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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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Ta A, Kaur S, Mader M, Franklin K, Williams M, Williams R, Blaize JP, Naqvi A, Ananth S, Song M, Warnecke BO, Pandya A, Djoumessi LRD, Nazarewicz P, Espinoza-Gutarra M, Lucero KT, Whitehead J, Al-Abayechi A, Boyle L, Lee S, Roman Souza G, Toro Velez E, Mines I, Nooruddin Z. The impact of race and ethnicity on diffuse large B-cell lymphoma outcomes within the veterans health administration (VHA). Leuk Lymphoma 2024:1-10. [PMID: 38619488 DOI: 10.1080/10428194.2024.2338856] [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: 01/22/2024] [Accepted: 03/31/2024] [Indexed: 04/16/2024]
Abstract
We performed a retrospective chart review of 6266 randomly selected DLBCL patients treated in the VHA nationwide between 1/1/2011 and 12/31/2021. The 3178 patients who met inclusion criteria were predominantly male (97%) and white (75%). Median age of diagnosis for Black patients was 63 years vs 69 years for the entire cohort (p < 0.001). However, patients in each race/ethnicity subgroup presented with similar rates of stage I/II and III/IV disease, IPI score, cell of origin and HIT status. Outcomes analysis revealed similar treatment, response rates, median overall survival, and 1-, 3-, and 5-year survival across all subgroups. Hispanic patients had a 21% lower risk of death (HR = 0.79) than white patients, and Black patients had no significant difference in survival (HR = 0.98). This large retrospective study shows that when standard of care therapy is given within an equal access system, short-term treatment and survival outcomes are the same for all races.
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Affiliation(s)
- Andrew Ta
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Supreet Kaur
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael Mader
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | | | - Ryan Williams
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Amna Naqvi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Snegha Ananth
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Brian Oliver Warnecke
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Abhishek Pandya
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lakene Raissa Djoufack Djoumessi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Manuel Espinoza-Gutarra
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kana Tai Lucero
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | | | - Alaq Al-Abayechi
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Lauren Boyle
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Sophia Lee
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Gabriel Roman Souza
- Department of Hematology and Medical Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Esteban Toro Velez
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Ian Mines
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zohra Nooruddin
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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Gandham AR, Geller S, Dusza SW, Kupper TS, Myskowski PL. Racial Disparities in Mycosis Fungoides/Sézary Syndrome-A Single-Center Observational Study of 292 Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e174-e180. [PMID: 38245472 PMCID: PMC10981557 DOI: 10.1016/j.clml.2023.12.017] [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: 11/20/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Clinical presentation of Mycosis fungoides/Sézary syndrome (MF/SS) in Black and African American (AA) patients can be heterogeneous with poor survival reported in AA/black patients. In this study, we aim to characterize differences between AA/black and white patients with MF/SS. PATIENTS AND METHODS A retrospective single-center hospital-based case-control study including 292 MF/SS patients (146 AA/black matched with 146 white patients). We analyzed demographic, clinical and survival differences. RESULTS AA/black patients were diagnosed at an earlier age (9 years younger), were predominantly females, had higher rates of Medicaid/Medicare insurance and lower income compared to matched white patients (P <.001). Adjusting for age, sex, insurance type, and income bracket, AA/black patients had significantly worse overall survival (hazard ratio [HR] 2.88, 95%CI 1.21-6.85, P = .017). Association of clinical MF phenotype with survival showed that hypopigmentation was associated with survival in AA/black patients but not in white patients. Erythroderma and ulceration were associated with worse survival risk in AA/black patients. CONCLUSIONS AA/black patients with MF/SS have a significant worse survival outcome compared to white patients. The association between clinical phenotypes and survival differed between these groups. Further studies are required to investigate whether race-specific pathogenesis or genetic factors may explain these differences.
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Affiliation(s)
- Ashley R Gandham
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Harvard Medical School, Boston, MA
| | - Shamir Geller
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Stephen W Dusza
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas S Kupper
- Harvard Medical School, Boston, MA; Department of Dermatology, Brigham and Women's Hospital, Boston, MA
| | - Patricia L Myskowski
- Dermatology Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Navarro Matilla B, Ortiz Romero PL, Pujol Vallverdú RM, Combalia Escudero A, Zapata Paz I, González Barca E, Muniesa Montserrat C, Morillo Andújar M, Pérez Ferriols A, Román Curto C, Fernández de Misa Cabrera R, Hospital Gil M, Marín Niebla A, Rios Rull PJ, de la Cruz Vicente F, Izu Belloso RM, Martín García-Sancho A, Parera Amer ME, Córdoba Mascuñano R, Ramón Quiles MD, Saus Carreres A, Del Campo García R, Machan S, Viguera Ester P, Blanco Garnelo J. Cost of Treating Cutaneous T-Cell Lymphoma in Spain: Analysis of MICADOS Study Data by Disease Stage. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:119-129. [PMID: 37689349 DOI: 10.1016/j.ad.2023.08.007] [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: 05/10/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. METHODS We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). RESULTS A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stageI disease, €23,506.21 for stageII disease, €38,771.81 for stageIII disease, and €72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. CONCLUSIONS The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.
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Affiliation(s)
- B Navarro Matilla
- Departamento de Hematología, Hospital Universitario Puerta de Hierro, Madrid, España
| | - P L Ortiz Romero
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - A Combalia Escudero
- Departamento de Dermatología, Hospital Universitario Clínic i Provincial, Barcelona, España
| | - I Zapata Paz
- Departamento de Radiación Oncológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - E González Barca
- Departamento de Hematología, Institut Catalá d'Oncología, Hospitalet de Llobregat, Barcelona, España
| | - C Muniesa Montserrat
- Departamento de Dermatología, Hospital Universitario de Bellvitge, Barcelona, España
| | - M Morillo Andújar
- Departamento de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - A Pérez Ferriols
- Departamento de Dermatología, Hospital General Universitario de Valencia, Valencia, España
| | - C Román Curto
- Departamento de Dermatología, Hospital General Universitario de Salamanca, Salamanca, España
| | - R Fernández de Misa Cabrera
- Departamento de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - M Hospital Gil
- Departamento de Dermatología, Hospital Universitario Puerta de Hierro, Madrid, España
| | - A Marín Niebla
- Departamento de Hematología, Hospital Universitario Vall d'Hebron/VHIO, Barcelona, España
| | - P J Rios Rull
- Departamento de Hematología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - F de la Cruz Vicente
- Departamento de Hematología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R M Izu Belloso
- Departamento de Dermatología, Hospital de Basurto, Bilbao, España
| | - A Martín García-Sancho
- Departamento de Hematología, Hospital General Universitario de Salamanca, Salamanca, España
| | - M E Parera Amer
- Departamento de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, España
| | - R Córdoba Mascuñano
- Departamento de Hematología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M D Ramón Quiles
- Departamento de Dermatología, Hospital Clínico Universitario, Valencia, España
| | - A Saus Carreres
- Departamento de Hematología, Hospital Clínico Universitario, Valencia, España
| | - R Del Campo García
- Departamento de Hematología, Hospital Son Llàtzer, Palma de Mallorca, España
| | - S Machan
- Departamento de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - P Viguera Ester
- Departamento Médico, Kyowa Kirin Farmacéutica, S.L., Madrid, España
| | - J Blanco Garnelo
- Departamento Médico, Kyowa Kirin Farmacéutica, S.L., Madrid, España.
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5
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Navarro Matilla B, Ortiz Romero PL, Pujol Vallverdú RM, Combalia Escudero A, Zapata Paz I, González Barca E, Muniesa Montserrat C, Morillo Andújar M, Pérez Ferriols A, Román Curto C, Fernández de Misa Cabrera R, Hospital Gil M, Marín Niebla A, Rios Rull PJ, de la Cruz Vicente F, Izu Belloso RM, Martín García-Sancho A, Parera Amer ME, Córdoba Mascuñano R, Ramón Quiles MD, Saus Carreres A, Del Campo García R, Machan S, Viguera Ester P, Blanco Garnelo J. [Translated article] Cost of Treating Cutaneous T-Cell Lymphoma in Spain: Analysis of MICADOS Study Data by Disease Stage. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T119-T129. [PMID: 38048944 DOI: 10.1016/j.ad.2023.11.017] [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: 05/10/2023] [Accepted: 08/08/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis. METHODS We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). RESULTS A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stageI disease, €23,506.21 for stageII disease, €38,771.81 for stageIII disease, and €72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each. CONCLUSIONS The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.
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Affiliation(s)
- B Navarro Matilla
- Departamento de Hematología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - P L Ortiz Romero
- Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - A Combalia Escudero
- Departamento de Dermatología, Hospital Universitario Clínic i Provincial, Barcelona, Spain
| | - I Zapata Paz
- Departamento de Radiación Oncológica, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - E González Barca
- Departamento de Hematología, Institut Catalá d'Oncología, Hospitalet de Llobregat, Barcelona, Spain
| | - C Muniesa Montserrat
- Departamento de Dermatología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - M Morillo Andújar
- Departamento de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Pérez Ferriols
- Departamento de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
| | - C Román Curto
- Departamento de Dermatología, Hospital General Universitario de Salamanca, Salamanca, Spain
| | - R Fernández de Misa Cabrera
- Departamento de Dermatología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - M Hospital Gil
- Departamento de Dermatología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - A Marín Niebla
- Departamento de Hematología, Hospital Universitario Vall d'Hebron/VHIO, Barcelona, Spain
| | - P J Rios Rull
- Departamento de Hematología, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - F de la Cruz Vicente
- Departamento de Hematología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - R M Izu Belloso
- Departamento de Dermatología, Hospital de Basurto, Bilbao, Spain
| | - A Martín García-Sancho
- Departamento de Hematología, Hospital General Universitario de Salamanca, Salamanca, Spain
| | - M E Parera Amer
- Departamento de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - R Córdoba Mascuñano
- Departamento de Hematología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M D Ramón Quiles
- Departamento de Dermatología, Hospital Clínico Universitario, Valencia, Spain
| | - A Saus Carreres
- Departamento de Hematología, Hospital Clínico Universitario, Valencia, Spain
| | - R Del Campo García
- Departamento de Hematología, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - S Machan
- Departamento de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - P Viguera Ester
- Departamento Médico, Kyowa Kirin Farmacéutica, S.L., Madrid, Spain
| | - J Blanco Garnelo
- Departamento Médico, Kyowa Kirin Farmacéutica, S.L., Madrid, Spain.
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Dettwiler M, Mauldin EA, Jastrebski S, Gillette D, Stefanovski D, Durham AC. Prognostic clinical and histopathological features of canine cutaneous epitheliotropic T-cell lymphoma. Vet Pathol 2023; 60:162-171. [PMID: 36541607 DOI: 10.1177/03009858221140818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Canine cutaneous epitheliotropic T-cell lymphoma is a neoplasm with heterogeneous clinical and histopathological presentations. Survival times and responses to therapy are variable, and indicators to predict outcomes are lacking. Clinical and histopathological parameters from 176 archival cases from the University of Pennsylvania and University of Bern (2012-2018) were investigated for associations with clinical outcomes. Histopathological evaluation used digitized whole slide images and QuPath software. Cases included 107 female and 69 male dogs from 48 breeds, with a mean age of 10.4 years. Most common clinical signs were erythema (n = 131), crusting (n = 108), and scaling (n = 102). Affected sites were haired skin (n = 159), lip (n = 74), nasal planum (n = 49), and paw pads (n = 48). The median survival time (MST) was 95 days (1-850). Dogs had 4.26-fold and 2.82-fold longer MST when treated with chemotherapy and prednisone, respectively, than when receiving supportive care. Haired skin involvement (hazard ratio [HR]: 2.039, 95% confidence interval [CI]: 1.180-3.523), erosions/ulcers (HR: 1.871, 95% CI: 1.373-2.548), nodules (HR: 1.496, 95% CI: 1.056-2.118), and crusting (HR: 1.454, 95% CI: 1.061-1.994) were clinical parameters predicting poor outcomes, whereas complete posttherapeutic clinical remission (HR: 0.469, 95% CI: 0.324-0.680) and a stable disease (HR: 0.323, 95% CI: 0.229-0.456) were associated with longer survival. Histopathological features associated with the increased risk of death were extensive infiltration of the panniculus (HR: 2.865, 95% CI: 1.565-4.809), mitotic count ≥7/high-power field (HR: 3.027, 95% CI: 2.065-4.439), cell diameter ≥10.0 µm (HR: 2.078, 95% CI: 1.281-3.372), and nuclear diameter ≥8.3 µm (HR: 3.787, 95% CI: 1.647-8.707).
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7
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Allen PB, McCook-Veal AA, Switchenko JM, Paulino DM, Niyogusaba T, Baird KM, Tarabadkar ES, Lechowicz MJ. Staging lymph nodes and blood at diagnosis in mycosis fungoides identifies patients at increased risk of progression to advanced stage: A retrospective cohort study. Cancer 2023; 129:541-550. [PMID: 36523150 PMCID: PMC9852075 DOI: 10.1002/cncr.34579] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Risk factors for progression to advanced-stage mycosis fungoides (MF) are poorly defined. METHODS The authors performed a single-center, retrospective cohort study among patients with MF at an academic medical center from 1990 to 2020 to identify clinical variables associated with progression to advanced-stage MF (stage IIB-IVB), and 388 patients who had a clinicopathologic diagnosis of early stage (IA-IIA) MF were identified from their cutaneous lymphoma database. Baseline clinical characteristics, laboratory values, imaging, and blood flow cytometry or T-cell receptor gene rearrangement (TCR) data were collected. Logistic regression was used to assess risk factors associated with progression. RESULTS Overall, 93 of 388 patients (24.0%) progressed to advanced stage. Patients who progressed had an increased risk of death (hazard ratio, 4.50; 95% CI, 2.89-7.00; p < .001). Progression was associated with a higher overall stage at diagnosis, tumor stage, lymph node stage, low-level blood involvement, as measured with TCR data and/or flow cytometry, and elevated lactate dehydrogenase (LDH). Limitations included missing data for LDH, imaging, peripheral blood TCR data, or flow cytometry assessed at diagnosis. CONCLUSIONS Staging and baseline laboratory assessments with imaging, peripheral blood flow cytometry, TCR data, and LDH in patients who have newly diagnosed MF may identify those who are at risk for progression to advanced stage.
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Affiliation(s)
- Pamela B. Allen
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
| | | | | | | | - Tim Niyogusaba
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
| | - Katelin M. Baird
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
| | - Erica S. Tarabadkar
- Winship Cancer Institute, Department of Hematology, Atlanta GA, USA
- Emory University, Department of Dermatology, Atlanta GA, USA
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Glinos G, Wei G, Nosewicz J, Abdulla F, Chen PL, Chung C, Kaffenberger BH, Querfeld C, Shinohara MM, Sokol L, Zain J, Kumar A, Seminario-Vidal L. Characteristics and Outcomes for Hospitalized Patients With Cutaneous T-Cell Lymphoma. JAMA Dermatol 2023; 159:192-197. [PMID: 36598766 PMCID: PMC9857769 DOI: 10.1001/jamadermatol.2022.5740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/03/2022] [Indexed: 01/05/2023]
Abstract
Importance Cutaneous T-cell lymphoma (CTCL) is a group of rare, complex cutaneous malignant neoplasms associated with significant disease burden on patients and the health care system. Currently, the population of patients with CTCL admitted to the hospital remains largely uncharacterized and poorly understood. Objective To characterize the clinical characteristics, course of hospitalization, and mortality outcomes of an inpatient CTCL cohort. Design, Setting, and Participants This multicenter retrospective cohort study reviewed medical records for adult patients (age ≥18 years) with a CTCL diagnosis per National Comprehensive Cancer Network guidelines admitted for inpatient hospitalization at 5 US academic medical centers with inpatient dermatology consult services and CTCL clinics between August 2016 and August 2020. Main Outcomes and Measures Patient demographics, clinical history and findings, hospitalization courses, and mortality outcomes. Results A total of 79 hospitalized patients with CTCL were identified, including 52 (70.3%) men and 22 (29.7%) women, with a median (IQR) age at hospitalization of 62.9 (27-92) years. The majority of admitted patients with CTCL were White (65 patients [82.3%]), had disease classified as mycosis fungoides (48 patients [61.5%]), and had advanced-stage disease (≥IIB, 70 patients [89.7%]). Most hospitalizations were complicated by infection (45 patients [57.0%]) and required intravenous antibiotic therapy (45 patients [57.0%]). In-hospital mortality occurred in 6 patients (7.6%) and was associated with higher body mass index (36.5 vs 25.3), history of thromboembolic disease (50.0% vs 12.3%), and diagnosis of sepsis on admission (66.7% vs 20.5%). At 1-year postdischarge, 36 patients (49.3%) patients had died, and mortality was associated with history of solid organ cancers (27.8% vs 10.8%), wound care as the reason for dermatology consultation (58.3% vs 24.3%), and presence of large cell transformation (58.3% vs 22.9%). Conclusions and Relevance The findings of this cohort study improve the understanding of hospitalized patients with CTCL and lend valuable insight into identifying factors associated with both in-hospital and long-term mortality outcomes. This refined understanding of the inpatient CTCL population provides a foundation for larger, more robust studies to identify causal risk factors associated with mortality, development of prognostic scoring systems to estimate the probability of hospital mortality. Overall, the findings may prompt physicians caring for patients with CTCL to implement preventive strategies to diminish hospitalization and improve clinical management across this unique disease spectrum.
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Affiliation(s)
- George Glinos
- Department of Dermatology and Cutaneous Surgery, USF Health Morsani College of Medicine, Tampa, Florida
| | - Grace Wei
- Department of Dermatology and Cutaneous Surgery, USF Health Morsani College of Medicine, Tampa, Florida
| | - Jacob Nosewicz
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus
| | - Farah Abdulla
- Division of Dermatology, Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California
| | - Pei-Ling Chen
- Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Catherine Chung
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus
| | | | - Christiane Querfeld
- Division of Dermatology, Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California
| | - Michi M. Shinohara
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Lubomir Sokol
- Malignant Hematology Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Jasmine Zain
- Division of Dermatology, Department of Pathology, City of Hope National Medical Center and Beckman Research Institute, Duarte, California
| | - Ambuj Kumar
- Center for Evidence-Based Medicine and Health Outcomes Research, University of South Florida, Tampa
| | - Lucia Seminario-Vidal
- Department of Dermatology and Cutaneous Surgery, USF Health Morsani College of Medicine, Tampa, Florida
- Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida
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9
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Alexander‐Savino CV, Bowers EV. A cross‐sectional analysis of Google images of mycosis fungoides: is dark skin adequately represented? Int J Dermatol 2022. [DOI: 10.1111/ijd.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 11/05/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Edith V. Bowers
- Department of Dermatology The University of North Carolina at Chapel Hill Chapel Hill NC USA
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10
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Allen PB, Goyal S, Niyogusaba T, O'Leary C, Ayers A, Tarabadkar ES, Khan MK, Lechowicz MJ. Clinical Presentation and Outcome Differences Between Black Patients and Patients of Other Races and Ethnicities With Mycosis Fungoides and Sézary Syndrome. JAMA Dermatol 2022; 158:1293-1299. [PMID: 36069854 PMCID: PMC9453633 DOI: 10.1001/jamadermatol.2022.3601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/10/2022] [Indexed: 11/14/2022]
Abstract
Importance Mycosis fungoides and Sézary syndrome (MF/SS) has an increased incidence in Black patients, but clinical characteristics, treatments, and outcomes have been poorly characterized. Objective To assess racial differences in presentation and outcome and identify drivers for racial disparities in MF/SS. Design, Setting, and Participants A retrospective cohort analysis was conducted of 566 patients with MF/SS diagnosed from 1990 to 2020 and seen at the Winship Cancer Institute of Emory University and Grady Memorial Hospital, both in Atlanta, Georgia. Self-reported race and ethnicity were obtained from patient medical records and analyzed as 2 groups: non-Hispanic Black (Black) and all other races and ethnicities, including Asian, Hispanic, White, and unknown/undeclared (non-Black). Main Outcomes and Measures Univariate and multivariable models and Kaplan-Meier assessments were analyzed for overall survival and time to next treatment. The primary outcome was to assess differences in overall survival by racial and ethnic group. The hypotheses were formulated prior to data collection. Results Of the 566 patients with MF/SS identified (mean [SD] age 55 [16.4] years; 270 (47.7%) female), 257 were Black and 309 were non-Black. Black race was associated with increased rates of progression to a higher TNMB stage (39.8% in Black patients vs 29.1% in non-Black patients; P < .001) but not survival. Black patients were younger and had increased female predominance, higher TNMB stage, higher tumor stage, nodal involvement, and higher lactate dehydrogenase level compared with non-Black patients with MF/SS. Hypopigmented MF (HMF) was found in 62 patients, who were mostly Black (n = 59). Hypopigmented MF was significantly associated with survival on univariate and multivariable models, with 10-year survival of 100% in patients with HMF compared with 51.8% in patients without HMF. Black race was only associated with inferior outcomes after excluding patients with HMF who were younger than 60 years (hazard ratio [HR], 1.61; 95% CI, 1.02-2.55; P = .04), but not in patients older than 60 years (HR, 1.20; 95% CI, 0.80-1.81; P = .37). On multivariate analysis, among the cohort without HMF who were younger than 60 years, Black race remained statistically significant when controlling for cancer stage and large-cell transformation (HR, 1.27; 95% CI, 1.08-2.87; P = .43). Conclusions and Relevance In this cohort study, Black patients with MF/SS showed distinct clinical presentations and patterns of progression with heterogeneous outcomes depending on age at presentation and presence of HMF.
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Affiliation(s)
- Pamela B Allen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Subir Goyal
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Tim Niyogusaba
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Colin O'Leary
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Amy Ayers
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Erica S Tarabadkar
- Department of Dermatology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Internal Medicine, Winship Cancer Institute Emory University, Atlanta, Georgia
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11
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Park A, Wong L, Lang A, Kraus C, Anderson N, Elsensohn A. Cutaneous T-cell lymphoma following dupilumab use: a systematic review. Int J Dermatol 2022. [PMID: 36073768 DOI: 10.1111/ijd.16388] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
In recent years, studies have associated dupilumab with unmasking or progression of cutaneous T-cell lymphoma (CTCL). The objective of this study was to synthesize reported cases of CTCL in the setting of dupilumab use. Two independent reviewers conducted a systematic review using PubMed and Embase databases. Twelve studies, of 27 total patients, were included. Dupilumab-associated CTCL was diagnosed on average 7.8 months following dupilumab initiation. Of reports that included body surface area (BSA), 100% had a BSA >50% prior to diagnosis, and the majority of patients were diagnosed at later stages of disease: stage III (4/18) or IV (6/18). Post-dupilumab biopsies revealed a greater density of cells and a predominant lichenoid pattern, compared to various histologic patterns and less cell density in pre-dupilumab biopsies. The majority of TCR gene rearrangement studies were equivocal (20%) or negative (60%), posing a potential diagnostic pitfall. Limitations included lack of standardized data collection and reporting and a small number of studies. We suggest that earlier biopsies, three to four months after initiation of dupilumab, may be helpful for earlier recognition of CTCL in patients who are not improving, progressing, or have morphologic changes on dupilumab.
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Affiliation(s)
- Ariel Park
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Lulu Wong
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Annalise Lang
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Christina Kraus
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Nancy Anderson
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
| | - Ashley Elsensohn
- Department of Dermatology, Loma Linda University, Loma Linda, CA, USA
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12
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Epidemiologic Trends of Cutaneous T-Cell Lymphoma in Arkansas Reveals Demographic Disparities. Cancers (Basel) 2022; 14:cancers14174329. [PMID: 36077864 PMCID: PMC9454538 DOI: 10.3390/cancers14174329] [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: 05/18/2022] [Revised: 07/14/2022] [Accepted: 08/20/2022] [Indexed: 11/17/2022] Open
Abstract
Accurate demographic data are critical for comprehending and treating cutaneous T-cell lymphoma (CTCL). Our research aimed to determine the demographics and incidence trends of CTCL patients in Arkansas compared to those of the national CTCL population to recognize the underlying disparities. We collected data from 143 CTCL patients at the University of Arkansas for Medical Sciences (UAMS) and national CTCL patient data from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis revealed that males are affected more than females across all ages and races. CTCL incidence and mortality data show that CTCL has a steady increase at the national level and in Arkansas while disproportionately affecting the young black male population. In Arkansas, more than one-third of black patients presented at an advanced stage (IIB+) compared to one-fifth in the white population, and the mean age of death was more than a decade younger for black (60 years) than for white patients (74.6 years). Nationally, black male patients had the greatest mortality rate (0.5) compared to 0.32 for white males. CTCL is 2.23 and 2.38 times more prevalent in urban versus rural areas in Arkansas and nationally, respectively. Most Arkansas patients reside near major interstates and chemical-emitting sites. In conclusion, our demographic analysis of Arkansas and national CTCL patients verifies recent trends toward more aggressive presentations in young black male patients, and our geographic findings suggest possible environmental risk factors.
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13
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Martini DJ, Goyal S, Switchenko JM, Lechowicz MJ, Allen PB. African American and Caucasian patients with Sézary syndrome have no differences in outcomes at an ethnically diverse urban medical center. Leuk Lymphoma 2022; 63:2094-2101. [PMID: 35481397 PMCID: PMC9842406 DOI: 10.1080/10428194.2022.2067999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sézary syndrome (SS) is an aggressive cutaneous T-cell lymphoma with poor survival. We performed a retrospective review of SS patients at Emory University from 1990 to 2020. We collected data on race, clinical characteristics, therapy, and social determinants of health. Clinical endpoints were overall survival (OS) and time to next treatment (TTNT). Univariate association and multivariable analyses were assessed by Cox proportional hazards models. Among 62 patients, 45.2% were AA. The median OS and TTNT were 3.1 years and 6.3 months, respectively, with no difference by race. AA patients had a higher median baseline LDH (360 vs. 232, p = 0.002) and a longer delay in initiation of systemic therapy compared to CC patients (3.17 vs. 2.14 months, p = 0.039), but a shorter commute (<10 miles) and no difference in insurance coverage (p = 0.260). AA patients at an academic center had unique clinical features and treatment patterns, but similar survival to CC SS patients.
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Affiliation(s)
- Dylan J. Martini
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA,Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Mary Jo Lechowicz
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA
| | - Pamela B. Allen
- Department of Hematology, Winship Cancer Institute, Atlanta, GA, USA
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14
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The Skin Microbiome in Cutaneous T-Cell Lymphomas (CTCL)—A Narrative Review. Pathogens 2022; 11:pathogens11080935. [PMID: 36015055 PMCID: PMC9414712 DOI: 10.3390/pathogens11080935] [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: 07/27/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
In recent years, numerous studies have shown a significant role of the skin microbiome in the development and exacerbation of skin diseases. Cutaneous T-cell lymphomas (CTCL) are a group of malignancies primary involving skin, with unclear pathogenesis and etiology. As external triggers appear to contribute to chronic skin inflammation and the malignant transformation of T-cells, some microorganisms or dysbiosis may be involved in these processes. Recently, studies analyzing the skin microbiome composition and diversity have been willingly conducted in CTCL patients. In this review, we summarize currently available data on the skin microbiome in CTLC. We refer to a healthy skin microbiome and the contribution of microorganisms in the pathogenesis and progression of other skin diseases, focusing on atopic dermatitis and its similarities to CTCL. Moreover, we present information about the possible role of identified microorganisms in CTCL development and progression. Additionally, we summarize information about the involvement of Staphylococcus aureus in CTCL pathogenesis. This article also presents therapeutic options used in CTCL and discusses how they may influence the microbiome.
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15
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Parsons MW, Wada DA, Halwani AS, Tao R, Gaffney DK. Improved overall survival over time in advanced stage mycosis fungoides: a cross-sectional study. Leuk Lymphoma 2022; 63:2428-2435. [DOI: 10.1080/10428194.2022.2081322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Matthew W. Parsons
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David A. Wada
- Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Ahmad S. Halwani
- Division of Hematology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Randa Tao
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - David K. Gaffney
- Department of Radiation Oncology, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
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16
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Nenonen J, Winther AH, Leijonhufvud E, Belfrage E, Smedby KE, Brauner H. Overall survival and registration of cutaneous T-cell lymphoma patients in Sweden: a multi-center cohort and validation study. Acta Oncol 2022; 61:597-601. [PMID: 35331072 DOI: 10.1080/0284186x.2022.2050296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Julia Nenonen
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna H. Winther
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Ellinor Leijonhufvud
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Uppsala Academic University Hospital, Uppsala, Sweden
| | - Emma Belfrage
- Dermato-Venereology Clinic, Skåne university hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Karin E. Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, and Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Brauner
- Division of Rheumatology, Department of Medicine, Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
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17
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Mizuno Y, Miyagaki T, Suga H, Kamijo H, Boki H, Kawana Y, Oka K, Hisamoto T, Oka T, Takahashi‐Shishido N, Sugaya M, Sato S. Poor prognostic factors of Sézary syndrome: A retrospective single‐center study from Japan. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yuka Mizuno
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Tomomitsu Miyagaki
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
- Department of Dermatology St. Marianna University School of Medicine Kawasaki Japan
| | - Hiraku Suga
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Hiroaki Kamijo
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Hikari Boki
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Yuki Kawana
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Kenta Oka
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Teruyoshi Hisamoto
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | - Tomonori Oka
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
| | | | - Makoto Sugaya
- Department of Dermatology International University of Health and Welfare Narita Japan
| | - Shinichi Sato
- Department of Dermatology University of Tokyo Graduate School of Medicine Tokyo Japan
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18
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Yang Z, Gong D, Huang F, Sun Y, Hu Q. Epidemiological Characteristics and the Development of Prognostic Nomograms of Patients With HIV-Associated Cutaneous T-Cell Lymphoma. Front Oncol 2022; 12:847710. [PMID: 35372067 PMCID: PMC8965059 DOI: 10.3389/fonc.2022.847710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of human immunodeficiency virus (HIV) associated cutaneous T-Cell lymphoma (HIV-associated CTCL) is very low, and there is a lack of relevant epidemiological and clinical prognostic studies. Therefore, we aimed to study the epidemiological characteristics of HIV-associated CTCL and to construct and validate a nomogram predicting patient survival. Methods Demographic, clinical characteristics, and incidence data from the Surveillance, Epidemiology and End Results (SEER) database were screened for patients with HIV-associated CTCL. Independent prognostic factors in patients with HIV-associated CTCL were analyzed to establish nomograms of overall survival (OS) and disease-specific survival (DSS) rates of patients. The performance of the prediction model was validated by the consistency index (C-index), the area under the receiver operating characteristic curve (AUC), and calibration plots. Results A total of 883 eligible patients were screened for inclusion in this study and randomized to the training cohort (70%, n = 619) and the validation cohort (30%, n = 264). The age-adjusted average incidence rate per 100,000 persons per year for HIV-associated CTCL was 0.071 for the period 2004-2017, with an increasing incidence rate. The median age of the included patients was 59 years, of which male Caucasian held a majority. 99.5% of the patients had a tumor tissue subtype of mycosis fungoides, while the other tumor subtypes were sézary syndrome. The median OS for patients with HIV-associated CTCL was 162 months, and the OS rates at 1, 3, 5, and 10 years were 0.964, 0.904, 0.835, and 0.766, respectively. Univariate and multivariate COX regression analysis were performed, and prognostic indicators such as "Age", "Radiation", "Chemotherapy", "Summary stage", "Sequence number" were ultimately incorporated and used to establish nomograms of OS and DSS rates at 1, 3, 5 and 10 years for the training cohort. The C-index, AUC, and calibration plot confirmed that our prediction model had good accuracy. Conclusion While HIV-associated CTCL is very rare, its incidence has been on the rise in the last decade or so. We described the epidemiological characteristics and prognostic factors in patients with HIV-associated CTCL.
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Affiliation(s)
- Zheng Yang
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, China
| | - Daoqing Gong
- Teaching Office, Jingzhou Hospital, Yangtze University, Jingzhou, China
| | - Fei Huang
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, China
| | - Yi Sun
- Department of Dermatology, Jingzhou Hosiptal, Yangtze University, Jingzhou, China
| | - Qinming Hu
- Department of Infectious Disease, Jingzhou Hospital, Yangtze University, Jingzhou, China
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19
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Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
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Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
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20
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Salant JA, Khan N, Nelson JE, Norton-Westbrook M, Desai AV. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Patients with Cutaneous T Cell Lymphoma. J Palliat Med 2021; 25:958-963. [PMID: 34978848 DOI: 10.1089/jpm.2021.0610] [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] [Indexed: 11/12/2022] Open
Abstract
Cutaneous T cell lymphoma and its subtypes, mycosis fungoides (MF) and Sézary syndrome (SS), comprise a spectrum of chronic lymphoproliferative disorders in which neoplastic T cells accumulate within the skin and visceral organs. This process is frequently characterized by severe pain, nonpain symptoms, and physical disfigurement. Significant emotional, spiritual, and existential distress is also felt by many of these patients as they experience a chronic, often incurable disease. Patients suffering from these diseases, though not commonly encountered, can benefit greatly from palliative care support. In this article, a team of palliative care clinicians, critical care physicians, and an oncologist specializing in lymphoma offer 10 tips to help palliative care teams to support these vulnerable and often-distressed patients and their caregivers.
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Affiliation(s)
- Jennifer A Salant
- Pediatric Advanced Care Team, Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Niloufer Khan
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Judith E Nelson
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Critical Care Service, Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moe Norton-Westbrook
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anjali V Desai
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Supportive Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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21
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Henry KA, Wiese D, Maiti A, Harris G, Vucetic S, Stroup AM. Geographic clustering of cutaneous T-cell lymphoma in New Jersey: an exploratory analysis using residential histories. Cancer Causes Control 2021; 32:989-999. [PMID: 34117957 DOI: 10.1007/s10552-021-01452-y] [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: 10/21/2020] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cutaneous T-cell lymphoma (CTCL) is a rare type of non-Hodgkin lymphoma. Previous studies have reported geographic clustering of CTCL based on the residence at the time of diagnosis. We explore geographic clustering of CTCL using both the residence at the time of diagnosis and past residences using data from the New Jersey State Cancer Registry. METHODS CTCL cases (n = 1,163) diagnosed between 2006-2014 were matched to colon cancer controls (n = 17,049) on sex, age, race/ethnicity, and birth year. Jacquez's Q-Statistic was used to identify temporal clustering of cases compared to controls. Geographic clustering was assessed using the Bernoulli-based scan-statistic to compare cases to controls, and the Poisson-based scan-statisic to compare the observed number of cases to the number expected based on the general population. Significant clusters (p < 0.05) were mapped, and standard incidence ratios (SIR) reported. We adjusted for diagnosis year, sex, and age. RESULTS The Q-statistic identified significant temporal clustering of cases based on past residences in the study area from 1992 to 2002. A cluster was detected in 1992 in Bergen County in northern New Jersey based on the Bernoulli (1992 SIR 1.84) and Poisson (1992 SIR 1.86) scan-statistics. Using the Poisson scan-statistic with the diagnosis location, we found evidence of an elevated risk in this same area, but the results were not statistically significant. CONCLUSION There is evidence of geographic clustering of CTCL cases in New Jersey based on past residences. Additional studies are necessary to understand the possible reasons for the excess of CTCL cases living in this specific area some 8-14 years prior to diagnosis.
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Affiliation(s)
- Kevin A Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, USA. .,Division of Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Daniel Wiese
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, USA
| | - Aniruddha Maiti
- Department of Computer and Information Sciences, Temple University, Philadelphia, PA, USA
| | - Gerald Harris
- Department of Health, New Jersey State Cancer Registry, Trenton, NJ, USA.,Rutgers Cancer Institute of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Biostatitics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Slobodan Vucetic
- Department of Computer and Information Sciences, Temple University, Philadelphia, PA, USA
| | - Antoinette M Stroup
- Department of Health, New Jersey State Cancer Registry, Trenton, NJ, USA.,Rutgers Cancer Institute of New Jersey, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Biostatitics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
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22
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Martinez XU, Chowdhury A, Stiller T, Palmer J, Loscalzo M, Barrios E, Abdulla FR, Zain J, Rosen ST, Querfeld C. The impact of gender, age, race/ethnicity, and stage on quality of life in a spectrum of cutaneous lymphomas. Support Care Cancer 2021; 29:6669-6679. [PMID: 33963457 DOI: 10.1007/s00520-021-06241-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 04/20/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Cutaneous lymphomas (CLs) are a group of rare, potentially disfiguring and disabling cancers that can have a significant impact on quality of life (QoL). While previous studies have shown that mycosis fungoides (MF) and Sézary syndrome (SS) impair QoL, the effect of other types of CL on QoL has not been evaluated. OBJECTIVE To determine the impact of disease on QoL in all CL patients and to assess how QoL between the CL sub-types varies by demographic and clinical factors. METHODS The Cutaneous Lymphoma Distress Questionnaire (CL-DQ) was used to assess QoL. All CL patients seen in a multidisciplinary CL clinic were screened for eligibility. Questionnaire responses were collected over a 22-month period between 2017 and 2019. A cross-sectional analysis of CL-DQ scores from an initial visit was performed to determine the effect of disease on QoL across CL sub-types and the potential impact of patient demographics, CL sub-type, and type of treatment. RESULTS The study population consisted of 151 patients presenting with distinct types of cutaneous B- and T-cell lymphomas. Notable across the study population were the findings of frustration (44%), worry about progress/spread (43%), itching/pruritus (32%), and embarrassment/shame (28%). QoL was found to be most negatively affected in SS patients, females, younger patients, Black patients, and those with advanced stages of MF/SS. CONCLUSIONS Impairment of QoL due to CL correlates with gender, age, race/ethnicity, and stage of MF/SS. While the negative impact on QoL is most pronounced in SS patients, other CL sub-types also affect QoL and impact psychosocial distress. Our findings highlight the need for QoL assessment in all CL patients and further examination of disparities noted across demographic groups.
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Affiliation(s)
| | | | | | | | | | | | | | - Jasmine Zain
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, USA
| | - Steven T Rosen
- Department of Hematology/Hematopoietic Cell Transplantation, City of Hope, Duarte, USA.,Beckman Research Institute, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Christiane Querfeld
- Division of Dermatology, City of Hope, Duarte, USA. .,Beckman Research Institute, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
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23
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Mycosis Fungoides and Sézary Syndrome: An Integrative Review of the Pathophysiology, Molecular Drivers, and Targeted Therapy. Cancers (Basel) 2021; 13:cancers13081931. [PMID: 33923722 PMCID: PMC8074086 DOI: 10.3390/cancers13081931] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary In the last few years, the field of cutaneous T-cell lymphomas has experienced major advances. In the context of an active translational and clinical research field, next-generation sequencing data have boosted our understanding of the main molecular mechanisms that govern the biology of these entities, thus enabling the development of novel tools for diagnosis and specific therapy. Here, we focus on mycosis fungoides and Sézary syndrome; we review essential aspects of their pathophysiology, provide a rational mechanistic interpretation of the genomic data, and discuss the current and upcoming therapies, including the potential crosstalk between genomic alterations and the microenvironment, offering opportunities for targeted therapies. Abstract Primary cutaneous T-cell lymphomas (CTCLs) constitute a heterogeneous group of diseases that affect the skin. Mycosis fungoides (MF) and Sézary syndrome (SS) account for the majority of these lesions and have recently been the focus of extensive translational research. This review describes and discusses the main pathobiological manifestations of MF/SS, the molecular and clinical features currently used for diagnosis and staging, and the different therapies already approved or under development. Furthermore, we highlight and discuss the main findings illuminating key molecular mechanisms that can act as drivers for the development and progression of MF/SS. These seem to make up an orchestrated constellation of genomic and environmental alterations generated around deregulated T-cell receptor (TCR)/phospholipase C, gamma 1, (PLCG1) and Janus kinase/ signal transducer and activator of transcription (JAK/STAT) activities that do indeed provide us with novel opportunities for diagnosis and therapy.
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24
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Miljkovic MD. T-cell lymphomas: A 5-body problem. Semin Hematol 2021; 58:67-69. [PMID: 33906723 DOI: 10.1053/j.seminhematol.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Milos D Miljkovic
- Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health Bethesda, MD.
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25
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Smith-Graziani D, Flowers CR. Understanding and Addressing Disparities in Patients With Hematologic Malignancies: Approaches for Clinicians. Am Soc Clin Oncol Educ Book 2021; 41:1-7. [PMID: 33793311 DOI: 10.1200/edbk_320079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Approximately 185,840 individuals will be diagnosed with hematologic malignancies in the United States in 2020. Disparities in disease incidence, prevalence, burden, mortality, and survivorship have been identified among this patient population. Contributing factors include genetic ancestry, race/ethnicity, sex, socioeconomic status, and geographic region. Historically, these inequities have been understudied. Addressing these disparities requires a systems-level approach, improving access to care and reducing biases in the clinical setting. Additional research is needed to construct comprehensive, multilevel models to explore systematic observational studies and perform strategic intervention trials to overcome these disparities.
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Affiliation(s)
| | - Christopher R Flowers
- Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer, Houston, TX
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26
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Thompson LL, Pan CX, Chang MS, Molina GE, Chen YB, Barnes JA, Chen ST. Alemtuzumab, total skin electron beam, and non-myeloablative allogeneic haematopoietic stem-cell transplantation in advanced sezary syndrome: a retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 35:e373-e375. [PMID: 33545747 DOI: 10.1111/jdv.17144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/08/2021] [Accepted: 01/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- L L Thompson
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - C X Pan
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - M S Chang
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - G E Molina
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Y B Chen
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - J A Barnes
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - S T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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27
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Allogeneic haematopoietic stem cell transplantation for advanced stage mycosis fungoides and Sézary syndrome: never-late, never-never? Bone Marrow Transplant 2021; 56:1232-1234. [PMID: 33526916 DOI: 10.1038/s41409-020-01150-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022]
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28
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Dobos G, Pohrt A, Ram-Wolff C, Lebbé C, Bouaziz JD, Battistella M, Bagot M, de Masson A. Epidemiology of Cutaneous T-Cell Lymphomas: A Systematic Review and Meta-Analysis of 16,953 Patients. Cancers (Basel) 2020; 12:cancers12102921. [PMID: 33050643 PMCID: PMC7600606 DOI: 10.3390/cancers12102921] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Cutaneous T-cell lymphomas (CTCL) are rare malignant diseases. In this study we have compared the cutaneous lymphoma registries of different countries, which included information on at least 100 patients. The frequencies of each CTCL subtype were compared within and between continents. We found that the registries differed importantly in terms of size and quality. Some rare CTCL subtypes, such as NK/T-cell lymphoma or subcutaneous panniculitis-like lymphomas, were more frequent in Asian countries, while others were evenly distributed. We discuss possible reasons for this and provide suggestions on how to build future CTCL registries. Abstract Cutaneous T-cell lymphomas (CTCL) are a heterogenous group of rare diseases. Many studies have reported on local epidemiology or geographic clustering, however we lack information from a global perspective. A systematic review and meta-analysis was conducted in Medline and the Cochrane Library based on a previously registered protocol and according to the preferred reporting of items for systematic reviews and meta-analyses (PRISMA). We selected publications that enrolled at least 100 patients with primary cutaneous lymphomas according to the current classifications. The relative frequencies (proportions) of subtypes were compared between studies and geographic regions in a meta-analysis. In total, 26 studies met our inclusion criteria, reporting on altogether 16,953 patients. Within primary cutaneous lymphomas, CTCL appeared to be 15% more frequent in Asian populations. Mycosis fungoides (MF) accounted for 62% of CTCL, with an important heterogeneity in frequencies between studies and continents. The proportion of Sézary syndrome (SS) was 3%, stable worldwide. Rare CTCL, such as NK/T-cell lymphoma or subcutaneous panniculitis-like lymphoma, were more frequent in Asian studies. This global meta-analysis of CTCL confirmed the predominance of CTCL among primary cutaneous lymphomas (83% on average) in the three analyzed continents, most of which were MF cases. It revealed the same proportions of SS across continents, and the heterogeneity of MF frequencies, suggesting the possible role of environmental factors in the pathophysiology of the latter. Registration number: CRD42020148295 (PROSPERO).
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Affiliation(s)
- Gabor Dobos
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité-Universitättsmedizin, 10117 Berlin, Germany;
| | - Caroline Ram-Wolff
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
| | - Céleste Lebbé
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
| | - Jean-David Bouaziz
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
| | - Maxime Battistella
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
- Pathology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France
| | - Martine Bagot
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
- Correspondence: ; Tel.: +33-1-5372-2093
| | - Adèle de Masson
- Dermatology Department, Saint-Louis Hospital, AP-HP, 75010 Paris, France; (G.D.); (C.R.-W.); (C.L.); (J.-D.B.); (A.d.M.)
- INSERM U976 Human Immunology, Pathophysiology and Immune Therapies, Institut de Recherche Saint-Louis, 75010 Paris, France;
- Department of Medicine, Université de Paris, 75010 Paris, France
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29
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Guja KE, Brown R, Girod B, Song H, Harrison C, Franc BL, Moradi F, Davidzon G, Iagaru A, Aparici CM. An unusual presentation of recurrent T cell lymphoma: angiocentric pattern of cutaneous uptake on [ 18F]FDG PET/CT. Eur J Nucl Med Mol Imaging 2020; 48:1256-1257. [PMID: 32918110 DOI: 10.1007/s00259-020-05026-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kip E Guja
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Ryanne Brown
- Departments of Pathology and Dermatology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Brad Girod
- School of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Hong Song
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Caitlyn Harrison
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Benjamin L Franc
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Farshad Moradi
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Guido Davidzon
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Andrei Iagaru
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Carina Mari Aparici
- Division of Nuclear Medicine and Molecular Imaging, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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30
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Chen IC, Sethy B, Liou JP. Recent Update of HDAC Inhibitors in Lymphoma. Front Cell Dev Biol 2020; 8:576391. [PMID: 33015069 PMCID: PMC7494784 DOI: 10.3389/fcell.2020.576391] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Modulating epigenetic modification has been recognized for over a decade as an effective therapeutic approach to cancer and many studies of histone deacetylase (HDAC), one of the best known epigenetic modulators, have been published. HDAC modulates cell proliferation and angiogenesis and plays an essential role in cell growth. Research shows that up-regulated HDACs are present in many cancer types and synthetic or natural HDAC inhibitors have been used to silence overregulated HDACs. Inhibiting HDACs may cause arrest of cell proliferation, angiogenesis reduction and cell apoptosis. Recent studies indicate that HDAC inhibitors can provide a therapeutic effect in various cancers, such as B-cell lymphoma, leukemia, multiple myeloma and some virus-associated cancers. Some evidence has demonstrated that HDAC inhibitors can increase the expression of immune-related molecules leading to accumulation of CD8 + T cells and causing unresponsive tumor cells to be recognized by the immune system, reducing tumor immunity. This may be a solution for the blockade of PD-1. Here, we review the emerging development of HDAC inhibitors in various cancer treatments and reduction of tumor immunity.
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Affiliation(s)
- I-Chung Chen
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Bidyadhar Sethy
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Jing-Ping Liou
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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31
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Dimitriou F, Schanz U, Nair G, Kimeswenger S, Brüggen MC, Hoetzenecker W, French LE, Dummer R, Cozzio A, Guenova E. Long-Term Disease Control After Allogeneic Hematopoietic Stem Cell Transplantation in Primary Cutaneous T-Cell Lymphoma; Results From a Single Institution Analysis. Front Med (Lausanne) 2020; 7:290. [PMID: 32714935 PMCID: PMC7344271 DOI: 10.3389/fmed.2020.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Allogeneic hematopoietic stem cell transplantation (alloHSCT) has been proposed as curative approach for advanced cutaneous T–cell lymphomas (CTCL). Currently, there is no established consensus for the management of disease relapse after alloHSCT. Results: Ten patients, previously treated with multiple lines of systemic treatment, received alloHSCT. Six patients had achieved partial response (PR, N = 5) and complete response (CR, N = 1) prior to HSCT. Post—HSCT, seven patients (N = 7) relapsed after a median time of 3.3 months (0.5–7.4 months) and were subsequently treated with radiotherapy (RT, N = 1), RT and adoptive T-cell transfer with EBV specific cells (N = 1), R-CHOP (N = 1) and interferon alpha−2a combined either with donor lymphocyte infusion (N = 1) or with brentuximab—vedotin (N = 1). One patient (N = 1) achieved PR only after reducing the immunosuppression. Two patients relapsed again and received interferon alpha−2a and brentuximab—vedotin, respectively. After a median follow-up time of 12.6 months (3.5–73.7 months) six patients were alive (60%) and four had deceased, three (N = 3) due to CTCL and one (N = 1) due to GVHD. Conclusion: Disease relapse after alloHSCT can be controlled with available treatments. For most patients who ultimately relapsed, reduction of immunosuppression and interferon alpha−2a either administered alone or in combination with another systemic agent were preferred. Although interferon alpha−2a, similarly to immunosuppression reduction, may be beneficial for the achievement of graft–vs.–lymphoma effect, the risk of simultaneous worsening of GVHD must be carefully evaluated and taken into consideration.
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Affiliation(s)
- Florentia Dimitriou
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Urs Schanz
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Gayathri Nair
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Kimeswenger
- Department of Dermatology, Kepler University Hospital Linz, Linz, Austria.,Department of Soft Matter Physics, Institute for Experimental Physics, Johannes Kepler University, Linz, Austria
| | - Marie-Charlotte Brüggen
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Lars E French
- Department of Dermatology, University Hospital Munich (LMU), Munich, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Antonio Cozzio
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland.,Lausanne University Hospital (CHUV) and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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32
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Abstract
Cutaneous T-cell lymphomas are a heterogeneous collection of non-Hodgkin lymphomas that arise from skin-tropic memory T lymphocytes. Among them, mycosis fungoides (MF) and Sézary syndrome (SS) are the most common malignancies. Diagnosis requires the combination of clinical, pathologic, and molecular features. Significant advances have been made in understanding the genetic and epigenetic aberrations in SS and to some extent in MF. Several prognostic factors have been identified. The goal of treatment is to minimize morbidity and limit disease progression. However, hematopoietic stem cell transplantation, considered for patients with advanced stages, is the only therapy with curative intent.
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Affiliation(s)
- Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02115, USA.
| | - Thomas Kupper
- Department of Dermatology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02115, USA
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33
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Qualliotine JR, Ahluwalia R, Tzachanis D, Sanghvi P, Weissbrod PA. Mycosis Fungoides of the True Vocal Folds: A Case Report. Ann Otol Rhinol Laryngol 2020; 129:930-934. [PMID: 32340473 DOI: 10.1177/0003489420916213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report a case of laryngeal involvement of mycosis fungoides and its symptomatic treatment with laser-assisted surgical ablation. METHODS Case report and literature review. RESULTS A 76-year-old woman with longstanding MF previously treated with Brentuximab Vedotin who developed persistent cough and dysphonia. The patient's laryngeal disease burden was treated with KTP-laser ablation and further reduced with doxorubicin and radiotherapy. CONCLUSIONS Although laryngeal, and especially glottic, involvement is a rare finding, suspicion should be maintained in symptomatic patients with cutaneous mycosis fungoides. This the first reported surgical laser treatment of laryngeal symptoms in this context, which can greatly improve a patient's quality of life.
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Affiliation(s)
- Jesse R Qualliotine
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, UC San Diego, San Diego, CA, USA
| | - Rohan Ahluwalia
- Department of Medicine, Division of Hematology-Oncology, UC San Diego, San Diego, CA, USA
| | - Dmitrios Tzachanis
- Department of Medicine, Division of Hematology-Oncology, UC San Diego, San Diego, CA, USA
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences, UC San Diego, San Diego, CA, USA
| | - Philip A Weissbrod
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, UC San Diego, San Diego, CA, USA
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34
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Ortiz-Romero PL, Servitje O, Estrach MT, Izu-Belloso RM, Fernández-de-Misa R, Gallardo F, López-Martínez N, Pérez-Mitru A. Cost of early-stage mycosis fungoides treatments in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:91-105. [PMID: 32104021 PMCID: PMC7024769 DOI: 10.2147/ceor.s233376] [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: 10/04/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To identify the most common therapeutic options for the treatment of early-stage mycosis fungoides in Spain, quantify their associated healthcare resource use and costs. METHODS After reviewing the literature, a panel of 6 Spanish clinical dermatologists validated the treatments and healthcare resource use through a structured questionnaire. Individual responses were collected, analyzed and presented into a face-to-face meeting in order to reach a consensus. Cost categories considered were: drug acquisition and administration, photo/radiotherapy session and maintenance, clinical follow-up visits and laboratory tests. Costs were expressed in euros from 2018. The Spanish National Health System perspective was considered, taking into account direct health costs and time horizons of 1, 3 and 6 months. RESULTS Costs for the skin-directed treatments (SDT) assessed at 1, 3 and 6 months, were: Topical carmustine [€6,593.36, €19,780.09 and €27,592.78]; Phototherapy with psoralens and ultraviolet A light (PUVA) [€1,098.68, €2,999.99 and €3,187.60]; Narrow-band ultraviolet B phototherapy [€1,657.47, €4,842.10 and €4,842.10]; Total skin electron beam therapy (TSEBT) [€6,796.45, €7,913.34 and €7,913.34]. Cost for topical corticosteroids, being considered an adjuvant option, were €17.16, €51.49 and €102.97. Costs for the assessed systemic treatments alone or in combination with SDT at 1, 3 and 6 months, were: Systemic retinoids [€2,026.03, €5,206.63 and €7,426.42]; Systemic retinoids + PUVA phototherapy [€3,066.50, €8,271.26 and €10,046.58]; Interferon alfa + PUVA phototherapy [€1,541.09, €5,167.57 and €6,404.55]. CONCLUSION According to the Spanish clinical practice, phototherapies in monotherapy were the treatments with the lowest associated costs regardless of the time horizon considered. TSEBT turned out as the treatment with the highest associated costs when considering 1 month. However, while considering 3 and 6 months the treatment with the highest associated costs was topical carmustine. The results of this analysis may provide critical information to measure the disease burden, to detect unmet medical needs and to advocate towards better treatments for this rare disease.
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Affiliation(s)
- Pablo Luis Ortiz-Romero
- Dermatology Department, Hospital 12 de Octubre, Institute I+12, Medical School, University Complutense, CIBERONC, Madrid, Spain
| | - Octavio Servitje
- Dermatology Department, Hospital Universitari de Bellvitge, IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - María Teresa Estrach
- Dermatology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Ricardo Fernández-de-Misa
- Department of Dermatology and Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Fernando Gallardo
- Dermatology Department, Parc de Salut Mar-Hospital del Mar, Barcelona, Spain
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Dalal M, Mitchell S, McCloskey C, Zagadailov E, Gautam A. The clinical and humanistic burden of cutaneous T-cell lymphomas and response to conventional and novel therapies: results of a systematic review. Expert Rev Hematol 2020; 13:405-419. [DOI: 10.1080/17474086.2020.1717945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Mehul Dalal
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | | | | | - Erin Zagadailov
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Ashish Gautam
- Global Outcomes Research, Millennium Pharmaceuticals, Inc., A Wholly Owned Subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
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Clough L, Bayakly AR, Ward KC, Khan MK, Chen SC, Lechowicz MJ, Flowers CR, Allen PB, Switchenko JM. Clustering of cutaneous T-cell lymphoma is associated with increased levels of the environmental toxins benzene and trichloroethylene in the state of Georgia. Cancer 2020; 126:1700-1707. [PMID: 31943154 DOI: 10.1002/cncr.32665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cutaneous T-cell lymphoma (CTCL) is a rare form of non-Hodgkin lymphoma arising in the skin. Geographic clustering of CTCL has recently been reported, but its association with environmental factors is unknown. Benzene and trichloroethylene (TCE) are environmental toxins with carcinogenic properties. The authors investigated associations between geographic clustering of CTCL incidence in the state of Georgia with benzene and TCE exposure. METHODS The statewide county-level incidence of CTCL within Georgia was obtained from the Georgia Cancer Registry for the years 1999 to 2015. Standardized incidence ratios (SIRs) were calculated by dividing observed cases by expected cases using national incidence rates by age, sex, and race. Clustering of CTCL was analyzed using spatial analyses. County-level concentrations of benzene and TCE between 1996 and 2014 were collected from the Environmental Protection Agency's National Air Toxics Assessment database. Linear regression analyses on CTCL incidence were performed comparing SIRs with levels of benzene and TCE by county. RESULTS There was significant geographic clustering of CTCL in Georgia, particularly around Atlanta, which was correlated with an increased concentration of benzene and TCE exposure. Among the 4 most populous counties in Georgia, CTCL incidence was between 1.2 and 1.9 times higher than the state average, and benzene and TCE levels were between 2.9 and 8.8 times higher. CONCLUSIONS The current results demonstrate nonrandom geographic clustering of CTCL incidence in Georgia. To the authors' knowledge, this is the first analysis to identify a correlation between geographic clustering of CTCL and environmental toxic exposures.
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Affiliation(s)
| | | | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammad K Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Mary Jo Lechowicz
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher R Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Pamela B Allen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Fatima S, Siddiqui S, Tariq MU, Ishtiaque H, Idrees R, Ahmed Z, Ahmed A. Mycosis Fungoides: A Clinicopathological Study of 60 Cases from a Tertiary Care Center. Indian J Dermatol 2020; 65:123-129. [PMID: 32180598 PMCID: PMC7059469 DOI: 10.4103/ijd.ijd_602_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Mycosis fungoides (MF) is the most common primary cutaneous lymphoma. It affects usually the covered areas of the body in elderly males in 6th and 7th decades of life. Atypical dermal lymphoid infiltrate is seen along with epidermotropism. Nuclei of neoplastic cells are convoluted. The neoplastic cells demonstrate positivity for CD3 (Pan T) immunohistochemical stain. Majority show increased CD4 to CD8 ratio. The present study was done to study the clinicopathological features, which might be of help in reaching a correct diagnosis in these cases. Materials and Methods: A retrospective descriptive study was conducted on 60 reported cases of MF. The retrieved slides were reviewed for clinical and histopathological features and immunohistochemical profile. Results: The ages ranged from 20–84 years, mean age was 47 years. Majority (75%) of patients were male. Trunk and extremities were the sites most commonly affected. There was significant inverse correlation between epidermal thickness and tumor stage (P = 0.02). Thickened epidermis was seen in patch stage and thickness reduced with progressing stage. The intensity of dermal infiltrate and cell size was also statistically significantly linked to stage progression (P < 0.001 each). In addition, proliferation index also correlated significantly with tumor stage (P = 0.002). Conclusion: Clinical information and histological features are equally important in the accurate diagnosis of MF. Papillary dermal fibrosis is a useful diagnostic clue. CD4:CD8 ratio is not increased in all cases; it may be decreased or remain unchanged.
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Affiliation(s)
- Saira Fatima
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sabeehuddin Siddiqui
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Usman Tariq
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Hira Ishtiaque
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Romana Idrees
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zubair Ahmed
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Section of Histopathology, Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Kaul S, Belzberg M, Hughes JDM, Mahadevan V, Khanna R, Bakhshi PR, Hong MS, Williams KA, Grossberg AL, Kwatra SG, Sweren RJ. Comorbidities in Mycosis Fungoides and Racial Differences in Co-Existent Lymphomatoid Papulosis: A Cross-Sectional Study of 580 Patients in an Urban Tertiary Care Center. MEDICINES 2019; 7:medicines7010001. [PMID: 31888015 PMCID: PMC7168128 DOI: 10.3390/medicines7010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/10/2019] [Accepted: 12/24/2019] [Indexed: 12/22/2022]
Abstract
Background: Mycosis fungoides (MF) is a cutaneous T-cell lymphoma. Previous reports have suggested MF is associated with inflammatory conditions such as psoriasis, increased cardiovascular risk factors as well as secondary neoplasms. Methods: A cross-sectional study of MF patients seen from 2013 to 2019 was performed. Comorbidities were selected based on the 2015 Medicare report highlighting the most common chronic medical illnesses in the United States. Lifetime comorbidity occurrence in patients with MF were compared with that in patients with atopic dermatitis, psoriasis and patients without MF. Additional analyses were performed with patients sub-stratified by race. Results: Compared to control groups, MF was strongly associated with lymphomatoid papulosis and Hodgkin's disease, but not significantly associated with lung, breast or colon cancer. Interestingly, the association with lymphomatoid papulosis was observed in Caucasians (CI 1062-4338; p < 0.001) and not African Americans (p = 0.9). Patients with MF had a greater association with congestive heart failure, hypertension (HT) and hyperlipidemia (HLD) compared with the general population. However, they were significantly less likely to have HT and HLD when compared with psoriasis patients (HT CI: 0.6-0.9; p < 0.001, and HLD CI: 0.05-0.07; p < 0.001). MF patients were also significantly less likely to have concomitant vitamin D deficiency compared with atopic dermatitis (AD) and psoriasis (p < 0.001). Conclusions: Our results suggest that the association of MF with lymphomatoid papulosis varies by race. Compared to the general population, hypertension and hyperlipidemia were positively associated with MF, however, these were significantly less likely on comparison to psoriasis. Unlike previously described, vitamin D deficiency was found to be significantly less in patients with MF.
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Affiliation(s)
- Subuhi Kaul
- Department of Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, USA
- Correspondence: ; Tel.: +1-312-864-7000
| | - Micah Belzberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | | | - Varun Mahadevan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Pegah R. Bakhshi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Michael S. Hong
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Kyle A. Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Annie L. Grossberg
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
| | - Ronald J. Sweren
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (M.B.); (V.M.); (R.K.); (P.R.B.); (M.S.H.); (K.A.W.); (A.L.G.); (S.G.K.); (R.J.S.)
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Erraji H, Hali F, Baline K, Marnissi F, Chiheb S. [Epidemiological and clinical profile and outcome in 166 mycosis fungoides patients in Casablanca]. Ann Dermatol Venereol 2019; 146:825-828. [PMID: 31519349 DOI: 10.1016/j.annder.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Affiliation(s)
- H Erraji
- Service de dermatologie, CHU Ibn Rochd, 20400 Casablanca, Maroc.
| | - F Hali
- Service de dermatologie, CHU Ibn Rochd, 20400 Casablanca, Maroc
| | - K Baline
- Service de dermatologie, CHU Ibn Rochd, 20400 Casablanca, Maroc
| | - F Marnissi
- Service d'anatomo-pathologie, CHU Ibn Rochd, 20400 Casablanca, Maroc
| | - S Chiheb
- Service de dermatologie, CHU Ibn Rochd, 20400 Casablanca, Maroc
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Geller S, Lebowitz E, Pulitzer MP, Horwitz SM, Moskowitz AJ, Dusza S, Myskowski PL. Outcomes and prognostic factors in African American and black patients with mycosis fungoides/Sézary syndrome: Retrospective analysis of 157 patients from a referral cancer center. J Am Acad Dermatol 2019; 83:430-439. [PMID: 31499157 DOI: 10.1016/j.jaad.2019.08.073] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/30/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of mycosis fungoides/Sézary syndrome (MF/SS) is higher in the black population than in the white population in the United States and worse outcomes have been observed in black patients. OBJECTIVE To describe the outcomes and to identify prognostic factors in African American and black patients with MF/SS. METHODS Clinical features and follow-up data were analyzed in 157 self-identified African American or black patients seen during 1994-2018. RESULTS We included 122 patients with early stage MF and 35 patients with advanced-stage disease (median follow-up of 25 months). Overall, >80% of the patients who died from disease or progressed had erythema or hyperpigmentation without hypopigmentation. Patients with hypopigmentation, either as the sole manifestation or in combination with other lesions, had better overall survival (P = .002) and progression-free survival (P = .014). Clinical stage, TNMB classification, plaque disease, and elevated serum lactate dehydrogenase were also significantly associated with outcomes. Demographic and socioeconomic parameters were not associated with prognosis. LIMITATIONS A retrospective study at a single cancer center. CONCLUSION MF/SS manifestations and outcomes in African American and black patients are heterogeneous. Demographic and socioeconomic factors do not seem to have a prognostic role, while clinical characteristics might help in the stratification of risk of progression and shorter survival, allowing for individually tailored therapeutic interventions.
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Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | | | - Melissa P Pulitzer
- Weill Cornell Medical College, New York, New York; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steven M Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison J Moskowitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Steve Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
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Ghazawi FM, Alghazawi N, Le M, Netchiporouk E, Glassman SJ, Sasseville D, Litvinov IV. Environmental and Other Extrinsic Risk Factors Contributing to the Pathogenesis of Cutaneous T Cell Lymphoma (CTCL). Front Oncol 2019; 9:300. [PMID: 31106143 PMCID: PMC6499168 DOI: 10.3389/fonc.2019.00300] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/01/2019] [Indexed: 01/17/2023] Open
Abstract
The applications of disease cluster investigations in medicine have developed rather rapidly in recent decades. Analyzing the epidemiology of non-random aggregation of patients with a particular disease fostered identification of environmental and external exposures as disease triggers and promoters. Observation of patient clusters and their association with nearby exposures, such as Dr. John Snow's astute mapping analysis in the mid-1800's, which revealed proximity of cholera patients in London to a contaminated water pump infected with Vibrio cholerae, have paved the way for the field of epidemiology. This approach enabled the identification of triggers for many human diseases including infections and cancers. Cutaneous T-cell lymphomas (CTCL) represent a group of non-Hodgkin lymphomas that primarily affect the skin. The detailed pathogenesis by which CTCL develops remains largely unknown. Notably, non-random clustering of CTCL patients was reported in several areas worldwide and this rare malignancy was also described to affect multiple members of the same family. These observations indicate that external factors are possibly implicated in promoting CTCL lymphomagenesis. Here, we review the epidemiology of CTCL worldwide and the clinical characteristics of CTCL patients, as revealed by global epidemiological data. Further, we review the known risk factors including sex, age, race as well as environmental, infectious, iatrogenic and other exposures, that are implicated in CTCL lymphomagenesis and discuss conceivable mechanisms by which these factors may trigger this malignancy.
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Affiliation(s)
- Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Nebras Alghazawi
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | - Michelle Le
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | | | | | - Denis Sasseville
- Division of Dermatology, McGill University, Montréal, QC, Canada
| | - Ivan V Litvinov
- Division of Dermatology, McGill University, Montréal, QC, Canada
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Highly cytotoxic natural killer cells are associated with poor prognosis in patients with cutaneous T-cell lymphoma. Blood Adv 2019; 2:1818-1827. [PMID: 30054309 DOI: 10.1182/bloodadvances.2018020388] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/19/2018] [Indexed: 12/23/2022] Open
Abstract
Key Points
Paradoxically higher NK-cell activity in CTCL patients is associated with increased expression of phosphorylated STAT5. These highly effective NK cells are associated with poor prognosis in patients with leukemic CTCL.
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Ling YL, Huang X, Mitri G, Lovelace B, Pham A, Knobler R, Li X, Gao X. Real-world use of extracorporeal photopheresis for patients with cutaneous T-cell lymphoma in the United States: 2010-2015. J DERMATOL TREAT 2019; 31:91-98. [PMID: 30892982 DOI: 10.1080/09546634.2019.1587144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The National Comprehensive Cancer Network and the European Organization for Research and Treatment of Cancer recommend extracorporeal photopheresis (ECP) as systemic therapy for cutaneous T-cell lymphoma (CTCL).Objective: To investigate real-world use of ECP in CTCL patients in the US.Methods: Data from the Truven MarketScan® database (2010-2015) were used to create a cohort of CTCL patients receiving systemic treatment. Multivariable regressions were performed to compare health care resource utilization between ECP and propensity score-matched non-ECP patients.Results: Of the 1106 eligible patients, 117 (10.6%) received ECP, with an average treatment duration of 13.6 months. Psoriasis, organ transplant, graft versus host disease, and scleroderma were the most common comorbidities. ECP was used as monotherapy in 76 patients (65.0%) and combination in 41 patients (35.0%), mostly with interferon and/or a retinoid. Higher Charlson Comorbidity Index (2.6 vs 2.2, p < .05), rates of organ transplant (49.6% vs 7.8%, p < .001), and graft vs host disease (41.9% vs 3.4%, p < .001) were observed in ECP versus non-ECP patients. Post-matching analyses showed that ECP patients had shorter all-cause inpatient stay (6.67 vs 11.80 days, p = .001).Conclusions: Approximately 1 out of 10 CTCL patients receiving systemic treatment were on ECP treatment in the US. Post-matching analysis showed ECP was associated with a shorter hospital stay.
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Affiliation(s)
- You-Li Ling
- Pharmerit International LP, Bethesda, MA, USA
| | | | - Ghaith Mitri
- Formerly of Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | | | - An Pham
- Formerly of Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA.,School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Xiaocong Li
- Pharmerit International LP, Bethesda, MA, USA
| | - Xin Gao
- Pharmerit International LP, Bethesda, MA, USA
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Zhang Q, Wang S, Chen J, Yu Z. Histone Deacetylases (HDACs) Guided Novel Therapies for T-cell lymphomas. Int J Med Sci 2019; 16:424-442. [PMID: 30911277 PMCID: PMC6428980 DOI: 10.7150/ijms.30154] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022] Open
Abstract
T-cell lymphomas are a heterogeneous group of cancers with different pathogenesis and poor prognosis. Histone deacetylases (HDACs) are epigenetic modifiers that modulate many key biological processes. In recent years, HDACs have been fully investigated for their roles and potential as drug targets in T-cell lymphomas. In this review, we have deciphered the modes of action of HDACs, HDAC inhibitors as single agents, and HDACs guided combination therapies in T-cell lymphomas. The overview of HDACs on the stage of T-cell lymphomas, and HDACs guided therapies both as single agents and combination regimens endow great opportunities for the cure of T-cell lymphomas.
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Affiliation(s)
- Qing Zhang
- Department of Minimally Invasive Intervention, Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, China
| | - Shaobin Wang
- Health Management Center of Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, China
| | - Junhui Chen
- Department of Minimally Invasive Intervention, Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, China
| | - Zhendong Yu
- China Central Laboratory of Peking University Shenzhen Hospital, Shenzhen, Guangdong, 518036, China
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Van Der Weyden C, Dickinson M, Whisstock J, Prince HM. Brentuximab vedotin in T-cell lymphoma. Expert Rev Hematol 2018; 12:5-19. [DOI: 10.1080/17474086.2019.1558399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - James Whisstock
- ARC Centre of Excellence in Advanced Molecular Imaging, Biomedicine Discovery Institute, Department of Biochemistry, Monash University, Melbourne, Australia
| | - H. Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Epworth Healthcare, Richmond, Australia
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Horna P, Moscinski LC, Sokol L, Shao H. Naïve/memory T-cell phenotypes in leukemic cutaneous T-cell lymphoma: Putative cell of origin overlaps disease classification. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:234-241. [PMID: 30328260 DOI: 10.1002/cyto.b.21738] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Mycosis fungoides (MF) and Sézary Syndrome (SS) are clinically distinct cutaneous T-cell lymphomas with strikingly similar morphologic and phenotypic features. Prior studies have suggested phenotypic differences based on markers of antigen experience, suggesting a different cell of origin. METHODS Seventy-nine involved peripheral blood or bone marrow samples from 33 patients with SS and 19 patients with MF were studied by 10-color flow cytometry, including CD62L, CD45RA, CCR4, and PD-1. Gated tumor events were classified as naïve (TN ), central memory (TCM ), effector memory (TEM ), or effector memory with reacquired CD45RA (TEMRA ); based on CD62L+ /CD45RA+ , CD62L+ /CD45RA- , CD62L- /CD45RA- , or CD62L- /CD45RA+ phenotype, respectively. Sequential specimens were compared to assess for phenotypic stability. RESULTS The naïve/memory phenotype of the neoplastic T-cells was markedly heterogeneous, with a dominant TN , TCM , TEM , or TEMRA subset on 11 (14%), 32 (41%), 30 (38%), and 6 (8%) cases, respectively. There was no correlation between the diagnosis of MF or SS and putative cell of origin (P = 0.4). Overexpression of CCR4 and PD1 was observed in most cases, with higher intensity in SS compared to MF. The naïve/memory phenotype remained the same for 10 patients up to 273 days after the initial analysis; while on six patients, the naïve/memory phenotype was different from the original phenotype. CONCLUSIONS Both SS and MF can have phenotypic features of any of the major naïve/memory T-cell subsets, which questions the current principle of "cell-of-origin" distinction between SS and MF. Phenotypic shifts within these subsets are common, suggesting a functional state rather than a cell-of-origin surrogate. © 2018 International Clinical Cytometry Society.
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Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, Minnesota
| | - Lynn C Moscinski
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Lubomir Sokol
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Haipeng Shao
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
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Lebowitz E, Geller S, Flores E, Pulitzer M, Horwitz S, Moskowitz A, Kheterpal M, Myskowski PL. Survival, disease progression and prognostic factors in elderly patients with mycosis fungoides and Sézary syndrome: a retrospective analysis of 174 patients. J Eur Acad Dermatol Venereol 2018; 33:108-114. [PMID: 30176169 DOI: 10.1111/jdv.15236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Advanced age at diagnosis is considered a poor prognostic factor in mycosis fungoides (MF) and Sézary syndrome (SS). OBJECTIVE To evaluate the outcomes and prognostic factors in patients diagnosed at an advanced age (≥65 years) with MF/SS. METHODS Survival, progression rates and various clinical and histopathological variables were studied in a group of 174 elderly patients diagnosed with MF/SS between 1992 and 2015 at a single referral cancer center in the United States. Kaplan-Meier estimates were used to determine survival and progression and Cox proportional hazards regression univariate and multivariate models were used to identify prognostic factors. RESULTS Of 174 elderly patients, 76.4% were diagnosed with early-stage (clinical stages IA-IIA) and 23.6% with late-stage MF/SS (IIB-IV). Advanced age was associated with poor overall survival, but not with disease-specific survival (DSS) or progression-free survival (PFS). Gender, increasing clinical stage, T and B classifications, elevated lactate dehydrogenase (LDH) levels and development of large cell transformation (LCT) were significant predictors of poor survival or disease progression. Patients with early-stage MF and <10% total skin involvement (T1 classification) or patch-only disease (T1a/T2a) showed better PFS with no observed disease-specific mortality. Folliculotropic MF was associated with poor DSS in patients with early-stage disease. CONCLUSIONS Older age at diagnosis of MF/SS does not predict worse disease-specific outcomes. Elderly patients with early-stage disease, specifically involving less than 10% of the skin surface with patches but without plaques or folliculotropism, have an excellent prognosis. However, the development of LCT is a strong prognostic indicator of poor survival in elderly patients with MF/SS.
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Affiliation(s)
- E Lebowitz
- Weill Cornell Medical College, New York, NY, USA
| | - S Geller
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - E Flores
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Pulitzer
- Weill Cornell Medical College, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Horwitz
- Weill Cornell Medical College, New York, NY, USA.,Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - A Moskowitz
- Weill Cornell Medical College, New York, NY, USA.,Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
| | - M Kheterpal
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Duke University, Durham, NC, USA
| | - P L Myskowski
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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48
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Holahan HM, Farah RS, Fitz S, Mott SL, Ferguson NN, McKillip J, Link B, Liu V. Health-related quality of life in patients with cutaneous T-cell lymphoma? Int J Dermatol 2018; 57:1314-1319. [DOI: 10.1111/ijd.14132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Heather M. Holahan
- Rutgers-New Jersey Medical School; Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Ronda S. Farah
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Sara Fitz
- Medical Associates Clinic & Health Plans; Dubuque IA USA
| | - Sarah L. Mott
- University of Iowa Hospitals and Clinics; Holden Comprehensive Cancer Center; Iowa City IA USA
| | - Nkanyezi N. Ferguson
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Julie McKillip
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Brian Link
- Department of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Vincent Liu
- Departments of Dermatology and Pathology; University of Iowa Hospitals and Clinics; Iowa City IA USA
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Large-scale computational drug repositioning to find treatments for rare diseases. NPJ Syst Biol Appl 2018; 4:13. [PMID: 29560273 PMCID: PMC5847522 DOI: 10.1038/s41540-018-0050-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/22/2018] [Accepted: 02/03/2018] [Indexed: 11/08/2022] Open
Abstract
Rare, or orphan, diseases are conditions afflicting a small subset of people in a population. Although these disorders collectively pose significant health care problems, drug companies require government incentives to develop drugs for rare diseases due to extremely limited individual markets. Computer-aided drug repositioning, i.e., finding new indications for existing drugs, is a cheaper and faster alternative to traditional drug discovery offering a promising venue for orphan drug research. Structure-based matching of drug-binding pockets is among the most promising computational techniques to inform drug repositioning. In order to find new targets for known drugs ultimately leading to drug repositioning, we recently developed eMatchSite, a new computer program to compare drug-binding sites. In this study, eMatchSite is combined with virtual screening to systematically explore opportunities to reposition known drugs to proteins associated with rare diseases. The effectiveness of this integrated approach is demonstrated for a kinase inhibitor, which is a confirmed candidate for repositioning to synapsin Ia. The resulting dataset comprises 31,142 putative drug-target complexes linked to 980 orphan diseases. The modeling accuracy is evaluated against the structural data recently released for tyrosine-protein kinase HCK. To illustrate how potential therapeutics for rare diseases can be identified, we discuss a possibility to repurpose a steroidal aromatase inhibitor to treat Niemann-Pick disease type C. Overall, the exhaustive exploration of the drug repositioning space exposes new opportunities to combat orphan diseases with existing drugs. DrugBank/Orphanet repositioning data are freely available to research community at https://osf.io/qdjup/.
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50
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Manfrere KCG, Torrealba MP, Miyashiro DR, Oliveira LMS, de Carvalho GC, Lima JF, Branco ACCC, Pereira NZ, Pereira J, Sanches JA, Sato MN. Toll-like receptor agonists partially restore the production of pro-inflammatory cytokines and type I interferon in Sézary syndrome. Oncotarget 2018; 7:74592-74601. [PMID: 27780938 PMCID: PMC5342689 DOI: 10.18632/oncotarget.12816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/14/2016] [Indexed: 12/31/2022] Open
Abstract
Sézary syndrome (SS) carries a poor prognosis, and infections represent the most frequent cause of death in SS patients. Toll-like receptors (TLRs) are a family of innate immune receptors that induce protective immune responses against infections. We sought to evaluate the ability of TLR agonists to induce inflammatory cytokine, Th2 cytokine, and type I interferon (IFN-I) production by peripheral blood mononuclear cells (PBMC) of untreated SS patients. We detected impaired IL-6, IL-10 and IL-13 secretion by PBMC induced by the agonists for TLR5, TLR3, TLR7 and TLR9 in SS patients, while it was partially recovered by TLR2/TLR4 and TLR7/8 agonists TNF secretion was restored following stimulation with TLR2/TLR4 agonists. IFN-γ was scarcely produced upon TLR activation in SS cells, albeit TLR 7/8 (CL097) enhanced their secretion at lower levels than the control group. TLR9 agonist efficiently induced IFN-I in SS patients, although this positive regulation was not observed for other cytokines, in direct contrast to the broad activity of CL097. Among the TLR agonists, TLR4 was able to induce pro-inflammatory, IL-10 and Th2 secretion, while TLR7-8 agonist induced the inflammatory cytokines, IFN-I and IFN-γ. These findings reveal a dysfunctional cytokine response upon both extracellular and intracellular TLR activation in SS patients, which was partially restored by TLRs agonists.
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Affiliation(s)
- Kelly C G Manfrere
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Marina P Torrealba
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Denis R Miyashiro
- Department of Dermatology, Cutaneous Lymphoma Clinic, Hospital das Clínicas, University of São Paulo, Medical School, Brazil
| | - Luanda M S Oliveira
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Gabriel C de Carvalho
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Josenilson F Lima
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Anna Claudia C C Branco
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Nátalli Z Pereira
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
| | - Juliana Pereira
- Department of Hematology, University of São Paulo Medical School, Brazil
| | - José A Sanches
- Department of Dermatology, Cutaneous Lymphoma Clinic, Hospital das Clínicas, University of São Paulo, Medical School, Brazil
| | - Maria N Sato
- Department of Dermatology, Laboratory of Medical Investigation (LIM 56), Tropical Medicine Institute of São Paulo, University of São Paulo Medical School, Brazil
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