta
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly Bohjanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan E Brammer
- Division of Hematology, Ohio State University James Comprehensive Cancer Center, Columbus, Ohio
| | - Joi B Carter
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nneka Comfere
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer A DeSimone
- Department of Dermatology, University of Virginia Schar Cancer Institute, Fairfax, Virginia
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Madeleine Duvic
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Auris Huen
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Michael S Khodadoust
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Neha Mehta-Shah
- Department of Medicine, Division of Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Alison J Moskowitz
- Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elise A Olsen
- Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christina Poh
- Division of Hematology and Oncology, University of Washington, Seattle, Washington
| | - Barbara Pro
- Department of Hematology and Oncology, New York Presbyterian - Columbia University Irving Medical Center, New York, New York
| | - Christiane Querfeld
- Department of Pathology, Division of Dermatology & Beckman Research Institute, City of Hope National Medical Center, Duarte, California
| | - Craig Sauter
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Lubomir Sokol
- Malignant Hematology, Moffitt Cancer Center, Tampa, Florida
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, Florida
| | - Ryan A Wilcox
- Division of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
| | - John A Zic
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mehdi Hamadani
- Division of Hematology & Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
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Campbell BA, Dobos G, Haider Z, Bagot M, Evison F, van der Weyden C, McCormack C, Ram-Wolff C, Miladi M, Prince HM, Scarisbrick JJ. Improving disease-specific survival for patients with Sezary syndrome in the modern era of systemic therapies. Br J Haematol 2024; 205:1825-1829. [PMID: 39031983 DOI: 10.1111/bjh.19647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 07/04/2024] [Indexed: 07/22/2024]
Abstract
Traditionally, Sezary syndrome (SS) has been associated with few therapeutic options and poor prognosis, with 5-year disease-specific survival (DSS) less than one-third in historical cohorts. However, newer therapies and combinations are associated with impressive time-to-next-treatment (TTNT), particularly allogeneic stem-cell transplantation (AlloSCT) and combination therapies notably those including extracorporeal photopheresis. In this multicentre, international study, we explored the prognostic outcomes of 178 patients exclusively managed for SS, diagnosed between 2012 and 2020, and treated in the modern therapeutic era. In this cohort, 58 different therapies were delivered, with 13.5% of patients receiving AlloSCT. Long-term survival exceeded historical reports with 5-year DSS and OS of 56.4% and 53.4% respectively. In those receiving AlloSCT, prognosis was excellent: 5-year DSS and OS were 90.5% and 78.0% respectively. Confirming the results from the Cutaneous Lymphoma International Consortium (CLIC), LDH and LCT had significant prognostic impact. Unlike earlier studies, stage did not have prognostic impact; we speculate that greater relative benefit favours patients with extensive lymphomatous nodal disease (Stage IVA2) compared to historical reports. For patients ineligible for AlloSCT, the prognosis remains relatively poor (5-year DSS 51.4% and OS 49.6%), representing ongoing unmet needs for more effective novel agents and investigation of improved therapeutic combinations.
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Affiliation(s)
- Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Gabor Dobos
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Zahra Haider
- Beckenham Beacon, Kings College Hospitals NHS Foundation Trust, London, UK
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Felicity Evison
- Health Data Science Team, Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Carrie van der Weyden
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Chris McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Caroline Ram-Wolff
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Maryam Miladi
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - H Miles Prince
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
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İsmail Mendi B, Şanlı H, Insel MA, Bayındır Aydemir B, Atak MF. Predicting Prognosis of Early-Stage Mycosis Fungoides with Utilization of Machine Learning. Life (Basel) 2024; 14:1371. [PMID: 39598170 PMCID: PMC11595863 DOI: 10.3390/life14111371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/17/2024] [Accepted: 10/23/2024] [Indexed: 11/29/2024] Open
Abstract
Mycosis fungoides (MF) is the most prevalent type of cutaneous T cell lymphomas. Studies on the prognosis of MF are limited, and no research exists on the potential of artificial intelligence to predict MF prognosis. This study aimed to compare the predictive capabilities of various machine learning (ML) algorithms in predicting progression, treatment response, and relapse and to assess their predictive power against that of the Cox proportional hazards (CPH) model in patients with early-stage MF. The data of patients aged 18 years and over who were diagnosed with early-stage MF at Ankara University Faculty of Medicine Hospital from 2006 to 2024 were retrospectively reviewed. ML algorithms were utilized to predict complete response, relapse, and disease progression using patient data. Of the 185 patients, 94 (50.8%) were female, and 91 (49.2%) were male. Complete response was observed in 114 patients (61.6%), while relapse and progression occurred in 69 (37.3%) and 54 (29.2%) patients, respectively. For predicting progression, the Support Vector Machine (SVM) algorithm demonstrated the highest success rate, with an accuracy of 75%, outperforming the CPH model (C-index: 0.652 for SVM vs. 0.501 for CPH). The most successful model for predicting complete response was the Ensemble model, with an accuracy of 68.89%, surpassing the CPH model (C-index: 0.662 for the Ensemble model vs. 0.543 for CPH). For predicting relapse, the decision tree classifier showed the highest performance, with an accuracy of 78.17%, outperforming the CPH model (C-index: 0.782 for the decision tree classifier vs. 0.505 for CPH). The results suggest that ML algorithms may be useful in predicting prognosis in early-stage MF patients.
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Affiliation(s)
- Banu İsmail Mendi
- Department of Dermatology, Niğde Ömer Halisdemir University Training and Research Hospital, Niğde 51000, Türkiye
| | - Hatice Şanlı
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara 06620, Türkiye; (H.Ş.); (B.B.A.)
| | - Mert Akın Insel
- Department of Chemical Engineering, Yıldız Technical University, İstanbul 34220, Türkiye;
| | - Beliz Bayındır Aydemir
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara 06620, Türkiye; (H.Ş.); (B.B.A.)
| | - Mehmet Fatih Atak
- Department of Dermatology, New York Medical College, Valhalla, NY 10595, USA;
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Danielsen M, Emmanuel T, Nielsen MM, Lindahl LM, Gluud M, Ødum N, Raaby L, Steiniche T, Iversen L, Bech R, Buus TB, Johansen C. RUNX2 as a novel biomarker for early identification of patients progressing to advanced-stage mycosis fungoides. Front Oncol 2024; 14:1421443. [PMID: 39435287 PMCID: PMC11491341 DOI: 10.3389/fonc.2024.1421443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 09/04/2024] [Indexed: 10/23/2024] Open
Abstract
Introduction The majority of patients with mycosis fungoides (MF) have an indolent disease course, but a substantial fraction (20-30%) of patients progress to advanced stages - usually with a grave prognosis. Early differentiation between indolent and aggressive types of MF is important for the choice of treatment regimen and monitoring of the individual patient. Good biomarkers are therefore desired. Methods Here, we used spatial transcriptomics on skin samples at time-of-diagnosis to enable prediction of patients who later progressed to advanced stages of MF. Formalin-fixed, paraffin-embedded skin biopsies at time of diagnosis from six patients with MF who progressed to advanced stages of disease within 4 months to 12 years after diagnosis, and nine patients who remained in early-stage disease over 9 to 27 years were analyzed using the GeoMx Digital Spatial Profiler to capture spatially resolved high-plex RNA gene expression data. Five different regions of interest (the epidermis, the basal layer of epidermis, CD4+ T-cells and neighboring cells, and Pautrier's microabscesses) were profiled for further assessment. Results and discussion Interestingly, RUNX2, SHMT2, and MCM7 were upregulated in the enriched population of malignant T-cells in Pautrier's microabscesses in patients who later developed advanced stages of disease. Expression of RUNX2, SHMT2 and MCM7 in malignant T-cells was confirmed in a subset of patients in MF skin using scRNA-seq datasets across multiple studies and correlating with stage of disease. Taken together, we provide first evidence that RUNX2 has potential as a biomarker to identify MF patients progressing to advanced stage disease. As RUNX2 has not previously been linked to MF, our data also shows the analytical strength of combining spatial transcriptomics with scRNA-seq analysis.
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Affiliation(s)
- Maria Danielsen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Emmanuel
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Muhlig Nielsen
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus, Denmark
| | | | - Maria Gluud
- Skin Immunology Research Center, Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Niels Ødum
- Skin Immunology Research Center, Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Line Raaby
- Department of Molecular Medicine (MOMA), Aarhus University Hospital, Aarhus, Denmark
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Bech
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Terkild Brink Buus
- Skin Immunology Research Center, Department of Immunology & Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Claus Johansen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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Atci T, Ozturk Sari S, Buyukbabani N, Besisik S, Baykal C. Evaluation of the prognostic significance of clinical features of tumoral lesions in an extensive series of mycosis fungoides. Int J Dermatol 2024; 63:1404-1413. [PMID: 38440839 DOI: 10.1111/ijd.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/31/2024] [Accepted: 02/19/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Tumors indicating the advanced stage of mycosis fungoides (MF) have a rich clinical spectrum. Although it is known that the prognosis of MF generally worsens following the development of tumors, some cases may have a relatively indolent course, and the role of clinical characteristics regarding prognosis has still not been well understood. METHODS MF patients were retrospectively evaluated regarding the development of tumors. Besides demographic characteristics, data of the subtype and stage of the disease were recorded. The clinical features of tumors, including number (<5, 5-10, 11-20, or >20), location, dimension (diameter of ≥5 cm), presence of ulceration, and surrounding inflammation, were noted. Univariate and multivariate analyses evaluated the relationship between overall survival (OS) with demographic and clinical features. RESULTS Among 730 consecutive MF patients, tumors developed in 8.2% (n = 60), of whom 46.7% were diagnosed with advanced-stage MF from the beginning. The most common subtype was folliculotropic MF (53.3%). Most patients (55%) had multiple tumors, and the most frequent localization was the trunk (71.7%). Most tumors presented as smooth-surfaced, indurated papules and/or nodules (70%), while others were reddish-purple, occasionally accompanied by ulceration (50%), perilesional inflammation (23.3%), and attaining large dimensions (25%). Mortality was recorded in 51.7% of patients, and the 5-year OS rate from the diagnosis of tumors was 49%. Independent poor prognostic factors for OS in multivariate analysis included older age at the time of diagnosis, presence of tumors at the initial MF diagnosis, presence of over 20 tumors, and the existence of large tumors. CONCLUSIONS Tumoral MF seen in older patients, the first diagnosis of MF in this stage, presenting with generalized and large tumors, seems to be a predictive factor for OS.
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Affiliation(s)
- Tugba Atci
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sule Ozturk Sari
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
- Department of Pathology, Koc University Medical Faculty, Istanbul, Turkey
| | - Sevgi Besisik
- Department of Hematology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Can Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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Melchers S, Roemer M, Albrecht JD, Assaf C, von Gugelberg C, Guenova E, Klemke CD, Moritz RKC, Schlaak M, Stadler R, Wehkamp U, Wobser M, Albrecht T, Goerdt S, Schneider S, Nicolay JP. Evaluation of Sézary cell marker expression and cell death behaviour upon in vitro treatment by flow cytometry in Sézary syndrome patients. Exp Dermatol 2024; 33:e15171. [PMID: 39219147 DOI: 10.1111/exd.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 08/12/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
The diagnosis of Sézary syndrome (SS) relies on the identification of blood Sézary cells (SC) by different markers via flow cytometry. Treatment of SS is challenging since its pathogenesis is characterized by cell death resistance rather than hyperproliferation. In this study, we establish an integrated approach that considers both the expression of SC markers and sensitivity to cell death both spontaneously and upon in vitro treatment. Peripheral blood mononuclear cells were isolated from 20 SS patients and analysed for the SC markers CD7 and CD26 loss as well as CD158k and PD1 gain. The cells were then treated with different established and experimental therapies in vitro and cell death was measured. Spontaneous and therapeutically induced cell death were measured and correlated to cellular marker profiles. In the marker-positive cells, spontaneous cell death sensitivity was reduced. Different treatments in vitro managed to specifically induce cell death in the putative CTCL cell populations. Interestingly, a repeated analysis after 3 months of treatment revealed the CTCL cell death sensitivity to be restored by therapy. We propose this novel integrated approach comprising the evaluation of SC marker expression and analysis of cell death sensitivity upon treatment that can also enable a better therapy stratification.
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Affiliation(s)
- S Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Roemer
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - J D Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Assaf
- Department of Dermatology, HELIOS Klinik Krefeld, Krefeld, Germany
| | - C von Gugelberg
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - E Guenova
- Department of Dermatology, Lausanne University Hospital, Lausanne, Switzerland
| | - C-D Klemke
- Department of Dermatology, Municipal Medical Center Karlsruhe, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - R K C Moritz
- Department of Dermatology, University Hospital Halle, Halle, Germany
- Department of Dermatology, Venerology and Allergology, Freie Universität Berlin and Humboldt-Universität zu Berlin, University Medical Centre Berlin, Berlin, Germany
| | - M Schlaak
- Department of Dermatology, University Hospital Munich, Munich, Germany
| | - R Stadler
- Department of Dermatology, Johannes-Wesling-Clinic Minden and University of Bochum, Bochum, Germany
| | - U Wehkamp
- Department of Dermatology, University Hospital Kiel, Kiel, Germany
| | - M Wobser
- Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany
| | - T Albrecht
- Department of Pathology, Ruprechts-Karls-University of Heidelberg, Heidelberg, Germany
| | - S Goerdt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
| | - S Schneider
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mannheim, Ruprecht-Karls-University of Heidelberg, Mannheim, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim/University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section of Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Moreno-Vílchez C, Servitje O, Íñiguez-Arroyo Ó, Muniesa C. Survival Analysis and Prognostic Factors in a Case Series of 148 Cutaneous T-Cell Lymphomas. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:766-772. [PMID: 38159841 DOI: 10.1016/j.ad.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cutaneous T-cell lymphomas (CTCL) such as mycosis fungoides (MF) and Sézary syndrome (SS) are rare lymphomas with varying prognoses. The aim of the study was to describe the survival of a cohort of patients with MF/SS and evaluate the prognostic factors impacting disease survival. MATERIALS AND METHODS All cases of MF/SS diagnosed from 2008 through 2022 were retrospectively analyzed. The demographic variables, histological parameters, and analytical data were analyzed too. Progression-free survival (PFS) and disease-specific survival (DSS) were calculated. RESULTS A total of 148 cases were included. A total of 121 (82%) and 27 cases were diagnosed with MF, and SS, respectively. A total of 37 patients (25%) experienced progression at some point disease progression. The median PFS and median DSS were 127 and 135 months, respectively. Age >60 years, diagnosis of SS, the presence of large cell transformation (LCT) at diagnosis, folliculotropism in early stages, high Ki-67 expression, the presence of the clonal T-cell receptor (TCR) in blood, elevated LDH and B2M levels, and advanced stages (IIB, IVA, T3, T4, N3/Nx) were associated with worse prognosis across the entire cohort. CONCLUSIONS Stage IVA and the presence of LCT at diagnosis stood out as independent factors of unfavorable prognosis. LCT was the variable that most significantly impacted the patients' survival and was closely associated with tumor skin involvement and stage IIB.
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Affiliation(s)
- C Moreno-Vílchez
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España
| | - O Servitje
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España
| | - Ó Íñiguez-Arroyo
- Facultad de Medicina y Ciencias de la Salud, Campus Bellvitge, Universitat de Barcelona, Barcelona, España
| | - C Muniesa
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España.
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48
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Moreno-Vílchez C, Servitje O, Íñiguez-Arroyo Ó, Muniesa C. [Translated article] Survival Analysis and Prognostic Factors in a Case Series of 148 Cutaneous T-Cell Lymphomas. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T766-T772. [PMID: 38972577 DOI: 10.1016/j.ad.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cutaneous T-cell lymphomas (CTCL) such as mycosis fungoides (MF) and Sézary syndrome (SS) are rare lymphomas with varying prognoses. The aim of the study was to describe the survival of a cohort of patients with MF/SS and evaluate the prognostic factors impacting disease survival. MATERIALS AND METHODS All cases of MF/SS diagnosed from 2008 through 2022 were retrospectively analyzed. The demographic variables, histological parameters, and analytical data were analyzed too. Progression-free survival (PFS) and disease-specific survival (DSS) were calculated. RESULTS A total of 148 cases were included. A total of 121 (82%) and 27 cases were diagnosed with MF, and SS, respectively. A total of 37 patients (25%) experienced progression at some point disease progression. The median PFS and median DSS were 127 and 135 months, respectively. Age >60 years, diagnosis of SS, the presence of large cell transformation (LCT) at diagnosis, folliculotropism in early stages, high Ki-67 expression, the presence of the clonal T-cell receptor (TCR) in blood, elevated LDH and B2M levels, and advanced stages (IIB, IVA, T3, T4, N3/Nx) were associated with worse prognosis across the entire cohort. CONCLUSIONS Stage IVA and the presence of LCT at diagnosis stood out as independent factors of unfavorable prognosis. LCT was the variable that most significantly impacted the patients' survival and was closely associated with tumor skin involvement and stage IIB.
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Affiliation(s)
- C Moreno-Vílchez
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - O Servitje
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Ó Íñiguez-Arroyo
- Facultad de Medicina y Ciencias de la Salud, Campus Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - C Muniesa
- Servicio de Dermatología, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
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Licht P, Dominelli N, Kleemann J, Pastore S, Müller ES, Haist M, Hartmann KS, Stege H, Bros M, Meissner M, Grabbe S, Heermann R, Mailänder V. The skin microbiome stratifies patients with cutaneous T cell lymphoma and determines event-free survival. NPJ Biofilms Microbiomes 2024; 10:74. [PMID: 39198450 PMCID: PMC11358159 DOI: 10.1038/s41522-024-00542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/31/2024] [Indexed: 09/01/2024] Open
Abstract
Mycosis fungoides (MF) is the most common entity of Cutaneous T cell lymphomas (CTCL) and is characterized by the presence of clonal malignant T cells in the skin. The role of the skin microbiome for MF development and progression are currently poorly understood. Using shotgun metagenomic profiling, real-time qPCR, and T cell receptor sequencing, we compared lesional and nonlesional skin of 20 MF patients with early and advanced MF. Additionally, we isolated Staphylococcus aureus and other bacteria from MF skin for functional profiling and to study the S. aureus virulence factor spa. We identified a subgroup of MF patients with substantial dysbiosis on MF lesions and concomitant outgrowth of S. aureus on plaque-staged lesions, while the other MF patients had a balanced microbiome on lesional skin. Dysbiosis and S. aureus outgrowth were accompanied by ectopic levels of cutaneous antimicrobial peptides (AMPs), including adaptation of the plaque-derived S. aureus strain. Furthermore, the plaque-derived S. aureus strain showed a reduced susceptibility towards antibiotics and an upregulation of the virulence factor spa, which may activate the NF-κB pathway. Remarkably, patients with dysbiosis on MF lesions had a restricted T cell receptor repertoire and significantly lower event-free survival. Our study highlights the potential for microbiome-modulating treatments targeting S. aureus to prevent MF progression.
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Affiliation(s)
- Philipp Licht
- University Medical Centre Mainz, Department of Dermatology, Mainz, Germany.
| | - Nazzareno Dominelli
- Johannes Gutenberg-University, Institute of Molecular Physiology (imP), Biocenter II, Microbiology and Biotechnology, Mainz, Germany
| | - Johannes Kleemann
- University Hospital Frankfurt, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Stefan Pastore
- University Medical Centre Mainz, Institute of Human Genetics, Mainz, Germany
- Johannes Gutenberg-University, Institute of Pharmaceutical and Biomedical Sciences, Mainz, Germany
| | - Elena-Sophia Müller
- Johannes Gutenberg-University, Institute of Molecular Physiology (imP), Biocenter II, Microbiology and Biotechnology, Mainz, Germany
| | - Maximilian Haist
- University Medical Centre Mainz, Department of Dermatology, Mainz, Germany
| | | | - Henner Stege
- University Medical Centre Mainz, Department of Dermatology, Mainz, Germany
| | - Matthias Bros
- University Medical Centre Mainz, Department of Dermatology, Mainz, Germany
| | - Markus Meissner
- University Hospital Frankfurt, Department of Dermatology, Venerology and Allergology, Frankfurt am Main, Germany
| | - Stephan Grabbe
- University Medical Centre Mainz, Department of Dermatology, Mainz, Germany
| | - Ralf Heermann
- Johannes Gutenberg-University, Institute of Molecular Physiology (imP), Biocenter II, Microbiology and Biotechnology, Mainz, Germany
| | - Volker Mailänder
- University Medical Centre Mainz, Department of Dermatology, Mainz, Germany.
- Max Planck Institute for Polymer Research, Mainz, Germany.
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Moon IJ, Won CH, Chang SE, Park CS, Yoon DH, Song SY, Lee MW, Lee WJ. Prevalence, clinical features, and survival outcome trends of 627 patients with primary cutaneous lymphoma over 29 years: a retrospective review from single tertiary center in Korea. Sci Rep 2024; 14:20118. [PMID: 39210040 PMCID: PMC11362517 DOI: 10.1038/s41598-024-71210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
The relative frequency of primary cutaneous lymphoma (PCL) subtypes shows wide variation across different geographical regions. This retrospective study was conducted in a tertiary referral center located in Korea to describe the relative frequency, demographics, survival outcomes, and temporal trend in PCL. A total of 627 PCL cases diagnosed between January 1994 and December 2022 were included. The majority of PCL cases (87.2%) were of T-/NK-cell lineage (CTCL), while the remaining cases (12.8%) were B-cell lineage lymphomas (CBCL). The prevalence of mycosis fungoides (MF) in CTCL increased significantly over time, while other CTCL subtypes, including primary cutaneous extranodal NK/T-cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma (SPTCL), decreased in frequency. Notably, the prevalence of CD4-positive small/medium T-cell lymphoproliferative disorder showed a substantial increase over time. Primary cutaneous marginal zone lymphoma was consistently the commonest CBCL subtype. Survival analysis demonstrated that CTCL had a more favorable 5-year overall survival (OS) than CBCL. OS rate of MF, SPTCL, and primary cutaneous peripheral T-cell lymphoma, NOS improved significantly over time. This study provides comprehensive insights into the dynamic change in the relative frequency and overall survival of PCL subtypes over time.
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MESH Headings
- Humans
- Male
- Female
- Retrospective Studies
- Republic of Korea/epidemiology
- Middle Aged
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Skin Neoplasms/epidemiology
- Prevalence
- Adult
- Tertiary Care Centers
- Aged
- Lymphoma, T-Cell, Cutaneous/mortality
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Young Adult
- Aged, 80 and over
- Adolescent
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/pathology
- Child
- Survival Analysis
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Affiliation(s)
- Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok-Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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