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Schirren AEC, Albrecht JD, Melchers S, Weiß C, Büttner S, Dippel E, Gosmann J, Jonak C, Klemke CD, Laturnus-Chang M, Livingstone E, Mitteldorf C, Schummer P, Stadler R, Stranzenbach R, Weyer-Fahlbusch SS, Wobser M, Ziemer M, Nicolay JP. Health-related quality of life and its influencing factors in patients with primary cutaneous B-cell lymphomas: A multicentric study in 100 patients. J Eur Acad Dermatol Venereol 2024; 38:954-966. [PMID: 38279594 DOI: 10.1111/jdv.19799] [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: 05/22/2023] [Accepted: 12/11/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas (CBCL) are a group of rare malignant skin diseases that represent approximately 20%-30% of all primary cutaneous lymphomas (PCL). Previous studies revealed impaired health-related quality of life (HRQoL) in patients diagnosed with primary cutaneous T-cell lymphoma (CTCL). Currently, only small-sized studies investigated HRQoL in CBCL patients and lacked detailed analysis of respective subtypes. OBJECTIVES This study aims to investigate HRQoL in CBCL patients to identify independent factors of HRQoL impairment in CBCL patients. METHODS One hundred CBCL patients were recruited from eight German PCL centres in this multicentric, cross-sectional study from 2021 to 2022. The patients completed the dermatologic HRQoL questionnaire Skindex-29 and an investigator-designed 'CBCL-Questionnaire' with additional questions on HRQoL and clinical characteristics. RESULTS The Skindex-29 revealed that HRQoL in CBCL patients is impaired on a mild to moderate level. The multiple regression analysis identified parameters like worries about dying, feeling prejudiced/discriminated and impairment of daily activities to be independently associated with impairment of HRQoL. Highest scores for HRQoL impairment were found in patients with primary cutaneous follicle centre lymphoma while on rituximab treatment and in patients with primary cutaneous marginal zone lymphoma while on watchful waiting. CONCLUSIONS HRQoL is impaired in CBCL patients, even though, in the face of indolent disease course and favourable prognosis in the majority of cases. Of note, our investigator-designed tool identified worries about dying, feeling prejudiced/discriminated, and the type of treatment to have a negative impact on patients' HRQoL. Our study highlights the importance of a thorough patient-doctor communication to capture overall disease burden because generic HRQoL tools might lack of disease-specific items.
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Affiliation(s)
- A E C Schirren
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J D Albrecht
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - S Melchers
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C Weiß
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim of the University of Heidelberg and University Medical Centre Mannheim, Mannheim, Germany
| | - S Büttner
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim of the University of Heidelberg and University Medical Centre Mannheim, Mannheim, Germany
| | - E Dippel
- Department of Dermatology, Ludwigshafen Medical Centre, Ludwigshafen, Germany
| | - J Gosmann
- University Clinic for Dermatology, Johannes Wesling Medical Centre, Minden, Germany
| | - C Jonak
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - C-D Klemke
- Department of Dermatology and Skin Cancer Centre, Municipal Hospital Karlsruhe, Academic Educational Hospital of the University of Freiburg, Karlsruhe, Germany
| | - M Laturnus-Chang
- Department of Dermatology, Ludwigshafen Medical Centre, Ludwigshafen, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - C Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - P Schummer
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - R Stadler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - R Stranzenbach
- Department of Dermatology, Bochum Medical Centre, Bochum, Germany
| | | | - M Wobser
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - M Ziemer
- Department of Dermatology, University Medical Centre, Leipzig, Germany
| | - J P Nicolay
- Department of Dermatology, Venereology and Allergology, University Medical Centre Mannheim, Mannheim, Germany
- Section for Clinical and Experimental Dermatology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Skin Cancer Unit, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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Aires D, Abhyankar S. Early intervention of extracorporeal photopheresis for advancing/progressing cutaneous T-cell lymphoma. Hematol Oncol 2023; 41:809-816. [PMID: 37974524 DOI: 10.1002/hon.3229] [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: 10/06/2022] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Patients with cutaneous T-cell lymphoma with progressive disease typically undergo a series of skin-directed and systemic therapy regimens during cycles of response and relapse. Extracorporeal photopheresis (ECP) is an effective and safe systemic treatment option, often reserved for later stages of disease and typically employed after failure of several other therapies. ECP has benefits in response rate, time to next treatment, and tolerability that may support its use earlier in the treatment cycle for advancing/progressing disease.
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Affiliation(s)
| | - Sunil Abhyankar
- University of Kansas Cancer Center and the University of Kansas Medical Center, Kansas City, Kansas, USA
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Chalaka CW, Mahurin HM, Tarabadkar E, Hippe DS, Loggers ET, Shinohara MM. Gender disparities in health-related quality of life (HRQoL) in patients with cutaneous T-cell lymphoma. Int J Womens Dermatol 2023; 9:e085. [PMID: 37284299 PMCID: PMC10241495 DOI: 10.1097/jw9.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/08/2023] [Indexed: 06/08/2023] Open
Abstract
Patients with cutaneous T-cell lymphoma (CTCL) often experience debilitating symptoms that impair health-related quality of life (HRQoL). Existing evidence for HRQoL differences with respect to gender is conflicting. Objective To investigate potential gender differences in HRQoL for patients with CTCL. Methods We performed a cross-sectional study to assess HRQoL in patients with CTCL by partnering with the Cutaneous Lymphoma Foundation to distribute an electronic survey from February to April 2019. Results A total of 292 patient responses (66% women, mean age 57 years) were included in the analysis. Most of the cohort had early-stage (IA-IIA) (74%; 162/203) mycosis fungoides (MFs) (87%; 241/279), followed by Sézary syndrome (SS) (12%; 33/279). Women with CTCL experienced significantly worse HRQoL compared with men (Skindex-16: 51±26 vs. 36±26, P ≤ 0.001; FACT-G: 69±21 vs. 77±16, P = 0.005). This gender difference was present even when controlling for stage of disease. Women experienced worse HRQoL in all three of the Skindex-16 subscales (symptoms: β = 14.0, P ≤ 0.001; emotions: β = 15.1, P ≤ 0.001; functioning: β = 11.3, P = 0.006), but only two of the four FACT-G subscales (physical: β =-2.8, P ≤ 0.001; emotional: β = -2.0, P = 0.004). Limitations Due to the method of distribution of the survey, we were unable to estimate a participant response rate. Participants' diagnosis and stage were self-reported. Conclusion In this cohort women with CTCL experienced significantly worse HRQoL when compared to men. Additional studies are necessary to determine what factors contribute to this gender disparity.
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Affiliation(s)
| | | | | | - Daniel S. Hippe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Elizabeth T. Loggers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Division of Hematology/Oncology, Department of Medicine, University of Washington, Seattle, WA
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Beltraminelli H. Cutaneous T-cell lymphoma-Focus on some problems, and some solutions. Hematol Oncol 2023; 41 Suppl 1:20-24. [PMID: 37294972 DOI: 10.1002/hon.3147] [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: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 06/11/2023]
Abstract
Cutaneous lymphomas are a heterogeneous group of several distinct entities of lymphoproliferative diseases. The diagnosis of a cutaneous lymphoma is a challenge, and it is always the result of a careful analysis of several information's consisting of clinical history, clinical picture, histological and molecular analyses. For this reason, experts taking care of patients with a skin lymphoma need to know all the peculiar diagnostic elements very well, in order not to run into mistakes. In this article, we will focus the discussion on some issues as the skin biopsy (when and where). In addition, we will discuss the approach to the erythrodermic patient, whose differential diagnoses include mycosis fungoides, and Sézary syndrome, beside more frequent inflammatory conditions. Finally, we will address the issue of quality of life and the possible support of the suffering patient with a cutaneous lymphoma, well knowing that the current therapeutic possibilities are unfortunately limited.
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Affiliation(s)
- Helmut Beltraminelli
- Head of Dermatology, Responsible of Dermatopathology at Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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Crimp C, Gangal A, Tarabadkar ES, Shinohara MM. Mechlorethamine Hydrochloride Gel in the Treatment of Mycosis Fungoides–Type Cutaneous T-Cell Lymphoma (MF-CTCL): A Focus on Patient Selection and Special Considerations. Cancer Manag Res 2022; 14:3271-3279. [DOI: 10.2147/cmar.s351420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
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Wind SS, Jansen MAA, Rijsbergen M, van Esdonk MJ, Ziagkos D, Cheng WC, Niemeyer-van der Kolk T, Korsten J, Gruszka A, Schmitz-Rohmer D, Bonnel D, Legouffe R, Barré F, Bekkenk MW, de Haas ERM, Quint KD, Rolli M, Streefkerk HJ, Burggraaf J, Vermeer MH, Rissmann R. Topical Bimiralisib Shows Meaningful Cutaneous Drug Levels in Healthy Volunteers and Mycosis Fungoides Patients but No Clinical Activity in a First-in-Human, Randomized Controlled Trial. Cancers (Basel) 2022; 14:cancers14061510. [PMID: 35326659 PMCID: PMC8946662 DOI: 10.3390/cancers14061510] [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: 12/17/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
Mycosis fungoides (MF) is a subtype of CTCL with a low incidence and high medical need for novel treatments. The objective of this randomized, placebo-controlled, double-blinded, first-in-human study was to evaluate safety, efficacy, cutaneous and systemic pharmacokinetics (PK) of topical bimiralisib in healthy volunteers (HVs) and MF patients. In this trial, a total of 6 HVs and 19 early-stage MF patients were treated with 2.0% bimiralisib gel and/or placebo. Drug efficacy was assessed by the Composite Assessment of Index Lesion Severity (CAILS) score, supported by objective measuring methods to quantify lesion severity. PK blood samples were collected frequently and cutaneous PK was investigated in skin punch biopsies on the last day of treatment. Local distribution of bimiralisib in HVs showed a mean exposure of 2.54 µg/g in the epidermis. A systemic concentration was observed after application of a target dose of 2 mg/cm2 on 400 cm2, with a mean Cavg of 0.96 ng/mL. Systemic exposure of bimiralisib was reached in all treated MF patients, and normalized plasma concentrations showed a 144% increased exposure compared to HVs, with an observed mean Cavg of 4.49 ng/mL and a mean cutaneous concentration of 5.3 µg/g. No difference in CAILS or objective lesion severity quantification upon 42 days of once-daily treatment was observed in the MF patient group. In general, the treatment was well tolerated in terms of local reactions as well as systemic adverse events. In conclusion, we showed that topical bimiralisib treatment leads to (i) meaningful cutaneous drug levels and (ii) well-tolerated systemic drug exposure in MF patients and (iii) a lack of clinical efficacy, in need of further exploration due to numerous unknown factors, before depreciation of topical bimiralisib as a novel therapeutic drug for CTCLs.
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Affiliation(s)
- Selinde S. Wind
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
| | - Manon A. A. Jansen
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Melanie Rijsbergen
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Michiel J. van Esdonk
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Dimitrios Ziagkos
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Wing C. Cheng
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - Tessa Niemeyer-van der Kolk
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
| | - John Korsten
- Charles River Laboratories Den Bosch B.V., 5231 DD Den Bosch, The Netherlands; (J.K.); (A.G.)
| | - Agnieszka Gruszka
- Charles River Laboratories Den Bosch B.V., 5231 DD Den Bosch, The Netherlands; (J.K.); (A.G.)
| | | | - David Bonnel
- MS Imaging Department, ImaBiotech, 59120 Lille, France; (D.B.); (R.L.); (F.B.)
| | - Raphael Legouffe
- MS Imaging Department, ImaBiotech, 59120 Lille, France; (D.B.); (R.L.); (F.B.)
| | - Florian Barré
- MS Imaging Department, ImaBiotech, 59120 Lille, France; (D.B.); (R.L.); (F.B.)
| | - Marcel W. Bekkenk
- Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | | | - Koen D. Quint
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
| | - Melanie Rolli
- PIQUR Therapeutics AG, 4057 Basel, Switzerland; (D.S.-R.); (M.R.); (H.J.S.)
| | | | - Jacobus Burggraaf
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
- Leiden Academic Centre for Drug Research, Leiden University, 2333 CC Leiden, The Netherlands
| | - Maarten H. Vermeer
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
| | - Robert Rissmann
- Centre for Human Drug Research, 2333 CL Leiden, The Netherlands; (S.S.W.); (M.A.A.J.); (M.R.); (M.J.v.E.); (D.Z.); (W.C.C.); (T.N.-v.d.K.); (J.B.)
- Department of Dermatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (K.D.Q.); (M.H.V.)
- Leiden Academic Centre for Drug Research, Leiden University, 2333 CC Leiden, The Netherlands
- Correspondence:
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