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Osman S, Chia JC, Street L, Hardin J. Transitioning to Pegylated Interferon for the Treatment of Cutaneous T-Cell Lymphoma: Meeting the Challenge of Therapy Discontinuation and a Proposed Algorithm. Dermatol Ther 2023; 2023:1-11. [DOI: 10.1155/2023/7171937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Cutaneous T-cell lymphoma (CTCL) is an uncommon non-Hodgkin lymphoma characterized by skin involvement, with the most recognized subtypes being mycosis fungoides (MF) and Sezary syndrome (SS). Interferon has been an established treatment for MF/SS since 1984 and is integrated into management guidelines internationally. In 2019, manufacturers abruptly discontinued interferon-α2b and interferon-α2a. Many alternative systemic therapies in MF/SS remain unfunded or unavailable in Canada, presenting a unique challenge. Although off-label use of pegylated interferon is a logical substitute, there are no established dosing guidelines and limited published experience. This case series provides a single-center experience on pegylated interferon-α2b for treatment of MF/SS, a suggested management algorithm, and a review of the literature. All patients identified in the Calgary Cutaneous Lymphoma Program with stage IIB–IVB MF/SS treated with interferon-α2b (4.5–9 MU/week) were switched to once weekly pegylated interferon (90 μg, 0.5 mL) between February and July 2021. Response was monitored using the mSWAT and SkinDex-29 tools. Eight patients were switched to pegylated interferon, with a median disease duration of 69 months (range: 8–275 months). Five out of eight patients remain on pegylated interferon, with the remainder having switched to preplanned therapies. Two patients required dose reduction due to side effects, including grade II anemia and mood changes. The remaining patients had normal laboratory investigations and no additional side effects. Uncommon lymphomas like MF/SS have limited treatment options, and the impact of abrupt product discontinuation is substantial. We propose a management algorithm for the transition of patients from interferon to pegylated interferon.
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Vorontsova AA, Karamova AE. Phototherapy combined with systemic agents for mycosis fungoides. Vestnik dermatologii i venerologii 2022. [DOI: 10.25208/vdv1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The choice of tactics for managing a patient with mycosis fungoides is determined by the stage of the disease. In the early stages of mycosis fungoides, a treatment approach using external therapy and various ultraviolet irradiation spectra (UVB-311 nm and PUVA therapy) is preferable. With insufficient efficiency and / or short remissions in some patients, it is possible to use combined methods in the early stages: PUVA therapy or UVB-311 nm therapy. in combination with systemic therapy, including interferon (IFN) 2b preparations, methotrexate and retinoids. The results of original studies demonstrate an increase in the overall response rate when combining PUVA therapy with IFN- or retinoids in patients with stages IB-IIB. The effectiveness of combined treatment regimens using UVB-311 nm remains insufficiently studied.
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Xiong F, Wang Q, Wu GH, Liu WZ, Wang B, Chen YJ. Direct and indirect effects of IFN-α2b in malignancy treatment: not only an archer but also an arrow. Biomark Res 2022; 10:69. [PMID: 36104718 PMCID: PMC9472737 DOI: 10.1186/s40364-022-00415-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Interferon-α2b (IFN-α2b) is a highly active cytokine that belongs to the interferon-α (IFN-α) family. IFN-α2b has beneficial antiviral, antitumour, antiparasitic and immunomodulatory activities. Direct and indirect antiproliferative effects of IFN-α2b have been found to occur via multiple pathways, mainly the JAK-STAT pathway, in certain cancers. This article reviews mechanistic studies and clinical trials on IFN-α2b. Potential regulators of the function of IFN-α2b were also reviewed, which could be utilized to relieve the poor response to IFN-α2b. IFN-α2b can function not only by enhancing the systematic immune response but also by directly killing tumour cells. Different parts of JAK-STAT pathway activated by IFN-α2b, such as interferon alpha and beta receptors (IFNARs), Janus kinases (JAKs) and IFN‐stimulated gene factor 3 (ISGF3), might serve as potential target for enhancing the pharmacological action of IFN-α2b. Despite some issues that remain to be solved, based on current evidence, IFN-α2b can inhibit disease progression and improve the survival of patients with certain types of malignant tumours. More efforts should be made to address potential adverse effects and complications.
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Sanches JA, Cury-Martins J, Abreu RM, Miyashiro D, Pereira J. Mycosis fungoides and Sézary syndrome: focus on the current treatment scenario. An Bras Dermatol 2021; 96:458-471. [PMID: 34053802 PMCID: PMC8245718 DOI: 10.1016/j.abd.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/23/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022] Open
Abstract
Cutaneous T-cell lymphomas are a heterogeneous group of lymphoproliferative disorders, characterized by infiltration of the skin by mature malignant T cells. Mycosis fungoides is the most common form of cutaneous T-cell lymphoma, accounting for more than 60% of cases. Mycosis fungoides in the early-stage is generally an indolent disease, progressing slowly from some patches or plaques to more widespread skin involvement. However, 20% to 25% of patients progress to advanced stages, with the development of skin tumors, extracutaneous spread and poor prognosis. Treatment modalities can be divided into two groups: skin-directed therapies and systemic therapies. Therapies targeting the skin include topical agents, phototherapy and radiotherapy. Systemic therapies include biological response modifiers, immunotherapies and chemotherapeutic agents. For early-stage mycosis fungoides, skin-directed therapies are preferred, to control the disease, improve symptoms and quality of life. When refractory or in advanced-stage disease, systemic treatment is necessary. In this article, the authors present a compilation of current treatment options for mycosis fungoides and Sézary syndrome.
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Affiliation(s)
- José Antonio Sanches
- Dermatology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Jade Cury-Martins
- Dermatology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Denis Miyashiro
- Dermatology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Pereira
- Hematology Clinic Division, Faculty of Medicine, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Soday L, Potts M, Hunter LM, Ravenhill BJ, Houghton JW, Williamson JC, Antrobus R, Wills MR, Matheson NJ, Weekes MP. Comparative Cell Surface Proteomic Analysis of the Primary Human T Cell and Monocyte Responses to Type I Interferon. Front Immunol 2021; 12:600056. [PMID: 33628210 PMCID: PMC7897682 DOI: 10.3389/fimmu.2021.600056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/13/2021] [Indexed: 12/28/2022] Open
Abstract
The cellular response to interferon (IFN) is essential for antiviral immunity, IFN-based therapy and IFN-related disease. The plasma membrane (PM) provides a critical interface between the cell and its environment, and is the initial portal of entry for viruses. Nonetheless, the effect of IFN on PM proteins is surprisingly poorly understood, and has not been systematically investigated in primary immune cells. Here, we use multiplexed proteomics to quantify IFNα2a-stimulated PM protein changes in primary human CD14+ monocytes and CD4+ T cells from five donors, quantifying 606 and 482 PM proteins respectively. Comparison of cell surface proteomes revealed a remarkable invariance between donors in the overall composition of the cell surface from each cell type, but a marked donor-to-donor variability in the effects of IFNα2a. Furthermore, whereas only 2.7% of quantified proteins were consistently upregulated by IFNα2a at the surface of CD4+ T cells, 6.8% of proteins were consistently upregulated in primary monocytes, suggesting that the magnitude of the IFNα2a response varies according to cell type. Among these differentially regulated proteins, we found the viral target Endothelin-converting enzyme 1 (ECE1) to be an IFNα2a-stimulated protein exclusively upregulated at the surface of CD4+ T cells. We therefore provide a comprehensive map of the cell surface of IFNα2a-stimulated primary human immune cells, including previously uncharacterized interferon stimulated genes (ISGs) and candidate antiviral factors.
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Affiliation(s)
- Lior Soday
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Martin Potts
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Leah M. Hunter
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin J. Ravenhill
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Jack W. Houghton
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - James C. Williamson
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Robin Antrobus
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Mark R. Wills
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Nicholas J. Matheson
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, United Kingdom
- NHS Blood and Transplant, Cambridge, United Kingdom
| | - Michael P. Weekes
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
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Abstract
BACKGROUND Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma, a malignant, chronic disease initially affecting the skin. Several therapies are available, which may induce clinical remission for a time. This is an update of a Cochrane Review first published in 2012: we wanted to assess new trials, some of which investigated new interventions. OBJECTIVES To assess the effects of interventions for MF in all stages of the disease. SEARCH METHODS We updated our searches of the following databases to May 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched 2 trials registries for additional references. For adverse event outcomes, we undertook separate searches in MEDLINE in April, July and November 2017. SELECTION CRITERIA Randomised controlled trials (RCTs) of local or systemic interventions for MF in adults with any stage of the disease compared with either another local or systemic intervention or with placebo. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcomes were improvement in health-related quality of life as defined by participants, and common adverse effects of the treatments. Key secondary outcomes were complete response (CR), defined as complete disappearance of all clinical evidence of disease, and objective response rate (ORR), defined as proportion of patients with a partial or complete response. We used GRADE to assess the certainty of evidence and considered comparisons of psoralen plus ultraviolet A (PUVA) light treatment as most important because this is first-line treatment for MF in most guidelines. MAIN RESULTS This review includes 20 RCTs (1369 participants) covering a wide range of interventions. The following were assessed as either treatments or comparators: imiquimod, peldesine, hypericin, mechlorethamine, nitrogen mustard and intralesional injections of interferon-α (IFN-α) (topical applications); PUVA, extracorporeal photopheresis (ECP: photochemotherapy), and visible light (light applications); acitretin, bexarotene, lenalidomide, methotrexate and vorinostat (oral agents); brentuximab vedotin; denileukin diftitox; mogamulizumab; chemotherapy with cyclophosphamide, doxorubicin, etoposide, and vincristine; a combination of chemotherapy with electron beam radiation; subcutaneous injection of IFN-α; and intramuscular injections of active transfer factor (parenteral systemics). Thirteen trials used an active comparator, five were placebo-controlled, and two compared an active operator to observation only. In 14 trials, participants had MF in clinical stages IA to IIB. All participants were treated in secondary and tertiary care settings, mainly in Europe, North America or Australia. Trials recruited both men and women, with more male participants overall. Trial duration varied from four weeks to 12 months, with one longer-term study lasting more than six years. We judged 16 trials as at high risk of bias in at least one domain, most commonly performance bias (blinding of participants and investigators), attrition bias and reporting bias. None of our key comparisons measured quality of life, and the two studies that did presented no usable data. Eighteen studies reported common adverse effects of the treatments. Adverse effects ranged from mild symptoms to lethal complications depending upon the treatment type. More aggressive treatments like systemic chemotherapy generally resulted in more severe adverse effects. In the included studies, CR rates ranged from 0% to 83% (median 31%), and ORR ranged from 0% to 88% (median 47%). Five trials assessed PUVA treatment, alone or combined, summarised below. There may be little to no difference between intralesional IFN-α and PUVA compared with PUVA alone for 24 to 52 weeks in CR (risk ratio (RR) 1.07, 95% confidence interval (CI) 0.87 to 1.31; 2 trials; 122 participants; low-certainty evidence). Common adverse events and ORR were not measured. One small cross-over trial found once-monthly ECP for six months may be less effective than twice-weekly PUVA for three months, reporting CR in two of eight participants and ORR in six of eight participants after PUVA, compared with no CR or ORR after ECP (very low-certainty evidence). Some participants reported mild nausea after PUVA but no numerical data were given. One participant in the ECP group withdrew due to hypotension. However, we are unsure of the results due to very low-certainty evidence. One trial comparing bexarotene plus PUVA versus PUVA alone for up to 16 weeks reported one case of photosensitivity in the bexarotene plus PUVA group compared to none in the PUVA-alone group (87 participants; low-certainty evidence). There may be little to no difference between bexarotene plus PUVA and PUVA alone in CR (RR 1.41, 95% CI 0.71 to 2.80) and ORR (RR 0.94, 95% CI 0.61 to 1.44) (93 participants; low-certainty evidence). One trial comparing subcutaneous IFN-α injections combined with either acitretin or PUVA for up to 48 weeks or until CR indicated there may be little to no difference in the common IFN-α adverse effect of flu-like symptoms (RR 1.32, 95% CI 0.92 to 1.88; 82 participants). There may be lower CR with IFN-α and acitretin compared with IFN-α and PUVA (RR 0.54, 95% CI 0.35 to 0.84; 82 participants) (both outcomes: low-certainty evidence). This trial did not measure ORR. One trial comparing PUVA maintenance treatment to no maintenance treatment, in participants who had already had CR, did report common adverse effects. However, the distribution was not evaluable. CR and OR were not assessable. The range of treatment options meant that rare adverse effects consequently occurred in a variety of organs. AUTHORS' CONCLUSIONS There is a lack of high-certainty evidence to support decision making in the treatment of MF. Because of substantial heterogeneity in design, missing data, small sample sizes, and low methodological quality, the comparative safety and efficacy of these interventions cannot be reliably established on the basis of the included RCTs. PUVA is commonly recommended as first-line treatment for MF, and we did not find evidence to challenge this recommendation. There was an absence of evidence to support the use of intralesional IFN-α or bexarotene in people receiving PUVA and an absence of evidence to support the use of acitretin or ECP for treating MF. Future trials should compare the safety and efficacy of treatments to PUVA, as the current standard of care, and should measure quality of life and common adverse effects.
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Affiliation(s)
- Arash Valipour
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
- Evidence-Based Medicine Frankfurt, Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Manuel Jäger
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
- Hautklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Peggy Wu
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technischen Universität (TU) Dresden, Dresden, Germany
| | - Charles Bunch
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Tobias Weberschock
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe-University Hospital, Frankfurt am Main, Germany
- Evidence-Based Medicine Frankfurt, Institute of General Practice, Goethe University, Frankfurt, Germany
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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. Clinicoecon Outcomes Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Heyman B, Kelsey CR, Beaven A. Durable Control of Mycosis Fungoides after Sepsis: "Coley's Toxin?" Case Report and Review of the Literature. Case Rep Hematol 2019; 2019:1507014. [PMID: 31467737 DOI: 10.1155/2019/1507014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Mycosis fungoides, along with Sezary syndrome, is the most common subtype of cutaneous T-cell lymphoma. In this report, we present a patient with advanced-stage mycosis fungoides, who after successful treatment of methicillin-resistant Staphylococcus aureus bacteremia had prolonged disease control off systemic therapy. While this may have been due to single-agent gemcitabine, which can result in long remission, we hypothesize that our patient's durable response was in part due to the immune response elicited after treatment of her severe infection.
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Abstract
Introduction: Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of skin-homing T-cell neoplasms, which represent approximately 75% of all primary cutaneous lymphomas. Mycosis fungoides and Sézary syndrome are the most common CTCL. Early stage disease follows a protracted course, carries a 5-year disease specific survival of 97% and can be treated with skin-directed therapies. Widespread, advanced disease has a 5-year OS of less than 25% and necessitates systemic treatment. Allogeneic stem cell transplantation is a potentially curative treatment option for advanced CTCL, however, transplant-related morbidity and mortality must be considered and a risk-benefit assessment performed on individual basis. Areas covered: Herein, we provide a review of investigative drugs in early-stage trials for the treatment of cutaneous CTCL, including topically applied immunomodulators such as replicating herpes virus or toll-like receptor 7/8 agonist resiquimod and systemic therapies with monoclonal antibodies, such as anti-CD47, recombinant cytotoxic interleukin 2 fusion protein anti-KIR3DL2 antibody and anti-miR-155 antibody. Expert Opinion: Among the reviewed drugs, resiquimod shows promising clinical efficacy with good tolerability in early CTCL. In refractory or relapsed disease, intratumoral anti-CD47-, anti-CCR4- and anti-KIR3DL2-antibodies show high response rates, however, latter two also show considerable toxicity. Larger trials are needed to better evaluate the discussed therapies.
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Affiliation(s)
- Egle Ramelyte
- Department of Dermatology, University Hospital of Zurich , Zurich , Switzerland.,Faculty of Medicine, University of Zurich , Zurich , Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich , Zurich , Switzerland.,Faculty of Medicine, University of Zurich , Zurich , Switzerland
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital of Zurich , Zurich , Switzerland.,Faculty of Medicine, University of Zurich , Zurich , Switzerland
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Abstract
Adequate therapeutic management of cutaneous T-cell lymphoma (CTCL) requires the identification of the exact CTCL stage and entity within the current WHO classification. There is no curative therapy for CTCL yet, so that treatment currently aims at improving symptoms and quality of life as well as reducing relapse rates. The treatment has to be stage-adapted. Therapeutic options comprise skin-directed as well as systemic treatment. In early stages, phototherapy and local steroids are the first-line therapeutic options. For the therapy of higher stages, interferon alpha and the RXR-specific retinoid bexarotene are used as first-line medications. Second-line treatment comprises monochemotherapy with agents like gemcitabine or liposomal doxorubicine. Nevertheless, the high relapse rates in higher stages make novel alternative treatment options necessary. As future therapy, especially the fusion protein brentuximab-vedotin directed against CD30 shows promising potential in clinical studies.
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Affiliation(s)
- J P Nicolay
- Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Deutschland.
| | - C Assaf
- Klinik für Dermatologie und Venerologie, HELIOS Klinikum Krefeld, Krefeld, Deutschland
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11
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Gilson D, Whittaker S, Child F, Scarisbrick J, Illidge T, Parry E, Mohd Mustapa M, Exton L, Kanfer E, Rezvani K, Dearden C, Morris S, McHenry P, Leslie T, Wakelin S, Hunasehally R, Cork M, Johnston G, Chiang N, Worsnop F, Salim A, Buckley D, Petrof G, Callachand N, Flavell T, Salad A. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol 2018; 180:496-526. [DOI: 10.1111/bjd.17240] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
Affiliation(s)
- D. Gilson
- Leeds Cancer Centre St James's University Hospital Leeds LS9 7TF U.K
| | - S.J. Whittaker
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - F.J. Child
- St John's Institute of Dermatology Guy's and St Thomas NHS Foundation Trust St Thomas’ Hospital London SE1 7EH U.K
| | - J.J. Scarisbrick
- Queen Elizabeth Hospital University Hospital Birmingham Birmingham B15 2TH U.K
| | - T.M. Illidge
- Institute of Cancer Sciences University of Manchester The Christie NHS Foundation Trust Manchester M20 4BX U.K
| | - E.J. Parry
- Tameside Hospital Integrated Care NHS Foundation Trust Ashton‐under‐Lyne OL6 9RW U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House, 4 Fitzroy Square London W1T 5HQ U.K
| | - E. Kanfer
- Haematology Department Hammersmith Hospital Du Cane Road London W12 0HS U.K
| | - K. Rezvani
- The University of Texas MD Anderson Cancer Centre Houston TX U.S.A
| | - C.E. Dearden
- Chronic Lymphocytic Leukaemia (CLL) Unit The Royal Marsden NHS Foundation Trust Sutton SW3 6JJ U.K
| | - S.L. Morris
- Guy's and St Thomas’ NHS Foundation Trust Guy's Hospital London SE1 9RT U.K
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Grandi V, Fava P, Rupoli S, Alberti Violetti S, Canafoglia L, Quaglino P, Berti E, Pimpinelli N. Standardization of regimens in Narrowband UVB and PUVA in early stage mycosis fungoides: position paper from the Italian Task Force for Cutaneous Lymphomas. J Eur Acad Dermatol Venereol 2018; 32:683-691. [DOI: 10.1111/jdv.14668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
Affiliation(s)
- V. Grandi
- Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence Medical School; Florence Italy
| | - P. Fava
- Department of Medical Sciences; Dermatologic Clinic; University of Turin; Turin Italy
| | - S. Rupoli
- Clinic of Hematology; United Ancona Hospitals; Polytechnic University of Marche; Ancona Italy
| | - S. Alberti Violetti
- Dermatology Unit; IRCCS Ca’ Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - L. Canafoglia
- Clinic of Hematology; United Ancona Hospitals; Polytechnic University of Marche; Ancona Italy
| | - P. Quaglino
- Department of Medical Sciences; Dermatologic Clinic; University of Turin; Turin Italy
| | - E. Berti
- Dermatology Unit; IRCCS Ca’ Granda - Ospedale Maggiore Policlinico; Milan Italy
| | - N. Pimpinelli
- Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence Medical School; Florence Italy
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Schiller M, Tsianakas A, Sterry W, Dummer R, Hinke A, Nashan D, Stadler R. Dose-escalation study evaluating pegylated interferon alpha-2a in patients with cutaneous T-cell lymphoma. J Eur Acad Dermatol Venereol 2017; 31:1841-1847. [PMID: 28557110 DOI: 10.1111/jdv.14366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND This open-label, multicenter, dose-escalation study evaluated the safety, tolerability, and efficacy of subcutaneous pegylated (40 kD) interferon α-2a (PEG-IFN α-2a) in patients with cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS PEG-IFN α-2a was administered subcutaneously at 180 (n = 4), 270 (n = 6), or 360 μg (n = 3) once weekly for 12 weeks. Efficacy was assessed by the proportion of patients with complete response (CR) or partial response (PR). RESULTS PEG-IFN α-2a was generally well tolerated, with a moderate number of reductions or withholding of doses because of adverse events (AEs) (25% (n = 1), 66% (n = 4), and 0% (n = 0) in the 180-, 270-, and 360-μg/week groups, respectively). The only dose-limiting toxicity was a grade 3 elevation of liver enzymes in the 270-μg dose group. The most common AEs were fatigue, acute flu-like symptoms, and hepatic toxicity. The major response rate (CR or PR) was 50% in the 180-μg group (CR, 50%; PR, 0%), 83% in the 270-μg group (CR, 67%; PR, 17%), and 66% in the 360-μg group (CR, 33%; PR, 33%). CONCLUSION PEG-IFN α-2a at doses up to 360 μg once weekly was well tolerated in patients with CTCL up to the highest dose group and showed good response rates. Due to their good tolerance even in high doses, they might be an option for patients not tolerating standard IFN-α preparations. However, for this purpose and to evaluate comparability between standard and PEG-IFN larger clinical trials are needed, alone and in combination with oral photochemotherapy (PUVA).
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Affiliation(s)
- M Schiller
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany.,Dermatological Office Professor Schiller, Coesfeld, Germany
| | - A Tsianakas
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - W Sterry
- Department of Dermatology, Charité, Berlin, Germany
| | - R Dummer
- Department of Dermatology, University Hospital, Zurich, Switzerland
| | - A Hinke
- WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - D Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - R Stadler
- Department of Dermatology, Johannes Wesling Klinikum Minden, University Hospital of Ruhr University of Bochum, Bochum, Germany
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14
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Trautinger F, Eder J, Assaf C, Bagot M, Cozzio A, Dummer R, Gniadecki R, Klemke C, Ortiz-romero PL, Papadavid E, Pimpinelli N, Quaglino P, Ranki A, Scarisbrick J, Stadler R, Väkevä L, Vermeer MH, Whittaker S, Willemze R, Knobler R. European Organisation for Research and Treatment of Cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome – Update 2017. Eur J Cancer 2017; 77:57-74. [DOI: 10.1016/j.ejca.2017.02.027] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 02/19/2017] [Accepted: 02/24/2017] [Indexed: 01/03/2023]
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Abstract
T-cell lymphomas are rare and aggressive malignancies associated with poor outcome, often because of the development of resistance in the lymphoma against chemotherapy as well as intolerance in patients to the established and toxic chemotherapy regimens. In this review article, we discuss the epidemiology, pathophysiology, current standard of care, and future treatments of common types of T-cell lymphomas, including adult T-cell leukemia/lymphoma, angioimmunoblastic T-cell lymphoma, anaplastic large-cell lymphoma, aggressive NK/T-cell lymphoma, and cutaneous T-cell lymphoma.
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Affiliation(s)
- Helen Ma
- Department of Internal Medicine, New York University, New York, NY, USA
| | - Maher Abdul-Hay
- Department of Internal Medicine, New York University, New York, NY, USA. .,Perlmutter Cancer Center, New York University, New York, NY, USA.
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16
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Ling T, Clayton T, Crawley J, Exton L, Goulden V, Ibbotson S, McKenna K, Mohd Mustapa M, Rhodes L, Sarkany R, Dawe R, McHenry P, Hughes J, Griffiths M, McDonagh A, Buckley D, Nasr I, Swale V, Duarte Williamson C, Levell N, Leslie T, Mallon E, Wakelin S, Hunasehally P, Cork M, Ungureanu S, Donnelly J, Towers K, Saunders C, Davis R, Brain A, Exton L, Mohd Mustapa M. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen–ultraviolet A therapy 2015. Br J Dermatol 2016; 174:24-55. [DOI: 10.1111/bjd.14317] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/28/2023]
Affiliation(s)
- T.C. Ling
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - T.H. Clayton
- Dermatology Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - J. Crawley
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - V. Goulden
- Department of Dermatology Leeds Teaching Hospitals NHS Trust Leeds LS7 4SA U.K
| | - S. Ibbotson
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
| | - K. McKenna
- Department of Dermatology Belfast City Hospital Belfast BT9 7AB U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - L.E. Rhodes
- Dermatology Research Centre Faculty of Medical and Human Sciences Salford Royal NHS Foundation Trust Salford Manchester M6 8HD U.K
| | - R. Sarkany
- Department of Dermatology University College Hospital 235 Euston Road London NW1 2BU U.K
| | - R.S. Dawe
- Department of Dermatology Ninewells Hospital and Medical School University of Dundee Dundee DD1 9SY U.K
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17
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Abstract
Interferons are polypeptides that naturally occur in the human body as a part of the innate immune response. By harnessing these immunomodulatory functions, synthetic interferons have shown efficacy in combating various diseases including cutaneous T-cell lymphoma. This article closely examines the qualities of interferon alfa and interferon gamma and the evidence behind their use in the 2 most common types of cutaneous T-cell lymphomas, namely, mycosis fungoides and Sézary syndrome.
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Affiliation(s)
- Natalie Spaccarelli
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104, USA.
| | - Alain H Rook
- Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104, USA
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18
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Humme D, Nast A, Erdmann R, Vandersee S, Beyer M. Systematic review of combination therapies for mycosis fungoides. Cancer Treat Rev 2014; 40:927-33. [PMID: 24997678 DOI: 10.1016/j.ctrv.2014.06.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/29/2014] [Accepted: 06/08/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND A variety of therapeutic options are available for mycosis fungoides, the most prevalent subtype of cutaneous T cell lymphomas, but thus far, no regimen has been proven to be curative. A combination of treatments is a well-established strategy to increase the therapeutic efficacy. However, data from clinical trials analyzing such combinations for the treatment of mycosis fungoides are scarce. OBJECTIVE To analyze the available evidence on combination therapies with emphasis on the combination of psoralen with UVA phototherapy (PUVA), interferon-alpha and bexarotene with another treatment. METHODS Systematic literature review of the databases Embase, Cochrane, Medline, and Medline in Process. RESULTS Combination of PUVA with interferon-alpha or retinoids did not result in an increased overall response rate. Addition of methotrexate but not retinoids to interferon-alpha may increase the overall response rate. Bexarotene was investigated in one trial each with vorinostat, methotrexate or gemcitabine, whereby only methotrexate possibly enhanced the effect of bexarotene. CONCLUSION For mycosis fungoides, no combination treatment has been demonstrated to be superior to monotherapy. Based on our analysis, we conclude that in certain clinical situations, patients may benefit from a combination of PUVA with interferon-alpha or a retinoid or a combination of the latter two. Furthermore, patients in advanced stages may benefit from the combination of methotrexate and interferon-alpha or bexarotene. Finally, the combination of bexarotene with either vorinostat or gemcitabine did not increase the overall response rate but resulted in more pronounced side effects and cannot be recommended.
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20
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Abstract
The discipline that investigates the biologic effects of ultraviolet radiation on the immune system is called photoimmunology. Photoimmunology evolved from an interest in understanding the role of the immune system in skin cancer development and why immunosuppressed organ transplant recipients are at a greatly increased risk for cutaneous neoplasms. In addition to contributing to an understanding of the pathogenesis of nonmelanoma skin cancer, the knowledge acquired about the immunologic effects of ultraviolet radiation exposure has provided an understanding of its role in the pathogenesis of other photodermatologic diseases.
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Affiliation(s)
- Craig A Elmets
- Department of Dermatology, UAB Skin Diseases Research Center, UAB Comprehensive Cancer Center, Birmingham VA Medical Center, University of Alabama at Birmingham, EFH 414, 1720 2nd Avenue South, Birmingham, AL 35294-0009, USA.
| | - Cather M Cala
- Department of Dermatology, University of Alabama at Birmingham, EFH 414, 1720 2nd Avenue South, Birmingham, AL 35294-0009, USA
| | - Hui Xu
- Department of Dermatology, UAB Skin Diseases Research Center, UAB Comprehensive Cancer Center, Birmingham VA Medical Center, University of Alabama at Birmingham, EFH 414, 1720 2nd Avenue South, Birmingham, AL 35294-0009, USA
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21
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Duvic M, Geskin L, Prince HM. Duration of Response in Cutaneous T-Cell Lymphoma Patients Treated With Denileukin Diftitox: Results From 3 Phase III Studies. Clinical Lymphoma Myeloma and Leukemia 2013; 13:377-84. [DOI: 10.1016/j.clml.2013.02.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 01/04/2013] [Accepted: 02/01/2013] [Indexed: 11/16/2022]
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22
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Whittaker S, Ortiz P, Dummer R, Ranki A, Hasan B, Meulemans B, Gellrich S, Knobler R, Stadler R, Karrasch M. Efficacy and safety of bexarotene combined with psoralen-ultraviolet A (PUVA) compared with PUVA treatment alone in stage IB-IIA mycosis fungoides: final results from the EORTC Cutaneous Lymphoma Task Force phase III randomized clinical trial 21011 (NCT00. Br J Dermatol 2012; 167:678-87. [DOI: 10.1111/j.1365-2133.2012.11156.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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23
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Goteri G, Rupoli S, Campanati A, Zizzi A, Picardi P, Cardelli M, Giantomassi F, Canafoglia L, Marchegiani F, Mozzicafreddo G, Brandozzi G, Stramazzotti D, Ganzetti G, Lisa R, Simonetti O, Offidani A, Federici I, Filosa G, Leoni P. Serum and tissue CTACK/CCL27 chemokine levels in early mycosis fungoides may be correlated with disease-free survival following treatment with interferon alfa and psoralen plus ultraviolet A therapy. Br J Dermatol 2012; 166:948-52. [PMID: 22233400 DOI: 10.1111/j.1365-2133.2012.10818.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Neoplastic T-cell recruitment into the skin is a critical step in the pathogenesis of mycosis fungoides (MF), and the cutaneous T-cell attracting chemokine, CTACK/CCL27, might be involved. OBJECTIVES To investigate the clinical and prognostic significance of CTACK/CCL27 levels in patients with early-stage MF. METHODS Serum samples and skin biopsy specimens were collected from 15 patients at the time of diagnosis and after the end of treatment with psoralen plus ultraviolet A/interferon alfa-2b combination therapy. Serum samples were also collected from 20 healthy donors as controls. CTACK/CCL27 serum levels were analysed by enzyme-linked immunosorbent assays. CTACK/CCL27 tissue expression was determined by immunohistochemistry on skin biopsy specimens taken at diagnosis and after therapy. Event-free survival was taken as the primary clinical outcome. RESULTS In patients with MF at diagnosis, CTACK/CCL27 serum levels were not significantly different from healthy controls, whereas CTACK/CCL27 expression in the skin was increased in 87% of cases compared with normal controls. After therapy, all patients obtained a clinical complete remission, serum levels did not change significantly and tissue expression remained abnormal in 80% of patients, even if complete histological remission was recorded. Serum levels were not significantly different in cases with different intensity of cutaneous immunostaining. Eight patients experienced a relapse: the combination of high CTACK/CCL27 levels both in sera and skin increased the probability of experiencing an event at 51 months from 36% to 83%. CONCLUSIONS Our data seem to indicate that CTACK/CCL27 levels in skin and sera after therapy might be correlated with risk of recurrence.
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Affiliation(s)
- G Goteri
- Ancona Hospital, Polytechnic Marche University, Ancona, Italy.
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24
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Bloom T, Kuzel TM, Querfeld C, Guitart J, Rosen ST. Cutaneous T-cell lymphomas: a review of new discoveries and treatments. Curr Treat Options Oncol 2012; 13:102-21. [PMID: 22311555 DOI: 10.1007/s11864-011-0179-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Treatment regimens of patients with CTCL vary widely based on clinician preference and patient tolerance. Skin directed therapies are recommended for patients with early stage IA and IB MF, with combinations used in refractory cases. While no regimen has been proven to prolong survival in advanced stages, immunomodulatory regimens should be used initially to reduce the need for cytotoxic therapies. In more advanced stages of disease, treatment efforts should strive for palliation and improvement of quality of life. With many new therapies and strategies on the horizon, the future looks promising for CTCL patients. Unfortunately, other than allogeneic HCT, there are no potential curative therapies for CTCL. Clinical trials are currently underway to identify new therapies to improve quality of life for patients, and researchers are hard at work to identify novel pathways and genes for prognostication and as targets for therapies. Importantly, collaborative clinical trials to enhance rates of accrual need to be conducted, and improved interpretation of data via standardizing end points and response criteria should be an emphasis. Recently, the International Society for Cutaneous Lymphomas (ISCL), the United States Cutaneous Lymphoma Consortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) met to develop consensus guidelines to facilitate collaboration on clinical trials. These proposed guidelines consist of: recommendations for standardizing general protocol design; a scoring system for assessing tumor burden in skin, lymph nodes, blood, and viscera; definition of response in skin, nodes, blood, and viscera; a composite global response score; and a definition of end points. Although these guidelines were generated by consensus panels, they have not been prospectively or retrospectively validated through analysis of large patient cohorts.
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25
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Li JY, Horwitz S, Moskowitz A, Myskowski PL, Pulitzer M, Querfeld C. Management of cutaneous T cell lymphoma: new and emerging targets and treatment options. Cancer Manag Res 2012; 4:75-89. [PMID: 22457602 PMCID: PMC3308634 DOI: 10.2147/cmar.s9660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cutaneous T cell lymphomas (CTCL) clinically and biologically represent a heterogeneous group of non-Hodgkin lymphomas, with mycosis fungoides and Sézary syndrome being the most common subtypes. Over the last decade, new immunological and molecular pathways have been identified that not only influence CTCL phenotype and growth, but also provide targets for therapies and prognostication. This review will focus on recent advances in the development of therapeutic agents, including bortezomib, the histone deacetylase inhibitors (vorinostat and romidepsin), and pralatrexate in CTCL.
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Affiliation(s)
- Janet Y Li
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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26
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Wong HK, Mishra A, Hake T, Porcu P. Evolving insights in the pathogenesis and therapy of cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome). Br J Haematol 2011; 155:150-66. [PMID: 21883142 DOI: 10.1111/j.1365-2141.2011.08852.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of malignancies derived from skin-homing T cells. The most common forms of CTCL are Mycosis Fungoides (MF) and Sezary Syndrome (SS). Accurate diagnosis remains a challenge due to the heterogeneity of presentation and the lack of highly characteristic immunophenotypical and genetic markers. Over the past decade molecular studies have improved our understanding of the biology of CTCL. The identification of gene expression differences between normal and malignant T-cells has led to promising new diagnostic and prognostic biomarkers that now need validation to be incorporated into clinical practice. These biomarkers may also provide insight into the mechanism of development of CTCL. Additionally, treatment options have expanded with the approval of new agents, such as histone deacetylase inhibitors. A better understanding of the cell biology, immunology and genetics underlying the development and progression of CTCL will allow the design of more rational treatment strategies for these malignancies. This review summarizes the clinical epidemiology, staging and natural history of MF and SS; discusses the immunopathogenesis of MF and the functional role of the malignant T-cells; and reviews the latest advances in MF and SS treatment.
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Affiliation(s)
- Henry K Wong
- Division of Dermatology, The Ohio State University, Columbus, OH 43221, USA.
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27
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Hüsken A, Tsianakas A, Hensen P, Nashan D, Loquai C, Beissert S, Luger T, Sunderkötter C, Schiller M. Comparison of pegylated interferon α-2b plus psoralen PUVA versus standard interferon α-2a plus PUVA in patients with cutaneous T-cell lymphoma. J Eur Acad Dermatol Venereol 2011; 26:71-8. [DOI: 10.1111/j.1468-3083.2011.04011.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Mycosis fungoides is the most common type of primary cutaneous lymphomas. The phenotype of the tumor cell corresponds to an effector/memory-type of helper T cell which, given its repertoire of homing receptors, is specialized for recirculation through the skin. In recent years genetic analyses have uncovered various chromosomal aberrations in the tumour cells of mycosis fungoides. Their relevance to the pathogenesis and clinical appearance are discussed in the following.
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Affiliation(s)
- Marc Beyer
- Department of Dermatology, Venereology and Allergology, Charité- Universitätsmedizin Berlin, Germany.
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Nikolaou V, Siakantaris MP, Vassilakopoulos TP, Papadavid E, Stratigos A, Economidi A, Marinos L, Papadaki T, Antoniou C. PUVA plus interferon α2b in the treatment of advanced or refractory to PUVA early stage mycosis fungoides: a case series. J Eur Acad Dermatol Venereol 2011; 25:354-7. [DOI: 10.1111/j.1468-3083.2010.03732.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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30
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Porcu P. A look at the National Comprehensive Cancer Network guidelines for cutaneous lymphomas. Clin Lymphoma Myeloma Leuk 2010; 10 Suppl 2:S109-11. [PMID: 20826394 DOI: 10.3816/clml.2010.s.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Pierluigi Porcu
- The Ohio State University Comprehensive Cancer Center, Columbus
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31
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Erter J, Alinari L, Darabi K, Gurcan M, Garzon R, Marcucci G, Bechtel MA, Wong H, Porcu P. New targets of therapy in T-cell lymphomas. Curr Drug Targets 2010; 11:482-93. [PMID: 20196721 DOI: 10.2174/138945010790980376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 10/09/2009] [Indexed: 12/23/2022]
Abstract
T-cell lymphomas (TCL) are characterized by poor response to chemotherapy and generally poor outcome. While molecular profiling has identified distinct biological subsets and therapeutic targets in B-cell lymphomas, the molecular characterization of TCL has been slower. Surface markers expressed on malignant T-cells, such as CD2, CD3, CD4, CD25, and CD52 were the first TCL-specific therapeutic targets to be discovered. However, the presence of these receptors on normal T-cells means that monoclonal antibody (mAb)- or immunotoxin (IT)-based therapy in TCL inevitably results in variable degrees of immunosuppression. Thus, although some mAbs/IT have significant activity in selected subsets of TCL, more specific agents that target signaling pathways preferentially activated in malignant T-cells are needed. One such novel class of agents is represented by the histone deacetylase (HDAC) inhibitors. These molecules selectively induce apoptosis in a variety of transformed cells, including malignant T-cells, both in vitro and in vivo. Several HDAC inhibitors have been studied in TCL with promising results, and have recently been approved for clinical use. Immunomodulatory drugs, such as interferons and Toll Receptor (TLR) agonists have significant clinical activity in TCL, and are particularly important in the treatment of primary cutaneous subtypes (CTCL). Although most classical cytotoxic drugs have limited efficacy against TCL, agents that inhibit purine and pyrimidine metabolism, known as nucleoside analogues, and novel antifolate drugs, such as pralatrexate, are highly active in TCL. With improved molecular profiling of TCL novel pharmacological agents with activity in TCL are now being discovered at an increasingly rapid pace. Clinical trials are in progress and these agents are being integrated in combination therapies for TCL, both in the relapsed/refractory setting as well as front line.
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Affiliation(s)
- Jack Erter
- Division of Hematology - Oncology, The Ohio State University, Comprehensive Cancer Center, B-320 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH, 43210, USA
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Prince HM, Duvic M, Martin A, Sterry W, Assaf C, Sun Y, Straus D, Acosta M, Negro-Vilar A. Phase III Placebo-Controlled Trial of Denileukin Diftitox for Patients With Cutaneous T-Cell Lymphoma. J Clin Oncol 2010; 28:1870-7. [DOI: 10.1200/jco.2009.26.2386] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This phase III, placebo-controlled, randomized trial was designed to investigate efficacy and safety of two doses of denileukin diftitox (DD; DAB389–interleukin-2 [IL-2]), a recombinant fusion protein targeting IL-2 receptor–expressing malignant T lymphocytes, in patients with stage IA to III, CD25 assay–positive cutaneous T-cell lymphoma (CTCL), including the mycosis fungoides and Sézary syndrome forms of the disease, who had received up to three prior therapies. The primary end point was overall response rate (ORR). Patients and Methods Patients (N = 144) with biopsy-confirmed, CD25 assay–positive CTCL were randomly assigned to DD 9 μg/kg/d (n = 45), DD 18 μg/kg/d (n = 55), or placebo infusions (n = 44), administered for 5 consecutive days every 3 weeks for up to eight cycles. Patients were monitored for drug efficacy, clinical benefit, and safety of DD. Results ORR was 44% for all participants treated with DD (n = 100; 10% complete response [CR] and 34% partial response [PR]) compared with 15.9% for placebo-treated patients (2% CR and 13.6% PR). ORR was higher in the 18 μg/kg/d group versus the 9 μg/kg/d group (49.1% v 37.8%, respectively), and both doses were significantly superior to placebo. Progression-free survival (PFS) was significantly longer (median, > 2 years) for both DD doses compared with placebo (median, 124 days; P < .001). Rates of moderately severe and severe adverse events (AEs) were slightly higher in the DD groups, whereas moderate and mild AEs were similar to placebo. No statistical differences were observed for drug-related serious AEs. Conclusion DD had a significant and durable effect on ORR and PFS with an acceptable safety profile in patients with early- and late-stage CTCL.
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Affiliation(s)
- H. Miles Prince
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Madeleine Duvic
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Ann Martin
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Wolfram Sterry
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Chalid Assaf
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Yijun Sun
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - David Straus
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Mark Acosta
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
| | - Andres Negro-Vilar
- From the Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia; Skin Cancer Center Charité, Universitätsmedizin, Berlin; Department of Dermatology, HELIOS Klinikum Krefeld, Krefeld, Germany; The University of Texas M.D. Anderson Cancer Center, Houston, TX; Washington University School of Medicine, St Louis, MO; Eisai, Woodcliff Lake, NJ; Memorial Sloan-Kettering Cancer Center, New York, NY; and TransMed Institute, Washington, DC
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Wozniak M, Tracey L, Ortiz-Romero P, Montes S, Alvarez M, Fraga J, Fernández Herrera J, Vidal S, Rodriguez-Peralto J, Piris M, Villuendas (deceased) R. Psoralen plus ultraviolet A ± interferon-α treatment resistance in mycosis fungoides: the role of tumour microenvironment, nuclear transcription factor-κB and T-cell receptor pathways. Br J Dermatol 2009; 160:92-102. [DOI: 10.1111/j.1365-2133.2008.08886.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Papadavid E, Antoniou C, Nikolaou V, Siakantaris M, Vassilakopoulos TP, Stratigos A, Stavrianeas N, Katsambas A. Safety and efficacy of low-dose bexarotene and PUVA in the treatment of patients with mycosis fungoides. Am J Clin Dermatol 2008; 9:169-73. [PMID: 18429646 DOI: 10.2165/00128071-200809030-00005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The new rexinoid bexarotene is a retinoid X receptor antagonist and immune response modifier. Although combinations of oral bexarotene and psoralen plus UVA (PUVA) have been tried in patients with all stages of mycosis fungoides (MF), the dosage of bexarotene used in these combination regimens has been variable. OBJECTIVE To assess the efficacy and safety of low-dose oral bexarotene and PUVA in patients with relapsed or treatment-refractory MF following monotherapy with multiple agents including PUVA, narrow-band UVB, interferon-alpha, oral bexarotene, and topical corticosteroids. METHOD Combination therapy with PUVA three times weekly and low-dose oral bexarotene (150 or 300 mg/day, depending on physicians' preference) was administered to 14 patients, seven men and seven women (median age 49.5 years, range 30-75 years), with relapsed or refractory MF stages I-III. All responders received maintenance treatment at the same bexarotene dose that induced remission until progression or unacceptable toxicity. RESULTS Low-dose oral bexarotene combined with PUVA was associated with an overall response rate (complete response or partial response) in 67% of the nine patients with refractory MF who completed the treatment course. Of these nine patients, four had a complete response, two had a partial response, one had stable disease, and two had progressive disease. Five patients withdrew because of hyperlipidemia. Oral bexarotene was continued as maintenance therapy in three of the four complete responders (one refused); two of these patients relapsed 2-10 months after PUVA discontinuation. Patients with partial response or stable disease received the combination for 3-5 months and were switched to another treatment regimen because of lack of further response. Therapy was fairly well tolerated. CONCLUSION In a select population of patients who had not responded to at least one monotherapy for early-stage MF, a combination of low-dose oral bexarotene and PUVA was successful in achieving a satisfactory overall response rate in 67% of patients who completed the treatment course and was fairly well tolerated. Limitations of the study include the small number of patients evaluated, its retrospective nature, and the fact that patients were commenced on different bexarotene starting doses (150 or 300 mg/day), depending on physicians' preference.
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Affiliation(s)
- Evangelia Papadavid
- 1st Department of Dermatology, Athens University Medical School, Skin Lymphoma Clinic, A Sygros Hospital, Athens, Greece.
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Smith DI, Swamy PM, Heffernan MP. Off-label uses of biologics in dermatology: Interferon and intravenous immunoglobulin (Part 1 of 2). J Am Acad Dermatol 2007; 56:e1-54. [PMID: 17190617 DOI: 10.1016/j.jaad.2006.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 05/04/2006] [Accepted: 06/19/2006] [Indexed: 11/29/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration-approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.
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Abstract
Mycosis fungoides (MF), and the associated leukemic variant Sezary Syndrome (SS), are the most common group of cutaneous T-cell lymphomas. MF/SS is a non-Hodgkin's lymphoma of mature, skin-homing, clonal, malignant T lymphocytes that initially presents in the skin as patches, plaques, tumors, or generalized erythema (erythroderma) and can involve the lymph nodes and peripheral blood. Much progress has been made in recent years in understanding the origin of the malignant T cell in MF/SS and the pathophysiology and immunology of the disease. This recent work has made a great impact on diagnosis, prognostication, and treatment. In this review, we survey the MF/SS published literature over the past year and highlight some of the important advances.
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Affiliation(s)
- Ellen J Kim
- Department of Dermatology, University of Pennsylvania Health System, Philadelphia, 19104, USA.
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Abstract
Cutaneous lymphomas are a heterogeneous group of clonal proliferations of T and B lymphocytes with various clinical manifestations and prognosis. The new EORTC WHO classification of cutaneous T- and B-cell lymphomas provides a uniform nomenclature based on clinical, histologic, cytologic and molecular biological features. Accurate classification is a prerequisite for uniform therapeutic concepts. For office-based dermatologist, more than 50% of the therapies deal with classic forms of cutaneous T-cell lymphomas, type mycosis fungoides. In recent years the paradigm for the therapy of cutaneous T-cell lymphomas has changed. Since early aggressive treatment with cytostatic agents does not increase the response rate or overall survival, a commonly accepted stage-adapted therapy is recommended. In this review the current status of the therapy of cutaneous lymphoma is described in detail.
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Affiliation(s)
- R Stadler
- Hautklinik am Klinikum Minden, Portastrasse 7-9, 32423 Minden, Deutschland.
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Affiliation(s)
- Joan Guitart
- Northwestern University, Chicago, IL 60091, USA.
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Abstract
Cutaneous T-cell lymphomas, including mycosis fungoides and Sezary syndrome, are often responsive to treatment, but current therapies have not been shown to increase survival, and in advanced stages, durable remissions are hard to achieve. We present a patient who was initially misdiagnosed with psoriasis and, 16 years later, was diagnosed with mycosis fungoides. Denileukin diftitox was used as a tumor debulking agent to give a partial response that was further improved with a combination of systemic interferon/oral bexarotene and skin-directed psorlen plus UV-A. The purpose of this case report is to show the value of sequential combination therapy for improving overall response.
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Affiliation(s)
- Rakhshandra Talpur
- Department of Dermatology, The University of Texas M. D. Anderson Cancer Center, Houston, 77030-4095, USA
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Abstract
The WHO-EORTC classification of cutaneous lymphomas is a good start to unifying nomenclature, a necessity before coherent consensus diagnoses can be made. There are three provisional diagnoses in this new classification that are not covered in detail in this review because they are rare diseases that still require further study for definitive classification. Much remains to be elucidated about cutaneous lymphomas, but understanding of the major entities within the new classification is an important first step in understanding these diverse diseases.
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Affiliation(s)
- Christine J Ko
- Yale University, 15 York Street, LMP 5031, New Haven, CT 06510, USA.
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Carrascosa JM, Gardeazábal J, Pérez-Ferriols A, Alomar A, Manrique P, Jones-Caballero M, Lecha M, Aguilera J, de la Cuadra J. Documento de consenso sobre fototerapia: terapias PUVA y UVB de banda estrecha. Actas Dermo-Sifiliográficas 2005; 96:635-58. [PMID: 16476315 DOI: 10.1016/s0001-7310(05)73153-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
It is essential to develop a consensus document on phototherapy in order to adapt this procedure to the specific characteristics, needs and reality of our milieu. Using a review of existing literature on the subject and the experience of its own members as a reference, the Spanish Photobiology Group (GEF) of the Spanish Academy of Dermatology and Venereology (AEDV) has developed some therapeutic guidelines for the most widely used modes of phototherapy: PUVA therapy and narrow-band UVB (NBUVB) therapy. These guidelines deal with generalities about the equipment, calibration and regulation in phototherapy booths, and the concept and indications for these forms of treatment are reviewed. Recommendations are also proposed regarding patient selection, therapeutic procedures, associated pharmacological agents of interest and the prevention and management of adverse effects. The consensus document is designed as a flexible and practical instrument intended for use in daily clinical practice, aimed at optimizing the possibilities of phototherapy while reducing risks for patients and therapists.
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