Clinical Outcomes of Advanced-Stage Cutaneous Lymphoma under Low-Dose Gemcitabine Treatment: Real-Life Data from the German Cutaneous Lymphoma Network

Neue Therapien kutaner T-Zell-Lymphome

Kutane Lymphome gehören zu den seltenen Erkrankungen. Sie stellen eine heterogene Gruppe mit sehr unterschiedlicher klinischer Symptomatik und Prognose dar. Aufgrund der Komplexität der Erkrankung ist die Einbeziehung eines spezialisierten Zentrums empfehlenswert.

Wir stellen im Folgenden drei Patienten mit primär kutanen T-Zell-Lymphomen (CTCL) aus unserem Hauttumorzentrum vor. Anhand dieser Fallbeispiele möchten wir die multimodale Therapie von CTCL unter Berücksichtigung neu zugelassener Medikamente für diese Indikation beschreiben.

[New treatment concepts and combination therapies for cutaneous T-cell lymphomas]

Primary cutaneous T‑cell lymphomas are a heterogeneous group of rare diseases. Patients often suffer from visible, severely pruritic skin lesions, infections, relapses, and their life expectancy may be reduced. Under current therapies, long-lasting, complete remission is rare. However, new treatment approaches and combination therapies are changing the future. Here, we provide an overview on this topic.

[Current therapeutic options in Mycosis fungoides and Sézary syndrome]

Driven by the approval of new targeted therapies, significant progress has been made in recent years in the clinical management of cutaneous T‑cell lymphomas. Although there are no curative treatment options for cutaneous T‑cell lymphomas, response rates are often encouraging, in particular when using combination therapies. The decision for the appropriate form of treatment depends on the specific diagnosis, disease stage, and the history of prior therapies. This article provides a comprehensive overview of current treatment options in mycosis fungoides and Sézary syndrome, based on the recently published, revised German S2k guidelines on cutaneous lymphomas (update 2021). In addition, we present promising, yet-to-be-approved therapies that at least in part can be already used off-label in clinical practice today.

Current treatment strategies and emerging therapies for cutaneous lymphoma

Cutaneous lymphoma is generally treated with skin-directed therapies (SDT) during the early and localized stages. For the refractory or advanced stages, systemic therapies are used. Previously, retinoids and interferons were used for SDT-resistant cases. Only a few chemotherapy options were available for more advanced disease. In recent years, many novel agents have been introduced and the strategy for systemic therapy has changed, especially for cutaneous T-cell lymphoma (CTCL). For SDT, helical tomotherapy, a new radiation modality, has been drawing attention as an option for radiotherapy. Targeted therapies such as histone deacetylase inhibitors, mogamulizumab, brentuximab vedotin, and denileukin diftitox are new treatment options. Chemotherapy agents such as gemcitabine and pralatrexate have been introduced; they are expected to have meaningful efficacy as monotherapy. Allogeneic hematopoietic stem cell transplantation is still considered for young patients with advanced CTCL as the only potentially curative treatment.