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Ma H, Marchi E, O'Connor OA, Lue JK. Mature T-cell and NK-cell lymphoma involvement of the central nervous system: a single center experience. Leuk Lymphoma 2023; 64:1964-1970. [PMID: 37565580 DOI: 10.1080/10428194.2023.2245513] [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: 03/27/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Mature T-cell and NK-cell lymphomas (MTNKL) are rare and heterogeneous lymphoproliferative disorders with poor clinical outcomes despite novel therapeutic advances. Although infrequent, central nervous system (CNS) involvement by MTNKL is associated with poor outcomes with a median overall survival (OS) of <12 months based on retrospective studies. We performed a retrospective analysis of patients who developed CNS involvement of MTNKL diagnosed at a single center from 1999 through 2020. Twenty-five patients were identified. Characteristics such as a diagnosis of adult T-cell leukemia/lymphoma, extranodal involvement, and poor performance status were associated with a higher risk of CNS involvement (p < 0.01). The median OS after diagnosis with CNS involvement was approximately 1 month (0.03-103.97 months). Patients exposed to novel therapeutics and/or clinical trial enrollment tolerated treatment without safety concerns and appeared to derive reasonable therapeutic benefit. Despite advances in the field, new therapeutic approaches are needed for patients with MTNKL with CNS involvement.
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Affiliation(s)
- Helen Ma
- Section of Hematology/Oncology, Department of Medicine, VA Long Beach Healthcare System, Long Beach, CA, USA
- Division of Hematology-Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Enrica Marchi
- Program for T-Cell Lymphoma Research, Division of Hematology-Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Owen A O'Connor
- Program for T-Cell Lymphoma Research, Division of Hematology-Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Jennifer K Lue
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Gordon MJ, Duan Z, Zhao H, Nastoupil L, Ng S, Danilov AV, Iyer S, Giordano SH. Influence of treatment intensity and medical comorbidities in older adults with peripheral T cell lymphoma. Leuk Lymphoma 2023; 64:2258-2268. [PMID: 37706491 PMCID: PMC10841322 DOI: 10.1080/10428194.2023.2256908] [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: 06/22/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
We conducted a population-based study of patients >65 years, diagnosed 2008-2017, with peripheral T-cell lymphoma (PTCL) using SEER-Medicare. Associations between PTCL subtype, treatment regimen, comorbidity, and mortality were assessed using the Kaplan-Meier method and multivariable Cox regression. Amongst the 2,546 patients, the median age was 77 years (interquartile range, 71-83). 5-year overall survival (OS) ranged from 22.2% to 37.3% depending on PTCL subtype. The most common frontline regimen was cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). 5-year OS rate was 47.0% for patients treated with etoposide + CHOP (N = 67; CHOEP), 33.7% for those treated with CHOP (N = 732), and 23.8% for patients treated with non-anthracycline-containing regimens (N = 105; p < 0.001). In patients without comorbidities, CHOEP remained independently associated with improved OS (HR 0.52, 95% CI,0.30-0.91). Median OS was 1.2 years from initiation of second-line therapy (N = 228) independent of treatment regimen. Frontline but not second-line treatment regimen is associated with OS in older patients with PTCL.
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Affiliation(s)
- Max J. Gordon
- The University of Texas MD Anderson Cancer Center, Department of Cancer Medicine, Houston, TX, USA
| | - Zhigang Duan
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, USA
| | - Hui Zhao
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, USA
| | - Loretta Nastoupil
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma and Myeloma, Houston, TX, USA
| | - Samuel Ng
- National Cancer Institute, Lymphoid Malignancies Branch, Bethesda, MD, USA
| | - Alexey V. Danilov
- City of Hope National Medical Center, Department of Hematology & Hematopoietic Cell Transplantation, Duarte, CA, USA
| | - Swaminathan Iyer
- The University of Texas MD Anderson Cancer Center, Department of Lymphoma and Myeloma, Houston, TX, USA
| | - Sharon H. Giordano
- The University of Texas MD Anderson Cancer Center, Department of Health Services Research, Houston, TX, USA
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3
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Carty SA, Murga-Zamalloa CA, Wilcox RA. SOHO State of the Art Updates and Next Questions | New Pathways and New Targets in PTCL: Staying on Target. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:561-574. [PMID: 37142534 PMCID: PMC10565700 DOI: 10.1016/j.clml.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/05/2023] [Accepted: 04/16/2023] [Indexed: 05/06/2023]
Abstract
While the peripheral T-cell lymphomas (PTCL) remain a therapeutic challenge, and increasingly account for a disproportionate number of lymphoma-related deaths, improved understanding of disease pathogenesis and classification, and the development of novel therapeutic agents over the past decade, all provide reasons for a more optimistic outlook in the next. Despite their genetic and molecular heterogeneity, many PTCL are dependent upon signaling input provided by antigen, costimulatory, and cytokine receptors. While gain-of-function alterations effecting these pathways are recurrently observed in many PTCL, more often than not, signaling remains ligand-and tumor microenvironment (TME)-dependent. Consequently, the TME and its constituents are increasingly recognized as "on target". Utilizing a "3 signal" model, we will review new-and old-therapeutic targets that are relevant for the more common nodal PTCL subtypes.
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Affiliation(s)
- Shannon A Carty
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI
| | | | - Ryan A Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI.
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Kalac M, Jain S, Tam CS, Xiao Z, Montanari F, Kanakry J, Huber BD, Goldfinger M, O’Connor OA, Marchi E. Real-world experience of combined treatment with azacitidine and romidepsin in patients with peripheral T-cell lymphoma. Blood Adv 2023; 7:3760-3763. [PMID: 36790924 PMCID: PMC10368677 DOI: 10.1182/bloodadvances.2022009445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- Matko Kalac
- Department of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Hematology and Oncology, University of California, Irvine, CA
| | - Salvia Jain
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Constantine S. Tam
- Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Zhengrui Xiao
- Department of Medicine, Albert Einstein College of Medicine, New York, NY
| | | | - Jennifer Kanakry
- Experimental Transplantation & Immunotherapy Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bryan D. Huber
- Blood and Marrow Transplant/Acute Leukemia Program, Intermountain Medical Group, Salt Lake City, UT
| | - Mendel Goldfinger
- Department of Medicine, Albert Einstein College of Medicine, New York, NY
| | - Owen A. O’Connor
- Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA
| | - Enrica Marchi
- Division of Hematology and Oncology, University of Virginia Cancer Center, Charlottesville, VA
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Sterling CH, Hughes MS, Tsai HL, Yarkony K, Fuchs EJ, Swinnen LJ, Paul S, Bolaños-Meade J, Luznik L, Imus PH, Ali SA, Jain T, Ambinder A, DeZern A, Huff CA, Gocke CB, Varadhan R, Wagner-Johnston N, Jones RJ, Ambinder RF. Allogeneic Blood or Marrow Transplantation with Post-Transplantation Cyclophosphamide for Peripheral T Cell Lymphoma: The Importance of Graft Source. Transplant Cell Ther 2023; 29:267.e1-267.e5. [PMID: 36549386 PMCID: PMC10040425 DOI: 10.1016/j.jtct.2022.12.009] [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: 10/05/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
The use of post-transplantation cyclophosphamide (PTCy) for graft-versus host-disease (GVHD) prophylaxis has revolutionized allogeneic blood or marrow transplantation (alloBMT), but there is limited published experience in peripheral T cell lymphoma (PTCL). We sought to assess outcomes in patients with PTCL who underwent alloBMT with PTCy. We reviewed the charts of all adult patients age ≥18 years who underwent alloBMT with nonmyeloablative conditioning and PTCy-based GVHD prophylaxis at the Sidney Kimmel Comprehensive Cancer Center between January 2004 and December 2020. Sixty-five patients were identified. The median age was 59 years (range, 24 to 75 years). Lymphoma histology included PTCL not otherwise specified (n = 24), anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (n = 14), angioimmunoblastic T cell lymphoma (n = 7), enteropathy-associated T cell lymphoma (n = 6), hepatosplenic T cell lymphoma (n = 4), and others (n = 10). Eleven patients were in first complete remission (17%); the remaining patients were in first partial remission or underwent salvage therapy to at least PR prior to transplantation. Forty-eight patients underwent alloBMT from a haploidentical related donor (74%), 10 from a fully matched donor (15%), and 7 from a mismatched unrelated donor (11%). All patients received fludarabine, cyclophosphamide, and total body irradiation (TBI). The graft source was bone marrow (BM) in 46 patients (71%) and peripheral blood (PB) in 19 patients (29%); all patients in the BM cohort received 200 cGy TBI, and most patients in the PB cohort (15 of 19) received 400 cGy TBI. GVHD prophylaxis comprised PTCy, mycophenolate mofetil, and a calcineurin inhibitor or sirolimus. With a median follow-up of 2.8 years (range, 290 days to 14.2 years), the 2-year progression-free survival (PFS) for the entire cohort was 49% (95% confidence interval [CI], 38% to 64%), and the 2-year overall survival (OS) was 55% (95% CI, 44% to 69%). Outcomes were significantly improved in those receiving PB compared to those receiving BM, including a 2-year PFS of 79% (95% CI 63% to 100%) versus 39% (95% CI, 27% to 56%), 2-year OS of 84% (95% CI, 69% to 100%) versus 46% (95% CI, 33% to 63%), and 1-year cumulative incidence of relapse of 5% (95% CI, 0 to 16%) versus 33% (95% CI, 19% to 46%), with no difference in GVHD and nonrelapse mortality. AlloBMT with PTCy is safe and well-tolerated in patients with PTCL. Our data suggest that increasing the TBI dose to 400 cGy and using PB allografts may offer improved disease control and better survival outcomes, though additional studies are needed to confirm these findings.
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Affiliation(s)
- Cole H Sterling
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Michael S Hughes
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hua-Ling Tsai
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathryn Yarkony
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ephraim J Fuchs
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lode J Swinnen
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Suman Paul
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leo Luznik
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Philip H Imus
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Abbas Ali
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tania Jain
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Ambinder
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy DeZern
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian B Gocke
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ravi Varadhan
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nina Wagner-Johnston
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Jones
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard F Ambinder
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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6
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Weiss J, Reneau J, Wilcox RA. PTCL, NOS: An update on classification, risk-stratification, and treatment. Front Oncol 2023; 13:1101441. [PMID: 36845711 PMCID: PMC9947853 DOI: 10.3389/fonc.2023.1101441] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
The peripheral T-cell lymphomas (PTCL) are relatively rare, heterogeneous, and therapeutically challenging. While significant therapeutic gains and improved understanding of disease pathogenesis have been realized for selected PTCL subtypes, the most common PTCL in North America remains "not otherwise specified (NOS)" and is an unmet need. However, improved understanding of the genetic landscape and ontogeny for the PTCL subtypes currently classified as PTCL, NOS have been realized, and have significant therapeutic implications, which will be reviewed here.
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Affiliation(s)
- Jonathan Weiss
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - John Reneau
- Department of Medicine, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | - Ryan A. Wilcox
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
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7
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Pichler A. News on Peripheral T-cell lymphoma. MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2023. [DOI: 10.1007/s12254-022-00864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
SummaryPeripheral T‑cell lymphomas (PTCL) are a heterogeneous group of rare lymphoid malignancies. Brentuximab vedotin plus cyclophosphamide, doxorubicin, and prednisone (BV+CHP, anti-CD30) is indicated as first-line treatment in the subgroup anaplastic large cell lymphoma (ALCL). Romidepsin plus cyclophosphamide, doxorubicin, vincristine, and prednisone (Ro-CHOP) is inferior to CHOP in PTCL; however, the subtype angioimmunoblastic T‑cell lymphoma (AITL) might favor Ro-CHOP. An increase of survival after consolidation with autologous stem cell transplantation (ASCT) in first line was found in a retrospective analysis. New antibody (anti-CD47 or anti-KIR3DL2) and CAR T/NK treatments are emerging and entering clinical trials.
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8
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Stuver R, Moskowitz AJ. Therapeutic Advances in Relapsed and Refractory Peripheral T-Cell Lymphoma. Cancers (Basel) 2023; 15:cancers15030589. [PMID: 36765544 PMCID: PMC9913081 DOI: 10.3390/cancers15030589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Historic outcomes for patients with relapsed or refractory nodal-based T-cell lymphomas are poor, with survival generally measured in months in multiple reports from the late 20th and early 21st century. Until recently, salvage strategies have mostly been borrowed from other aggressive lymphomas. However, dedicated investigations into the pathogenesis of T-cell lymphomas have resulted in an outpouring of therapies that target these diseases in biologically rational strategies. In particular, an evolving appreciation of the multiple complex oncogenic pathways and epigenetic changes that underlie these diseases has led to numerous agents targeting these aberrancies. Moreover, large reports of salvage allogeneic stem cell transplants in T-cell lymphoma have now been published, showing that adaptive immunotherapy is a potentially curative strategy for patients with relapsed or refractory disease. This review highlights therapeutic advances for relapsed or refractory T-cell lymphomas, including cellular therapy and allogeneic stem cell transplant, and provides a framework for management.
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Shafagati N, Koh MJ, Boussi L, Park HJ, Stuver R, Bain P, Foss FM, Shen C, Jain S. Comparative efficacy and tolerability of novel agents vs chemotherapy in relapsed and refractory T-cell lymphomas: a meta-analysis. Blood Adv 2022; 6:4740-4762. [PMID: 35816645 PMCID: PMC9631658 DOI: 10.1182/bloodadvances.2022007425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Optimal treatment strategies for (relapsed and refractory [R/R]) peripheral T-cell lymphoma (PTCL) have not been well defined, and with the approval of several novel single agents (SA), the comparative efficacy of combination chemotherapy (CC) to single-agent strategies remains unclear. We conducted a meta-analysis to evaluate overall response rates (ORR) and toxicities of SA to CC. MEDLINE, Embase, Web of Science Core Collection, and Cochrane were systematically searched for phase I, phase II, and phase III trials investigating a defined SA or an anthracycline-, ifosfamide-, gemcitabine-, and platinum-based regimens. One hundred and fifty-one articles were included, encompassing single and combinations of 60 phase I trials involving 1075 patients, 95 phase II trials involving 3246, and 23 phase III trials involving 1888 patients. There was a high degree of heterogeneity in the trials. Using a random-effects model, the estimated ORR for SA in phase I trials were 40% (95% confidence interval [CI], 34.7%, 46.9%) relative to 41% for CC (95% CI, 27.4%, 56.1%; P = .97) and in phase II trials 34.4% (95% CI, 30.4%, 38.7%) for SA vs 55.3% (95% CI, 31%, 77.2%; P = .1) for CC. There were significant subgroup differences in ORR between histological subtypes of PTCL and drug classes. Our results highlight SA as an attractive outpatient option for R/R PTCL, and their incorporation in the development of upfront treatment paradigms merits urgent consideration. Our results underscore enrollment in clinical trials of SA as a critical strategy for R/R PTCL.
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Affiliation(s)
- Nazila Shafagati
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Min J. Koh
- School of Medicine, Georgetown University, Washington, DC
| | - Leora Boussi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Robert Stuver
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Bain
- Harvard Medical School, Harvard University, Boston, MA
| | - Francine M. Foss
- Department of Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT
| | - Changyu Shen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Biogen, Cambridge, MA
| | - Salvia Jain
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA; and
- Harvard Medical School, Boston, MA
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10
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Comprehensive comparison of international prognostic indexes for follicular helper T-cell lymphoma. Ann Hematol 2022; 101:1535-1543. [PMID: 35639152 DOI: 10.1007/s00277-022-04805-y] [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: 10/26/2021] [Accepted: 02/21/2022] [Indexed: 11/01/2022]
Abstract
In 2016, World Health Organization classification of lymphoid neoplasms separated firmly-follicular helper (Tfh) cell origin lymphomas from peripheral T-cell lymphoma-not specified (PTCL-NOS) based on their unique immunogenic characteristics. Generally, Tfh cell origin lymphoma, which has an approximately 25% incidence, is classified into three categories: angioimmunoblastic T-cell lymphoma (AITL), follicular peripheral T-cell lymphoma (F-PTCL), and nodal peripheral T-cell lymphoma with a T-follicular helper phenotype (nodal PTCL with Tfh cell phenotype). Their prognosis has been estimated using four traditional prognostic tools for T-cell lymphoid malignancies: the international prognostic index (IPI), the prognostic index for peripheral T-cell lymphoma unspecified (PIT), the modified PIT (mPIT) and the international T-cell lymphoma project index. In addition, the AITL score that reflects AITL characteristics well has been introduced recently. However, there are no clear guidelines for evaluating the prognosis of Tfh cell lymphoma. Thus, we performed a comparative analysis to determine which of these five indexes is most suitable for Tfh cell lymphoma. We evaluated the accuracy of classification according to risk score and predicted survival rate. Based on review by lymphoma pathology experts, we enrolled 198 patients diagnosed with Tfh cell lymphoma in this retrospective study. AITL was the most common subtype (n = 168), followed by F-PTCL (n = 21) and nodal PTCL with Tfh cell phenotype (n = 9). The median progression-free survival and overall survival with front-line treatment was 0.8 years (95% confidence interval [CI], 0.6-1.1 years) and 2.9 years (95% CI, 1.6-4.2 years), respectively. The AITL score showed better differentiation than other scoring systems in terms of classification according to risk score. However, for predicting PFS (concordance-index [C-index], IPI vs. PIT vs. modified PIT vs. international T-cell lymphoma project index vs. AITL score; 0.617 vs. 0.605 vs. 0.576 vs. 0.591 vs. 0.592) and OS (C-index, IPI vs. PIT vs. modified PIT vs. international T-cell lymphoma project index vs. AITL score; 0.663 vs. 0.651 vs. 0.612 vs. 0.672 vs. 0.583), the IPI, and the international T-cell lymphoma project index showed better performance. In conclusion, there are unmet needs to develop a prognostic index for Tfh cell lymphoma because its characteristics differ from PTCL-NOS. Although the AITL score reflects Tfh cell-origin lymphoma characteristics well and clearly shows their power of classification according to risk score, there are concerns about accurate prediction of survival outcomes. Therefore, it seems too early to settle on a single scoring system in Tfh cell origin lymphoma. In the future, along with classification, a more effective tool for survival prediction needs to be developed that reflects the specific characteristics of T-cell lymphoma.
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11
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Impact of comorbidity in elderly patients with peripheral T-cell lymphoma: an international retrospective analysis of 891 patients. Blood Adv 2021; 6:2120-2128. [PMID: 34570186 PMCID: PMC9006283 DOI: 10.1182/bloodadvances.2021004269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/08/2021] [Indexed: 11/20/2022] Open
Abstract
This is the largest study to publish outcomes on an older PTCL cohort. Higher CCI score correlates with worse OS in PTCL.
Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive neoplasms with poor outcomes, commonly affecting older patients with comorbidities. This study aims to describe outcomes of older patients with PTCL in a large international cohort. Patients aged ≥70 years with PTCL diagnosed from 1 January 2010 to 31 December 2015 in the Swedish Lymphoma Registry (SLR) and California Cancer Registry (CCR) were identified. Data on comorbidity were retrospectively collected according to the Charlson Comorbidity Index (CCI), and clinical outcomes were extracted. A total of 891 patients were included (SLR, n = 173; CCR, n = 718). Median age was 77 (SLR) and 78 (CCR) years. Included subtypes were as follows: angioimmunoblastic T-cell lymphoma, n = 226; anaplastic large-cell lymphoma, n = 122; enteropathy-associated T-cell lymphoma (EATL), n = 31; hepatosplenic TCL, n = 7; natural killer–/T-cell lymphoma, n = 62; PTCL not otherwise specified, n = 443. CCI data were available in 775 patients (87%), and CCI scores were divided into the groups CCI = 0 (39%), CCI = 1 (22%), and CCI > 1 (39%). Median age did not differ among the CCI groups (P = .72). Patients with a CCI > 1 had a worse median overall survival (4.4 months) compared with patients with CCI = 0 (11.9 months) and CCI = 1 (8.4 months; P < .001). Comorbidity and advancing age in as little as 5-year increments are important adverse factors in this group. Most patients died of lymphoma within a year from diagnosis, underscoring the importance of developing new treatments.
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12
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Dai X, Chen X, Chen W, Chen Y, Zhao J, Zhang Q, Lu J. A Pan-cancer Analysis Reveals the Abnormal Expression and Drug Sensitivity of CSF1. Anticancer Agents Med Chem 2021; 22:1296-1312. [PMID: 34102987 DOI: 10.2174/1871520621666210608105357] [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: 12/19/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Colony-stimulating factor-1 (CSF1) is a cytokine that is closely related to normal organ growth and development as well as tumor progression. OBJECTIVE We aimed to summarize and clarify the reasons for the abnormal expression of CSF1 in tumors and explore the role of CSF1 in tumor progression. Furthermore, drug response analysis may provide a reference for clinical medication. METHODS The expression of CSF1 was analyzed by TCGA and CCLE. Besides, cBioPortal and MethSurv databases were used to conduct mutation and DNA methylation analyses. Further, correlations between CSF1 expression and tumor stage, survival, immune infiltration, drug sensitivity and enrichment analyses were validated via UALCAN, Kaplan-Meier plotter, TIMER, CTRP and Coexperia databases. RESULTS CSF1 is expressed in a variety of tissues, meaningfully, it can be detected in blood. Compared with normal tissues, CSF1 expression was significantly decreased in most tumors. The missense mutation and DNA methylation of CSF1 may cause the downregulated expression. Moreover, decreased CSF1 expression was related with higher tumor stage and worse survival. Further, the promoter DNA methylation level of CSF1 was prognostically significant in most tumors. Besides, CSF1 was closely related to immune infiltration, especially macrophages. Importantly, CSF1 expression was associated with a good response to VEGFRs inhibitors, which may be due to the possible involvement of CSF1 in tumor angiogenesis and metastasis processes. CONCLUSION The abnormal expression of CSF1 could serve as a promising biomarker of tumor progression and prognosis in pan-cancer. Significantly, angiogenesis and metastasis inhibitors may show a good response to CSF1-related tumors.
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Affiliation(s)
- Xiaoshuo Dai
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province 450001, China
| | - Xinhuan Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province 450001, China
| | - Wei Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province 450001, China
| | - Yihuan Chen
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province 450001, China
| | - Jun Zhao
- Department of Oncology, Changzhi People's Hospital, Changzhi 046000, Shanxi, China
| | - Qiushuang Zhang
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province 450001, China
| | - Jing Lu
- Department of Pathophysiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan Province 450001, China
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Whole-genome sequencing reveals potent therapeutic strategy for monomorphic epitheliotropic intestinal T-cell lymphoma. Blood Adv 2021; 4:4769-4774. [PMID: 33017466 DOI: 10.1182/bloodadvances.2020001782] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022] Open
Abstract
Key Points
Whole genomic and transcriptomic analyses of MEITL revealed multiple potential therapeutic targets. Synergistic effects of pimozide and romidepsin are shown in a well-characterized MEITL PDX model.
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14
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Miura K, Iriyama N, Hatta Y, Takei M. Personalized patient care with aggressive hematological malignancies in non-responders to first-line treatment. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1903314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Katsuhiro Miura
- Tumor Center, Nihon University Itabashi Hospital, 173-8610, Itabashi city, Japan
- Department of Hematology and Rheumatology, Nihon University School of Medicine, 173-8610, Itabashi city, Tokyo, Japan
| | - Noriyoshi Iriyama
- Department of Hematology and Rheumatology, Nihon University School of Medicine, 173-8610, Itabashi city, Tokyo, Japan
| | - Yoshihiro Hatta
- Department of Hematology and Rheumatology, Nihon University School of Medicine, 173-8610, Itabashi city, Tokyo, Japan
| | - Masami Takei
- Department of Hematology and Rheumatology, Nihon University School of Medicine, 173-8610, Itabashi city, Tokyo, Japan
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15
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Ma H, O'Connor OA, Marchi E. Management of Angioimmunoblastic T-Cell Lymphoma (AITL) and other T Follicular Helper Cell lymphomas (TFH PTCL). Semin Hematol 2021; 58:95-102. [PMID: 33906727 DOI: 10.1053/j.seminhematol.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
Despite the remarkable improvements in the treatment and outcome of patients with aggressive B-cell lymphoma, the peripheral T-cell lymphomas (PTCL) continue to carry a poor prognosis with the presently available treatment options. The PTCL are very rare diseases that account for only 10,000 to 15,000 new cases per year in the United States. The World Health Organization's 2016 classification describes 29 distinct subtypes of PTCL, thus making these both rate and incredibly heterogenous. The 2 most common forms of PTCL, for example, peripheral T-cell lymphoma-not otherwise specified and angioimmunoblastic T-cell lymphoma , have an incidence of only 2500 and 1800 cases per year respectively, in the United States.
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Affiliation(s)
- Helen Ma
- Division of Hematology/Oncology, University of California Irvine, Long Beach, CA
| | - Owen A O'Connor
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA
| | - Enrica Marchi
- Division of Hematology/Oncology, University of Virginia, Charlottesville, VA.
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16
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Ibrahim A, Noun P, Khalil C, Taher A. Changing Management of Hematological Malignancies With COVID-19: Statement and Recommendations of the Lebanese Society of Hematology and Blood Transfusion. Front Oncol 2021; 11:564383. [PMID: 33791197 PMCID: PMC8006377 DOI: 10.3389/fonc.2021.564383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/09/2021] [Indexed: 12/05/2022] Open
Abstract
COVID-19 caused by SARS-Cov-2 is a devastating infection in patients with hematological malignancies. In 2018, the Lebanese Society of Hematology and Blood Transfusion (LSHBT) updated the guidelines for the management of hematological malignancies in Lebanon. In 2019, it was followed by a second update. Given the rapidly changing evidence and general situation for COVID-19, the LSHBT established some recommendations and suggestions for the management of the patients with hematological malignancies taking into account the Lebanese condition, economic situation, and the facts that SARS-Cov-2 infection has apparently been devastating. In this article we present recommendations and proposals to reduce or to manage SARS-Cov-2 infection in the patients with myeloid and lymphoid hematological malignancies.
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Affiliation(s)
- Ahmad Ibrahim
- Division of Hematology-Oncology, Department of Medicine, Lebanese and Arab Universities, Beirut, Lebanon
- Cancer Center and Bone Marrow Transplantation (BMT) Program at Middle East Institute of Health, Bsalim, Lebanon
- Bone Marrow Transplantation (BMT) Program at Makassed University Hospital, Beirut, Lebanon
- Lebanese Society of Hematology and Blood Transfusion, Beirut, Lebanon
| | - Peter Noun
- Division of Pediatrics, Balamand University, Beirut, Lebanon
- Division of Pediatric Hematology-Oncology, Saint Georges University Medical Center, Beirut, Lebanon
| | - Charbel Khalil
- Bone Marrow Transplantation (BMT) Program at Middle East Institute of Health University Hospital, Beirut, Lebanon
- Faculty of Pharmacy, Saint Joseph University, Beirut, Lebanon
| | - Ali Taher
- Lebanese Society of Hematology and Blood Transfusion, Beirut, Lebanon
- Division of Hematology-Oncology, Department of Medicine, American University of Beirut, Beirut, Lebanon
- Cancer Center of the American University of Beirut, Beirut, Lebanon
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17
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Kempf W, Mitteldorf C, Battistella M, Willemze R, Cerroni L, Santucci M, Geissinger E, Jansen P, Vermeer MH, Marschalko M, Papadavid E, Piris MA, Ortiz-Romero PL, Novelli M, Paulli M, Quaglino P, Ranki A, Rodríguez Peralto JL, Wobser M, Auschra B, Robson A. Primary cutaneous peripheral T-cell lymphoma, not otherwise specified: results of a multicentre European Organization for Research and Treatment of Cancer (EORTC) cutaneous lymphoma taskforce study on the clinico-pathological and prognostic features. J Eur Acad Dermatol Venereol 2020; 35:658-668. [PMID: 32997839 DOI: 10.1111/jdv.16969] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cutaneous peripheral T-cell lymphoma, not otherwise specified (PTL NOS) is an aggressive, but poorly characterized neoplasm. OBJECTIVES The European Organization for Research and Treatment of Cancer cutaneous lymphoma taskforce (EORTC CLTF) investigated 33 biopsies of 30 patients with primary cutaneous PTL NOS to analyse their clinical, histological, immunophenotypic features and outcome. METHODS Retrospective analysis of clinical data and histopathological features by an expert panel. RESULTS Cutaneous PTL NOS manifested clinically either with solitary or disseminated rapidly grown ulcerated tumours or disseminated papulo-nodular lesions. Histologically, a mostly diffuse or nodular infiltrate in the dermis and often extending into the subcutis was found. Epidermotropism was rarely present and only mild and focal. Unusual phenotypes were frequent, e.g. CD3+ /CD4- /CD8- and CD3+ /CD4+ /CD8+ . Moreover, 18% of the cases exhibited an aberrant expression of the B-cell marker CD20 by the tumour cells. All solitary tumours were located on the limbs and presented a high expression of GATA-3 but this did not correlate with outcome and therefore could not serve as a prognostic factor. The prognosis was shown to be generally poor with 10 of 30 patients (33%) dying of lymphoma within the follow-up of 36 months (mean value; range 3-144). The survival rates were 61% after 3 years (CI, 43-85%) and 54% after 5 years (CI, 36-81%). Small to medium-sized morphology of tumour cells was associated with a better outcome than medium to large or large tumour cells. Age, gender, clinical stage, CD4/CD8 phenotype and GATA-3 expression were not associated with prognosis. Chemotherapy was the most common treatment modality, but surgical excision and/or radiotherapy may represent an appropriate first-line treatment for solitary lesions. CONCLUSIONS Cutaneous PTL NOS shows an aggressive course in most patients independent of initial presentation, age and phenotype. Cytomorphology was identified as a prognostic factor. The data indicate a need for more effective treatment modalities in PTL NOS.
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Affiliation(s)
- W Kempf
- Histologische Diagnostik, Kempf und Pfaltz, Zürich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - C Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - M Battistella
- Department of Pathology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, INSERM U976, Paris, France
| | - R Willemze
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Cerroni
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - M Santucci
- Department of Health Sciences, University of Florence School of Human Health Sciences, Florence, Italy.,Division of Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - E Geissinger
- Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - P Jansen
- Department of Clinical Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - M H Vermeer
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Marschalko
- Department of Dermatology and Venerology, Semmelweis Medical University, Budapest, Hungary
| | - E Papadavid
- Department of Dermatology-Venereology, Attikon University Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - M A Piris
- Department of Pathology, Fundacion Jimenez Diaz, CIBERONC, Madrid, Spain
| | - P L Ortiz-Romero
- Department of Dermatology, Hospital 12 de Octubre, Medical School, Institute i+12, University Complutense, Madrid, Spain
| | - M Novelli
- Cutaneous Immunopathology Laboratory, Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M Paulli
- Department of Molecular Pathology, University of Pavia, Pavia, Italy.,Department of Anatomic Pathology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Quaglino
- Dermatologic Clinic, Dept Medical Sciences, University of Turin Medical School, Torino, Italy
| | - A Ranki
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J L Rodríguez Peralto
- Department of Pathology, Hospital Universitario 12 de Octubre, Universidad, Complutense, Instituto de Investigación I+12, Madrid, Spain
| | - M Wobser
- Department of Dermatology, University of Würzburg, Würzburg, Germany
| | - B Auschra
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - A Robson
- Institute of Oncology, Lisbon, Portugal.,LDPath, London, UK
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18
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Ma H, Marchi E, O'Connor OA. The peripheral T-cell lymphomas: an unusual path to cure. LANCET HAEMATOLOGY 2020; 7:e765-e771. [DOI: 10.1016/s2352-3026(20)30207-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/29/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
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19
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Iluta S, Termure DA, Petrushev B, Fetica B, Badea ME, Moldovan-Lazar M, Lenghel M, Csutak C, Roman A, Pasca S, Zimta AA, Jitaru C, Tomuleasa C, Roman RC. Clinical Remission in a 72-Year-Old Patient with a Massive Primary Cutaneous Peripheral T-Cell Lymphoma-NOS of the Eyelid, Following Combination Chemotherapy with Etoposide Plus COP. Diagnostics (Basel) 2020; 10:diagnostics10090629. [PMID: 32847118 PMCID: PMC7555261 DOI: 10.3390/diagnostics10090629] [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: 07/25/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022] Open
Abstract
Peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) is the rarest subtype of primary cutaneous lymphoma, accounting for approximately 2% of cutaneous lymphomas. The rarity of primary cutaneous PTCL-NOS means that there is a paucity of data regarding clinical and histopathological features and its clinical course. This malignancy is an aggressive and life-threatening hematological malignancy that often presents mimicking other less severe plaque-like skin conditions. Due to the nonspecific nature of these lesions, CD4-positive cutaneous T-cell lymphoma (CTCL) is often misdiagnosed as either mycosis fungoides or Sezary syndrome. We describe a patient who presented with a large tumoral mass in the right frontal area, with involvement of the right upper eyelid and the ocular globe, causing loss of vision greatly impacting the quality of life. Biopsy revealed primary cutaneous PTCL-NOS, treated successfully with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide combination chemotherapy. As elderly patients are indicated to receive attenuated doses of chemotherapy, CHOP-based regimens represent viable options.
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Affiliation(s)
- Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (S.I.); (S.P.)
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj-Napoca, Romania;
| | - Dragos-Alexandru Termure
- Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania; (D.-A.T.); (M.M.-L.); (R.-C.R.)
- Department of Preventive Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania;
| | - Bobe Petrushev
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (B.P.); (A.-A.Z.)
- Department of Pathology, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, 400139 Cluj-Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj-Napoca, Romania;
| | - Mindra-Eugenia Badea
- Department of Preventive Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania;
| | - Madalina Moldovan-Lazar
- Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania; (D.-A.T.); (M.M.-L.); (R.-C.R.)
| | - Manuela Lenghel
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj-Napoca, Romania; (M.L.); (C.C.); (A.R.)
| | - Csaba Csutak
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj-Napoca, Romania; (M.L.); (C.C.); (A.R.)
| | - Andrei Roman
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400124 Cluj-Napoca, Romania; (M.L.); (C.C.); (A.R.)
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (S.I.); (S.P.)
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (B.P.); (A.-A.Z.)
| | - Alina-Andreea Zimta
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (B.P.); (A.-A.Z.)
| | - Ciprian Jitaru
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj-Napoca, Romania;
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (S.I.); (S.P.)
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400124 Cluj-Napoca, Romania;
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania; (B.P.); (A.-A.Z.)
- Correspondence:
| | - Rares-Calin Roman
- Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400001 Cluj-Napoca, Romania; (D.-A.T.); (M.M.-L.); (R.-C.R.)
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