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Ardigò M, Nikbakht N, Teoli M, Gleason L, Crisan L, Querfeld C. Chlormethine gel in combination with other therapies for treatment of mycosis fungoides: a review with patient cases. Front Med (Lausanne) 2024; 10:1308491. [PMID: 38274457 PMCID: PMC10810130 DOI: 10.3389/fmed.2023.1308491] [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: 10/06/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
Topical chlormethine gel has been approved as monotherapy for treatment of adult patients with mycosis fungoides (MF), the most common form of cutaneous T-cell lymphoma. In clinical practice, chlormethine gel is often combined with other skin-directed or systemic therapies to optimize response and target recalcitrant lesions. Positive outcomes with combination regimens using chlormethine gel and topical corticosteroids, phototherapy, retinoids, methotrexate, or interferon-α have been reported in literature. However, there are no treatment guidelines on the use of combination regimens with chlormethine gel. To provide real-world evidence and guidance on the use of chlormethine gel combination regimens, several cases of patients treated with chlormethine gel combined with phototherapy (n = 5), retinoids (n = 16), or mogamulizumab (n = 3) are presented. These different combination regimens showed promising results. Most patients had a complete or partial response following treatment and the combinations were well-tolerated over extended treatment periods. Patients receiving chlormethine gel with retinoids had long-term periods of remission, even after treatment discontinuation. Durations of response of up to 3 years were observed in these patients. This long-term disease control may be the result of disease-modifying effects of chlormethine. Previous studies have shown targeted reductions in malignant T-cell clones in patients treated with chlormethine gel as well as improved post-treatment responses. Further research is needed to determine the effectiveness and safety of combination treatment regimens with chlormethine gel and to assess the impact chlormethine gel has on disease control.
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Affiliation(s)
- Marco Ardigò
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Neda Nikbakht
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Miriam Teoli
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Gleason
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Liliana Crisan
- Division of Dermatology and Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, United States
| | - Christiane Querfeld
- Division of Dermatology and Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, United States
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Guenova E, Ortiz-Romero PL, Poligone B, Querfeld C. Mechanism of action of chlormethine gel in mycosis fungoides. J Eur Acad Dermatol Venereol 2023; 37:1739-1748. [PMID: 37262305 DOI: 10.1111/jdv.19237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023]
Abstract
Mycosis fungoides (MF), the most common type of cutaneous T-cell lymphoma, is characterized by proliferation of malignant skin-tropic T cells. Progression from early-stage disease (skin patches and/or plaques) to more advanced stages (cutaneous tumours, erythroderma or extracutaneous involvement) occurs slowly and can be discontinuous. Prognosis is poor for the ~25% of patients who progress to advanced disease. Patients at any stage of MF may experience reduced health-related quality of life (QoL) via a spectrum of physically and psychologically debilitating symptoms that can impact many aspects of daily life. Allogeneic stem-cell transplantation is a curative treatment option for some patients with advanced disease, but otherwise there is currently no cure for MF; patients are often refractory to several treatments and require lifelong management. The goals of therapy are symptom control, prevention of disease progression, avoidance of treatment-related toxicity and maintenance/improvement of QoL. Although treatment regimens exist it can be difficult to know how to prioritize them, hence therapies are tailored according to patient needs and drug availabilities, following clinical recommendations. International consensus guidelines recommend skin-directed therapies (SDTs) as first-line treatment for early-stage disease, and SDTs combined with systemic therapy for advanced stages. Chlormethine (CL), also known as mechlorethamine, chlorethazine, mustine, HN2, caryolysine and embichin, is a synthetic deoxyribonucleic acid-alkylating agent that was used as a chemical weapon (mustard gas) during the First World War. Subsequent investigation revealed that survivors of mustard gas exposure had lymphocytopenia, and that CL could inhibit rapidly proliferating malignant T cells. CL has since been developed as a topical treatment for MF and prescribed as such for over 70 years. This review aims to summarize the current knowledge regarding the mechanism of action of CL in the cutaneous micro-environment, in the specific context of MF treatment.
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Affiliation(s)
- E Guenova
- University Hospital Lausanne (CHUV), Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P L Ortiz-Romero
- Department of Dermatology, Institute i+12, CIBERONC, Medical School, Hospital 12 de Octubre, University Complutense, Madrid, Spain
| | - B Poligone
- Rochester Skin Lymphoma Medical Group, Fairport, New York, USA
| | - C Querfeld
- Division of Dermatology, Department of Pathology, City of Hope National Medical Center, Beckman Research Institute, Duarte, California, USA
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López-Cervantes VB, Obeso JL, Yañez-Aulestia A, Islas-Jácome A, Leyva C, González-Zamora E, Sánchez-González E, Ibarra IA. MFM-300(Sc): a chemically stable Sc(III)-based MOF material for multiple applications. Chem Commun (Camb) 2023; 59:10343-10359. [PMID: 37563983 DOI: 10.1039/d3cc02987e] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Developing robust multifunctional metal-organic frameworks (MOFs) is the key to advancing the further deployment of MOFs into relevant applications. Since the first report of MFM-300(Sc) (MFM = Manchester Framework Material, formerly known as NOTT-400), the development of applications of this robust microporous MOF has only grown. In this review, a summary of the applications of MFM-300(Sc), as well as some emerging advanced applications, have been discussed. The adsorption properties of MFM-300(Sc) are presented systematically. Particularly, this contribution is focused on acid and corrosive gas adsorption. In addition, recent applications for catalysis based on the outstanding hemilabile Sc-O bond character are highlighted. Finally, some new research areas are introduced, such as host-guest chemistry and biomedical applications. This highlight aims to showcase the recent advances and the potential for developing new applications of this promising material.
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Affiliation(s)
- Valeria B López-Cervantes
- Laboratorio de Fisicoquímica y Reactividad de Superficies (LaFReS), Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior s/n, CU, Del. Coyoacán, 04510, Ciudad de México, Mexico.
| | - Juan L Obeso
- Laboratorio de Fisicoquímica y Reactividad de Superficies (LaFReS), Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior s/n, CU, Del. Coyoacán, 04510, Ciudad de México, Mexico.
- Instituto Politécnico Nacional, CICATA U. Legaria, Laboratorio Nacional de Ciencia, Tecnología y Gestión Integrada del Agua (LNAgua), Legaria 694 Irrigación, 11500, Miguel Hidalgo, CDMX, Mexico
| | - Ana Yañez-Aulestia
- UAM-Azcapotzalco, San Pablo 180, Col. Reynosa-Tamaulipas, Azcapotzalco, C.P. 02200, Ciudad de México, Mexico
| | - Alejandro Islas-Jácome
- Departamento de Química, Universidad Autónoma Metropolitana-Iztapalapa, Av. Ferrocarril San Rafael Atlixco 186, Col. Leyes de Reforma 1A Sección, Iztapalapa, Ciudad de México, Mexico
| | - Carolina Leyva
- Instituto Politécnico Nacional, CICATA U. Legaria, Laboratorio Nacional de Ciencia, Tecnología y Gestión Integrada del Agua (LNAgua), Legaria 694 Irrigación, 11500, Miguel Hidalgo, CDMX, Mexico
| | - Eduardo González-Zamora
- Departamento de Química, Universidad Autónoma Metropolitana-Iztapalapa, Av. Ferrocarril San Rafael Atlixco 186, Col. Leyes de Reforma 1A Sección, Iztapalapa, Ciudad de México, Mexico
| | - Elí Sánchez-González
- Laboratorio de Fisicoquímica y Reactividad de Superficies (LaFReS), Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior s/n, CU, Del. Coyoacán, 04510, Ciudad de México, Mexico.
| | - Ilich A Ibarra
- Laboratorio de Fisicoquímica y Reactividad de Superficies (LaFReS), Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior s/n, CU, Del. Coyoacán, 04510, Ciudad de México, Mexico.
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