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Porkert S, Griss J, Hudelist-Venz M, Steiner I, Valencak J, Weninger W, Brunner PM, Jonak C. Mortalität, prognostische Parameter und Behandlungsstrategien bei Mycosis fungoides. J Dtsch Dermatol Ges 2024; 22:532-552. [PMID: 38574037 DOI: 10.1111/ddg.15331_g] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/14/2023] [Indexed: 04/06/2024]
Abstract
ZusammenfassungHintergrund und ZieleMycosis fungoides (MF), das häufigste primär kutane T‐ Zell‐Lymphom, ist durch einen variablen klinischen Verlauf charakterisiert. Dieser ist entweder indolent oder infaust bei Progression mit extrakutaner Beteiligung. Das Fehlen von Prognosemodellen bei überwiegend palliativen Therapiemodalitäten erschweren das Patientenmanagement. Ziel dieser Studie war es, Überlebensraten, Treffsicherheit von verfügbaren Prognosemodellen und den Therapieerfolg bei MF‐Patienten zu evaluieren.Patienten und MethodikHundertvierzig MF‐Patienten wurden retrospektiv untersucht. Prognose, Krankheitsprogression beziehungsweise Überlebensraten wurden anhand univariater Cox‐ Regressionsmodellen und Kaplan‐Meier‐ Schätzungen analysiert.ErgebnisseHauttumoren waren im Vergleich zu Erythrodermie mit einem kürzeren progressionsfreien Überleben und Gesamtüberleben sowie einem 3,48‐fach erhöhtem Risiko für Krankheitsprogression verbunden. Der Cutaneous Lymphoma International Prognostic Index identifizierte Risikopatienten lediglich im frühen Krankheitsstadium. Zudem waren die Expression von Ki‐67 > 20%, CD30 > 10%, CD20+ und CD7– unabhängig vom Krankheitsstadium mit einem signifikant schlechteren Outcome verbunden. Eine langfristige Krankheitskontrolle wurde lediglich mit Interferon‐α als Monotherapie oder durch Kombination von Phototherapie mit Interferon‐α oder Retinoiden/Bexaroten erreicht.SchlussfolgerungenUnsere Daten unterstützen die Vorhersagekraft von etablierten Prognoseparametern und ‐modellen bei MF. Zusätzlich wurden neue Parameter, die mit einer schlechten Prognose assoziiert sind, identifiziert. Prospektive Studien, die Prognoseindikatoren in Bezug auf Krankheitsstadium und Therapie synergistisch evaluieren sind erforderlich, um die Patientenbetreuung zu verbessern.
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Affiliation(s)
- Stefanie Porkert
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Johannes Griss
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | | | - Irene Steiner
- Zentrum für Medizinische Statistik, Information und intelligente Systeme, Institut für Medizinische Statistik, Medizinische Universität Wien, Wien, Österreich
| | - Julia Valencak
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Wolfgang Weninger
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Patrick M Brunner
- Department of Dermatology, Icahn School of Medicineat Mount Sinai, New York, NY, USA
| | - Constanze Jonak
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Porkert S, Griss J, Hudelist-Venz M, Steiner I, Valencak J, Weninger W, Brunner PM, Jonak C. Evaluation of mortality, prognostic parameters, and treatment efficacy in mycosis fungoides. J Dtsch Dermatol Ges 2024; 22:532-550. [PMID: 38444271 DOI: 10.1111/ddg.15331] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/14/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Mycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma, is characterized by a variable clinical course, presenting either as indolent disease or showing fatal progression due to extracutaneous involvement. Importantly, the lack of prognostic models and predominantly palliative therapy settings hamper patient care. Here, we aimed to define survival rates, disease prediction accuracy, and treatment impact in MF. PATIENTS AND METHODS Hundred-forty MF patients were assessed retrospectively. Prognosis and disease progression/survival were analyzed using univariate Cox proportional hazards regression model and Kaplan-Meier estimates. RESULTS Skin tumors were linked to shorter progression-free, overall survival and a 3.48 increased risk for disease progression when compared to erythroderma. The Cutaneous Lymphoma International Prognostic Index identified patients at risk in early-stage disease only. Moreover, expression of Ki-67 >20%, CD30 >10%, CD20+, and CD7- were associated with a significantly worse outcome independent of disease stage. Only single-agent interferon-α and phototherapy combined with interferon-α or retinoids/bexarotene achieved long-term disease control in MF. CONCLUSIONS Our data support predictive validity of prognostic factors and models in MF and identified further potential parameters associated with poor survival. Prospective studies on prognostic indices across disease stages and treatment modalities are needed to predict and improve survival.
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Affiliation(s)
- Stefanie Porkert
- Department of Dermatology, Medical University of Vienna, Viena, Austria
| | - Johannes Griss
- Department of Dermatology, Medical University of Vienna, Viena, Austria
| | - Mercedes Hudelist-Venz
- Department of Radiotherapy and Radiobiology, Medical University of Vienna, Viena, Austria
| | - Irene Steiner
- Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Medical Statistics, Medical University of Vienna, Viena, Austria
| | - Julia Valencak
- Department of Dermatology, Medical University of Vienna, Viena, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Viena, Austria
| | - Patrick M Brunner
- Department of Dermatology, Icahn School of Medicineat Mount Sinai, New York, NY, USA
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Viena, Austria
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Stelljes M, Advani AS, DeAngelo DJ, Wang T, Neuhof A, Vandendries E, Kantarjian H, Jabbour E. Time to First Subsequent Salvage Therapy in Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia Treated With Inotuzumab Ozogamicin in the Phase III INO-VATE Trial. Clin Lymphoma Myeloma Leuk 2022; 22:e836-e843. [PMID: 35643855 DOI: 10.1016/j.clml.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/11/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In relapsed/refractory acute lymphoblastic leukemia (R/R ALL), successive salvage therapies may worsen outcomes and decrease quality of life. This post hoc analysis of the phase III INO-VATE trial investigates subsequent salvage therapies and compared the time from randomization to first subsequent salvage therapy (TST) in the inotuzumab ozogamicin (InO) and standard-of-care chemotherapy (SoC) arms. PATIENTS AND METHODS Adults (aged ≥18 years) with CD22+ R/R ALL were randomized to InO (n = 164) or SoC (n = 162) treatment. We determined TST and proportion of patients receiving subsequent salvage therapies by treatment arm and for subgroups based on transplantation status and baseline characteristics. RESULTS In the InO versus SoC arm, a smaller proportion of patients received subsequent salvage therapy (34.1% [n = 56] vs. 56.8% [n = 92]), and TST was longer (median 19 vs. 4 months, hazard ratio 0.339, P < .0001). Similar benefits were seen with InO versus SoC irrespective of transplantation status, age, salvage phase, first remission duration, Philadelphia chromosome status, or CD22 expression. Following receipt of subsequent salvage therapy, median overall survival was 4 months, irrespective of treatment arm. CONCLUSION Patients in the InO versus SoC arm were less likely to receive subsequent salvage therapy, and showed a clinically meaningful extension of TST irrespective of subgroup. This suggests InO treatment leads to improved outcomes by increasing the likelihood that subsequent salvage therapies and their associated adverse impacts can be delayed or avoided. PLAIN LANGUAGE SUMMARY Available in Supplementary Materials. CLINICAL TRIAL REGISTRATION NCT01564784.
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Affiliation(s)
- Matthias Stelljes
- Department of Medicine A/Hematology and Oncology, University of Münster, Münster, Germany.
| | - Anjali S Advani
- Department of Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | - Tao Wang
- Oncology, Pfizer Inc, Cambridge, MA
| | | | | | - Hagop Kantarjian
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX
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Assaf C, Waser N, Bagot M, He M, Li T, Dalal M, Gavini F, Trinchese F, Zomas A, Little M, Pimpinelli N, Ortiz-Romero PL, Illidge TM. Contemporary Treatment Patterns and Response in Relapsed/Refractory Cutaneous T-Cell Lymphoma (CTCL) across Five European Countries. Cancers (Basel) 2021; 14:cancers14010145. [PMID: 35008309 PMCID: PMC8750476 DOI: 10.3390/cancers14010145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/26/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
The treatment pattern of cutaneous T-cell lymphoma (CTCL) remains diverse and patient-tailored. The objective of this study was to describe the treatment patterns and outcomes in CTCL patients who were refractory or had relapsed (R/R) after a systemic therapy. A retrospective chart review study was conducted at 27 sites in France, Germany, Italy, Spain and the United Kingdom (UK) of patients who received a first course of systemic therapy and relapsed or were refractory. Data were collected longitudinally from diagnosis to first-, second- and third-line therapy. The study included 157 patients, with a median follow-up of 3.2 years. In total, 151 proceeded to second-line and 90 to third-line therapy. In the first line (n = 147), patients were treated with diverse therapies, including single- and multi-agent chemotherapy in 67 (46%), retinoids in 39 (27%), interferon in 31 (21%), ECP in 4 (3%), corticosteroids in 3 (2%) and new biological agents in 3 (2%). In the second line, the use of chemotherapy and retinoids remained similar to the first line, while the use of new biologics increased slightly. In sharp contrast to the first line, combination chemotherapy was extremely diverse. In the third line, the use of chemotherapy remained high and diverse as in the second line. From the time of first R/R, the median PFS was 1.2 years and the median OS was 11.5 years. The presented real-world data on the current treatments used in the management of R/R CTCL in Europe demonstrate the significant heterogeneity of systemic therapies and combination therapies, as expected from the European guidelines.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology, HELIOS Klinikum Krefeld, Academic Teaching Hospital of the University of Aachen, 47805 Krefeld, Germany
- Department of Dermatology, Charité-Universitätsmedizin, 10117 Berlin, Germany
- Correspondence: or
| | - Nathalie Waser
- ICON Plc, 450-688 West Hastings St., Vancouver, BC V6B 1P1, Canada; (N.W.); (M.H.); (T.L.)
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, 75010 Paris, France;
| | - Mary He
- ICON Plc, 450-688 West Hastings St., Vancouver, BC V6B 1P1, Canada; (N.W.); (M.H.); (T.L.)
| | - Tina Li
- ICON Plc, 450-688 West Hastings St., Vancouver, BC V6B 1P1, Canada; (N.W.); (M.H.); (T.L.)
| | - Mehul Dalal
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA 02139, USA; (M.D.); (F.G.); (M.L.)
| | - Francois Gavini
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA 02139, USA; (M.D.); (F.G.); (M.L.)
| | - Fabrizio Trinchese
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (F.T.); (A.Z.)
| | - Athanasios Zomas
- Takeda Pharmaceuticals International AG, 8152 Zurich, Switzerland; (F.T.); (A.Z.)
| | - Meredith Little
- Takeda Development Center Americas, Inc. (TDCA), Lexington, MA 02139, USA; (M.D.); (F.G.); (M.L.)
| | - Nicola Pimpinelli
- Department of Health Sciences, Dermatology Unit, University of Florence, 50121 Florence, Italy;
| | - Pablo L. Ortiz-Romero
- Institute I+12, Medical School, Hospital Universitario 12 de Octubre, University Complutense, 28040 Madrid, Spain;
| | - Timothy M. Illidge
- Manchester NIHR Biomedical Research Centre, Christie Hospital, University of Manchester, Manchester M20 4BX, UK;
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