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Vadivel CK, Willerslev-Olsen A, Namini MRJ, Zeng Z, Yan L, Danielsen M, Gluud M, Pallesen EMH, Wojewoda K, Osmancevic A, Hedebo S, Chang YT, Lindahl LM, Koralov SB, Geskin LJ, Bates SE, Iversen L, Litman T, Bech R, Wobser M, Guenova E, Kamstrup MR, Ødum N, Buus TB. Staphylococcus aureus induces drug resistance in cancer T cells in Sézary syndrome. Blood 2024; 143:1496-1512. [PMID: 38170178 PMCID: PMC11033614 DOI: 10.1182/blood.2023021671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/13/2023] [Revised: 11/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT Patients with Sézary syndrome (SS), a leukemic variant of cutaneous T-cell lymphoma (CTCL), are prone to Staphylococcus aureus infections and have a poor prognosis due to treatment resistance. Here, we report that S aureus and staphylococcal enterotoxins (SE) induce drug resistance in malignant T cells against therapeutics commonly used in CTCL. Supernatant from patient-derived, SE-producing S aureus and recombinant SE significantly inhibit cell death induced by histone deacetylase (HDAC) inhibitor romidepsin in primary malignant T cells from patients with SS. Bacterial killing by engineered, bacteriophage-derived, S aureus-specific endolysin (XZ.700) abrogates the effect of S aureus supernatant. Similarly, mutations in major histocompatibility complex (MHC) class II binding sites of SE type A (SEA) and anti-SEA antibody block induction of resistance. Importantly, SE also triggers resistance to other HDAC inhibitors (vorinostat and resminostat) and chemotherapeutic drugs (doxorubicin and etoposide). Multimodal single-cell sequencing indicates T-cell receptor (TCR), NF-κB, and JAK/STAT signaling pathways (previously associated with drug resistance) as putative mediators of SE-induced drug resistance. In support, inhibition of TCR-signaling and Protein kinase C (upstream of NF-κB) counteracts SE-induced rescue from drug-induced cell death. Inversely, SE cannot rescue from cell death induced by the proteasome/NF-κB inhibitor bortezomib. Inhibition of JAK/STAT only blocks rescue in patients whose malignant T-cell survival is dependent on SE-induced cytokines, suggesting 2 distinct ways SE can induce drug resistance. In conclusion, we show that S aureus enterotoxins induce drug resistance in primary malignant T cells. These findings suggest that S aureus enterotoxins cause clinical treatment resistance in patients with SS, and antibacterial measures may improve the outcome of cancer-directed therapy in patients harboring S aureus.
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Affiliation(s)
- Chella Krishna Vadivel
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Willerslev-Olsen
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin R. J. Namini
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Ziao Zeng
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Lang Yan
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Maria Danielsen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Gluud
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Emil M. H. Pallesen
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Karolina Wojewoda
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amra Osmancevic
- Department of Dermatology and Venereology, Region Västra Götaland, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Signe Hedebo
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Yun-Tsan Chang
- Department of Dermatology and Venereology, University Hospital Centre (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lise M. Lindahl
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Sergei B. Koralov
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Larisa J. Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
| | - Susan E. Bates
- Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Litman
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Bech
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Marion Wobser
- Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| | - Emmanuella Guenova
- Department of Dermatology and Venereology, University Hospital Centre (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Maria R. Kamstrup
- Department of Dermatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Niels Ødum
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Terkild B. Buus
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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2
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Gunter SJ, Kim EJ. Changes to Registered and Pivotal Clinical Trials after the 2011 Tri-Societies Guidelines for Clinical Endpoints and Response Criteria in Mycosis Fungoides and Sézary Syndrome. J Invest Dermatol 2024; 144:855-861.e1. [PMID: 37925066 DOI: 10.1016/j.jid.2023.10.011] [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: 07/04/2023] [Revised: 09/09/2023] [Accepted: 10/12/2023] [Indexed: 11/06/2023]
Abstract
Guidelines for mycosis fungoides and Sézary syndrome clinical trials were published in 2011 to standardize endpoint criteria and trial design. Our retrospective cohort study of mycosis fungoides/Sézary syndrome clinical trials registered on ClinicalTrials.gov and pivotal trials supporting drug approvals and label extensions evaluates adherence to these guidelines. Sixty-three trials met our inclusion criteria. In a subpopulation of trials, mean adherence to the guidelines was approximately 60%. When comparing trials that began in the first 6 years after their publication with those that started after, we found no difference in mean adherence (4.12 vs 3.41) (P = .15). Among the 8 pivotal trials supporting new mycosis fungoides or Sézary syndrome systemic therapies from 1990 to 2020, systemic trials published after 2011 were more likely to randomize patients (100 vs 0%, P = .036), perform superiority testing (100 vs 0%, P = .036), and use an intention-to-treat analysis (100 vs 0%, P = .036). The design of trials registered on Clinicaltrials.gov did not change significantly between the first 6 years after the publication of the guidelines and after. This demonstrates that the guidelines are still not consistently implemented across all trials. However, registrational trials were more likely to implement the recommendations.
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Affiliation(s)
| | - Ellen J Kim
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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3
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Bass AR, Sama ML. Inflammatory arthritis complicating mogamulizumab treatment of Sézary syndrome. Rheumatology (Oxford) 2024; 63:e113-e114. [PMID: 37846040 DOI: 10.1093/rheumatology/kead551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Affiliation(s)
- Anne R Bass
- Department of Rheumatology, Hospital for Special Surgery, New York City, NY, USA
| | - Michael L Sama
- Department of Rheumatology, Hospital for Special Surgery, New York City, NY, USA
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4
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Rubio-Muniz CA, Sánchez-Velázquez A, Arroyo-Andrés J, Agud-de Dios M, Tarín-Vicente EJ, Falkenhain-López D, Ortiz-Romero PL. Mogamulizumab combined with extracorporeal photopheresis for the treatment of refractory mycosis fungoides and Sézary syndrome. Report of seven cases. J Eur Acad Dermatol Venereol 2024; 38:e102-e105. [PMID: 37611255 DOI: 10.1111/jdv.19457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Affiliation(s)
- C A Rubio-Muniz
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Sánchez-Velázquez
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Arroyo-Andrés
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Agud-de Dios
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E J Tarín-Vicente
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Falkenhain-López
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P L Ortiz-Romero
- Department of Dermatology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Institute i+12 CIBERONC, Medical School, University Complutense, Madrid, Spain
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5
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Nogueira M, Lau C, Teixeira MDA, Peixeiro R, Cabral R, Fernandes I. Alemtuzumab as first- and second-line treatment in patients with Sézary syndrome-The experience of a tertiary centre. J Eur Acad Dermatol Venereol 2024; 38:e86-e88. [PMID: 37595960 DOI: 10.1111/jdv.19441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Miguel Nogueira
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Catarina Lau
- Laboratory of Cytometry, Department of Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Maria Dos Anjos Teixeira
- Laboratory of Cytometry, Department of Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rita Peixeiro
- Department of Clinical Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Renata Cabral
- Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Department of Clinical Hematology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Iolanda Fernandes
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
- Multidisciplinary Consultation for Cutaneous Lymphomas and Mastocytosis, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Buffon S, Alberti Violetti S, Avallone G, Venegoni L, Marzano AV, Mastorino L, Fava P, Ribero S, Quaglino P, Ortoncelli M, Ferrucci SM. Mycosis fungoides and Sézary syndrome following dupilumab treatment: experience of two Italian tertiary care centres. Clin Exp Dermatol 2023; 48:1376-1378. [PMID: 37596961 DOI: 10.1093/ced/llad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 08/21/2023]
Abstract
Dupilumab is a monoclonal antibody targeting the interleukin-4 and -13 signalling pathway, and which is proven to be highly effective and safe in atopic dermatitis (AD). Its possible role in treating or inducing cutaneous T-cell lymphomas (CTCLs) has not yet been fully clarified, as several case reports seem to point not only at its beneficial effects but also at a possible pathogenetic role in mycosis fungoides and Sézary syndrome. We present data collected from a cohort of 995 patients with classic or prurigo nodularis-like AD who received dupilumab and were followed longitudinally for a mean period of 25.1 months after first administration to investigate a possible correlation between dupilumab and CTCL development.
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Affiliation(s)
- Stefano Buffon
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvia Alberti Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianluca Avallone
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luigia Venegoni
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luca Mastorino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Paolo Fava
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michela Ortoncelli
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Silvia M Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Campbell BA, Dobos G, Haider Z, Prince HM, Bagot M, Evison F, van der Weyden C, McCormack C, Ram-Wolff C, Miladi M, Scarisbrick JJ. International study of treatment efficacy in SS shows superiority of combination therapy and heterogeneity of treatment strategies. Blood Adv 2023; 7:6639-6647. [PMID: 37648672 PMCID: PMC10628811 DOI: 10.1182/bloodadvances.2023011041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
Despite increasing availability of therapies, patients with Sezary syndrome (SS) commonly endure multi-line treatment journeys, mostly with partial responses of short duration. Measuring clinical benefit is challenging; time-to-next-treatment (TTNT) provides a robust, objective measurement of efficacy. This international observational study examines patterns of clinical care and therapeutic benefit as measured by TTNT. TTNT was calculated for monotherapies and combination therapies, with consideration to treatment line. 178 patients with SS (73% de novo, 27% secondary) were included, receiving 721 lines of systemic therapy, with median follow-up of 56.9 months. Across all lines, 58 different therapeutic regimens were prescribed (54 were systemic therapies) and classified into 17 treatment groups. The most common first-line treatments were extracorporeal photopheresis (ECP)-containing combination therapy (20%) and retinoid monotherapy (19%). Median TTNT for all first-line therapies was short (5.4 months). First-line, combination therapies had longer median TTNT than monotherapies, 10.0 vs 5.0 months (P = .004), respectively. Later delivery of combination therapies was associated with shorter clinical benefit, with median TTNT reduced to 6.2 and 2.2 months for mid-line (2nd-4th line) and late-line (≥5th line), respectively (P < .001). First-line ECP-containing treatments were associated with longer median TTNT than non-ECP-containing treatments, 9.0 vs 4.9 months (P = .007). For both ECP-monotherapy and ECP-containing combination therapy, significant reductions in TTNT were seen in later lines. These data suggest therapeutic benefit from first-line delivery of combination therapy for SS and favor early inclusion of ECP in the treatment algorithm for those who can access it.
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Affiliation(s)
- Belinda A. Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Department of Clinical Pathology, The University of Melbourne, Parkville, Australia
| | - Gabor Dobos
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Zahra Haider
- Department of Dermatology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - H. Miles Prince
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne Australia
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Felicity Evison
- Health Data Science Team, Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Carrie van der Weyden
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne Australia
| | - Chris McCormack
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Surgery, The University of Melbourne, Parkville, Australia
| | - Caroline Ram-Wolff
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Maryam Miladi
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Julia J Scarisbrick
- Department of Dermatology, University Hospital Birmingham, Birmingham, United Kingdom
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Quadri I, Reneau JC, Hanel W, Chung CG. Advancements in the treatment of mycosis fungoides and Sézary syndrome: monoclonal antibodies, immunotherapies, and Janus kinase inhibitors. Front Immunol 2023; 14:1291259. [PMID: 38022633 PMCID: PMC10654973 DOI: 10.3389/fimmu.2023.1291259] [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: 09/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS) are forms of cutaneous T cell lymphoma (CTCL) that pose significant challenges in their clinical management, particularly in refractory and advanced-stage disease. With the emergence of novel therapeutic modalities however, there are increasing opportunities to exploit the current understanding of pathophysiologic mechanisms of MF/SS for treatment. This review summarizes recent advances in the treatment of MF/SS, with a focus on monoclonal antibodies, immunotherapies, and Janus kinase (JAK) inhibitors, including ongoing clinical trials.
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Affiliation(s)
- Iman Quadri
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - John C. Reneau
- Division of Hematology, The Ohio State University Wexner Medical Center and The James and Solove Research Center and Cancer Hospital, Columbus, OH, United States
| | - Walter Hanel
- Division of Hematology, The Ohio State University Wexner Medical Center and The James and Solove Research Center and Cancer Hospital, Columbus, OH, United States
| | - Catherine G. Chung
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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9
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Stuver R, Geller S. Advances in the treatment of mycoses fungoides and Sézary syndrome: a narrative update in skin-directed therapies and immune-based treatments. Front Immunol 2023; 14:1284045. [PMID: 37868986 PMCID: PMC10585160 DOI: 10.3389/fimmu.2023.1284045] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Mycoses fungoides (MF) and Sézary syndrome (SS) are cutaneous T-cell lymphomas that are often challenging to manage given the absence of reliably curative therapies, at times high symptom burden with significant detriment to quality of life, and need for ongoing treatment for disease and symptom control. Recent developments in skin-directed treatments include optimizing the use of existing topical therapies, the introduction of known dermatological agents and treatment modalities for the specific treatment of MF/SS (such as mechlorethamine gel, calcineurin inhibitor creams, and photodynamic therapy), and novel local and topical agents. For advanced disease, dedicated clinical trials have translated to exciting progress, leading to the approval of brentuximab vedotin (2017) and mogamulizumab (2018) for relapsed MF/SS. Additional studies of other active systemic agents, including various cellular therapies, represent further attempts to add to the therapeutic armamentarium in treating MF/SS. In this review, we highlight these recent advancements, ranging from optimization of skin-directed therapies to the introduction of novel systemic agents. We focus on therapies approved in the preceding five years or under investigation in advanced-phase clinical trials.
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Affiliation(s)
- Robert Stuver
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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10
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Hawkins N, Muszbek N, Evans R, McNamara L, Jones T. Overall survival in the UK in mycosis fungoides or Sézary syndrome cutaneous T-cell lymphoma: comparative effectiveness of mogamulizumab versus current standard of care. J Comp Eff Res 2023; 12:e230017. [PMID: 37642410 PMCID: PMC10690402 DOI: 10.57264/cer-2023-0017] [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: 02/03/2023] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
Aim: Due to extensive treatment switching in the MAVORIC trial, lack of UK regulatory licence for the comparator, overall survival (OS) with mogamulizumab was compared with patients with previously treated advanced mycosis fungoides/Sézary syndrome (MF/SS) in real-world setting. Design, setting & participants: Data were from the Hospital Episode Statistics database (all patients in NHS secondary care system in 2009-2019). Patients were selected according to trial inclusion criteria, then trial and HES samples were matched on selected variables with significant imbalance. Outcomes: The analysis indicated significant improvement in OS for mogamulizumab treatment compared with UK clinical practice (hazard ratio: 0.36, 95% CI: 0.24, 0.53). Conclusion: Results suggest an OS advantage for patients with advanced MF/SS treated with mogamulizumab in MAVORIC trial compared with UK clinical practice.
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Affiliation(s)
| | | | | | - Linda McNamara
- Kyowa Kirin, Payor Value and Patient Access, Marlow, SL7 1HZ, UK
| | - Trefor Jones
- Kyowa Kirin, Payor Value and Patient Access, Marlow, SL7 1HZ, UK
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11
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Beylot-Barry M, Quereux G, Nardin C, Duval-Modeste AB, Dereure O, Dalac-Rat S, Dobos G, Pham-Ledard A, Ram-Wolff C, D'Incan M, Grange F, Braniste V, Bagot M. Effectiveness of mogamulizumab in patients with Mycosis Fungoides or Sézary syndrome: A multicentre, retrospective, real-world French study. J Eur Acad Dermatol Venereol 2023; 37:1777-1784. [PMID: 37113040 DOI: 10.1111/jdv.19134] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/29/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Efficacy and safety of mogamulizumab, a monoclonal antibody directed against C-C chemokine receptor 4, were demonstrated in a previous multinational clinical trial conducted in patients with previously treated cutaneous T-cell lymphoma (CTCL): Sézary syndrome (SS) or Mycosis Fungoides (MF). OBJECTIVES The real-world French OMEGA study aimed to describe effectiveness and tolerability of mogamulizumab in adult patients with CTCL, overall and according to the disease (SS or MF). METHODS In this retrospective study, patients treated with mogamulizumab for SS or MF were included from 14 French expert centres. The overall response rate (ORR) under treatment was described (primary criterion), as well as treatment use and safety data. RESULTS The 122 analysed patients (69 SS, 53 MF) were aged 66.6 ± 12.1 years at mogamulizumab initiation, and their median disease duration was 2.5 years (IQR: 1.3-5.6). Prior to treatment start, they received a median of three systemic CTCL therapies (2-5). Overall, 77.8% of patients suffered from advanced disease (Stage IIB-IVB), with frequent blood (B1/B2) involvement (67.5%). Over the treatment period (median: 4.6 months, 2.1-7.2), 96.7% of patients received all the planned mogamulizumab infusions. Among the 109 patients evaluable for effectiveness, ORR was 58.7% (95% CI [48.9-68.1]) overall, 69.5% [56.1-80.8] in SS and 46.0% [31.8-60.7] in MF. Compartmental response in the blood was observed in 81.8% [69.1-90.9] of SS patients. Skin responses were observed in 57.0% [47.0-66.5] of patients overall, 66.7% [52.9-78.6] in SS and 46.0% [31.8-60.7] in MF. The most common serious adverse drug reactions were rash (8.1% of patients) and infusion-related reactions (2.4%) which led to treatment discontinuation in 7.3% and 0.8% of patients, respectively. One patient with SS died from mogamulizumab-related tumour lysis syndrome. CONCLUSIONS This large French study confirmed the effectiveness and tolerability of mogamulizumab in SS and MF patients in routine medical practice.
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Affiliation(s)
- M Beylot-Barry
- BoRdeaux Institute of Oncology, INSERM U1312, Team 5, Bordeaux University, Bordeaux, France
- Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - G Quereux
- Dermatology Department, Nantes University Hospital, University of Nantes, CIC 1413, INSERM UMR 1302/EMR6001 INCIT, Nantes, France
| | - C Nardin
- Dermatology Department, Minjoz Hospital, CHU Besancon, Besancon, France
- INSERM U1098, University of Franche Comté, EFS Bourgogne Franche-Comté and Franche-Comté University, Besançon, France
| | - A-B Duval-Modeste
- Department of Dermatology, INSERM U519, Rouen University Hospital, Rouen, France
| | - O Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - S Dalac-Rat
- Dermatology Department, Dijon Bourgogne University Hospital, Dijon, France
| | - G Dobos
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France
- Université Paris Cité, Paris, France
- Department of Dermatology, HTCC, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Pham-Ledard
- BoRdeaux Institute of Oncology, INSERM U1312, Team 5, Bordeaux University, Bordeaux, France
- Dermatology Department, CHU Bordeaux, Bordeaux, France
| | - C Ram-Wolff
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
| | - M D'Incan
- Dermatology and Cutaneous Oncology, Estaing University Hospital, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - F Grange
- Department of Dermatology, Valence Hospital, Valence, France
| | - V Braniste
- Kyowa Kirin Pharma, Medical Affairs, Neuilly-sur-Seine, France
| | - M Bagot
- Dermatology Department, Saint-Louis Hospital, AP-HP, Paris, France
- INSERM U976, Human Immunology Pathophysiology and Immune Therapies, Paris, France
- Université Paris Cité, Paris, France
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12
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Muszbek N, Remak E, Xin Q, McNamara L, Jones T. Cost-utility analysis of mogamulizumab in advanced mycosis fungoides and Sézary syndrome cutaneous T-cell lymphoma. J Comp Eff Res 2023; 12:CER. [PMID: 37338181 PMCID: PMC10508303 DOI: 10.57264/cer-2023-0028] [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: 02/21/2023] [Accepted: 05/22/2023] [Indexed: 06/21/2023] Open
Abstract
Aim: This study assessed the cost-utility of mogamulizumab, a novel monoclonal antibody, versus established clinical management (ECM) in UK patients in previously treated advanced mycosis fungoides (MF)/Sézary syndrome (SS). Materials & methods: Lifetime partitioned survival model based on overall survival, next treatment-free survival and the use of allogeneic stem cell transplant was developed. Inputs were from the pivotal MAVORIC trial, real-world evidence and published literature. Extensive sensitivity analyses were conducted. Results: Discounted incremental quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio were 3.08, £86,998 and £28,233. Results were most sensitive to the survival extrapolations, utilities and costs after loss of disease control. Conclusion: Mogamulizumab is a cost-effective alternative to ECM in UK patients with previously treated advanced MF/SS.
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13
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Khodadoust MS, Mou E, Kim YH. Integrating novel agents into the treatment of advanced mycosis fungoides and Sézary syndrome. Blood 2023; 141:695-703. [PMID: 36379025 DOI: 10.1182/blood.2020008241] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 09/27/2021] [Revised: 10/04/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
Agents targeting the unique biology of mycosis fungoides and Sézary syndrome are quickly being incorporated into clinical management. With these new therapies, we are now capable of inducing more durable responses and even complete remissions in advanced disease, outcomes which were exceedingly rare with prior therapies. Yet, even this new generation of therapies typically produce objective responses in only a minority of patients. As our therapeutic options increase, we are now challenged with selecting treatments from a growing list of options. To gain the full benefit of these novel agents, we must develop strategies to match treatments for the patients most likely to benefit from them. Here, we consider both the current approaches to treatment selection based on clinical features and the future of molecular biomarker-guided therapy for patients with this heterogeneous disease.
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Affiliation(s)
- Michael S Khodadoust
- Division of Oncology, Stanford University, Stanford, CA
- Department of Dermatology, Stanford University, Stanford, CA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA
| | - Youn H Kim
- Division of Oncology, Stanford University, Stanford, CA
- Department of Dermatology, Stanford University, Stanford, CA
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14
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Teoli M, Mandel VD, Franceschini C, Saraceni PL, Cicini MP, Ardigò M. Mogamulizumab and bexarotene are a promising association for the treatment of advanced cutaneous T-cell lymphomas: a case series. Eur Rev Med Pharmacol Sci 2022; 26:8118-8128. [PMID: 36394762 DOI: 10.26355/eurrev_202211_30166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Treatment choices for patients with advanced-stage mycosis fungoides (MF) or Sézary syndrome (SS) who have failed first-line systemic therapies can be challenging, as several options are available. However, most evidence is based on observational and early phase studies due to the rarity of the disease. Mogamulizumab has recently been approved for the treatment of adult patients with MF or SS who have received at least one prior systemic therapy; it has a good tolerability profile prompting its use in combination with other agents. This article aims at describing the role of the concomitant use of bexarotene with mogamulizumab in this setting. CASES PRESENTATION To add information in the field, we describe our experience with four patients with MF/SS who failed first- and second-line treatments and started the combination mogamulizumab in addition to bexarotene. The combination of bexarotene with mogamulizumab in patients with advanced MF/SS after the failure of bexarotene alone obtained a response in all the four patients observed. The response was maintained longer than expected. CONCLUSIONS The combination is promising and deserves further study.
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Affiliation(s)
- M Teoli
- Porphyria and Rare Diseases Unit, Clinical Dermatology Department, San Gallicano Dermatological Institute - IRCCS, Rome, Italy.
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15
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Zhao Y, Tang J, Zhou H, Takahashi T, Nomura T, Dennis E, Halwani A. TCL-456 Real-World Use of Mogamulizumab among Patients With Mycosis Fungoides and Sézary Syndrome Before and During COVID-19 in the United States. Clin Lymphoma Myeloma Leuk 2022; 22 Suppl 2:S400. [PMID: 36164130 DOI: 10.1016/s2152-2650(22)01580-4] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Per label, mogamulizumab (Moga) is administered on days 1, 8, 15, and 22 of the first 28-day cycle (loading) and on days 1 and 15 of each subsequent cycle (maintenance) for adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) after ≥1 prior systemic therapy. During the COVID-19 pandemic, professional organizations suggested dosing intervals for systemic cancer therapies be extended to limit in-person visits. This study examined the real-world use of Moga before and during the COVID-19 pandemic in the United States. METHODS Using the Symphony Health Solutions database, adults with ≥1 diagnosis of MF or SS (ICD-10 CM: C84.0x or C84.1x) and ≥1 Moga claim during 10/1/2018-5/6/2021 were identified. Within the MF (no SS diagnosis) and SS (any SS diagnosis) cohorts, patients were divided into 2 subgroups based on their Moga initiation date: 10/1/2018-3/31/2020 (pre COVID-19) and 4/1/2020-5/6/2021 (COVID-19). Patient characteristics and dosing intervals between Moga doses 1-4 (loading) and between subsequent doses (maintenance) were examined. RESULTS Overall, 154 MF and 204 SS patients initiated Moga during the study period (mean age: 66.8 and 69.2 years; male: 64% and 55%, respectively). In the MF cohort, 98 and 56 patients were in the pre COVID-19 and COVID-19 subgroups. The mean dosing interval was shorter among patients in the COVID-19 subgroup for both the loading (9.1 vs. 13.2 days) and maintenance doses (15.2 vs. 16.1 days). In the SS cohort, 121 and 83 patients were in the pre COVID-19 and COVID-19 subgroups. Mean loading (9.0 vs. 11.1 days) and maintenance (15.0 vs. 16.8 days) dosing intervals were shorter for patients included in the COVID-19 subgroup. For both MF and SS patients, the COVID-19 subgroup had a higher proportion of patients with ≤10 days between loading doses and ≤21 days between maintenance doses compared to the pre COVID-19 subgroup. CONCLUSIONS Among MF and SS patients, dosing intervals for Moga in loading and maintenance were not extended during the 1st year of the COVID-19 pandemic compared to pre COVID-19. There was a trend towards closer concordance with the label during COVID-19.
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Affiliation(s)
| | | | | | | | | | | | - Ahmad Halwani
- University of Utah Huntsman Cancer Institute, Salt Lake City, USA
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16
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Habault J, Thonnart N, Ram-Wolff C, Bagot M, Bensussan A, Poyet JL, Marie-Cardine A. Validation of AAC-11-Derived Peptide Anti-Tumor Activity in a Single Graft Sézary Patient-Derived Xenograft Mouse Model. Cells 2022; 11:cells11192933. [PMID: 36230895 PMCID: PMC9564267 DOI: 10.3390/cells11192933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Sézary syndrome (SS) is an aggressive cutaneous T cell lymphoma with poor prognosis mainly characterized by the expansion of a tumor CD4+ T cell clone in both skin and blood. So far, the development of new therapeutic strategies has been hindered by a lack of reproducible in vivo models closely reflecting patients’ clinical features. We developed an SS murine model consisting of the intravenous injection of Sézary patients’ PBMC, together with a mixture of interleukins, in NOD-SCID-gamma mice. Thirty-four to fifty days after injection, mice showed skin disorders similar to that observed in patients, with the detection of epidermis thickening and dermal tumor T cell infiltrates. Although experimental variability was observed, Sézary cells could be tracked in the blood stream, confirming that our model could efficiently exhibit both skin and blood involvement. Using this model, we evaluated the therapeutic potential of RT39, a cell-penetrating peptide derived from the survival protein anti-apoptosis clone 11 (AAC-11), that we previously characterized as specifically inducing apoptosis of Sézary patients’ malignant clone ex vivo. Systemic administration of RT39 led to cutaneous tumor T cells depletion, demonstrating efficient malignant cells’ targeting and a favorable safety profile. These preclinical data confirmed that RT39 might be an innovative therapeutic tool for Sézary syndrome.
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Affiliation(s)
- Justine Habault
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Nicolas Thonnart
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Caroline Ram-Wolff
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
- Department of Dermatology, Saint Louis Hospital, AP-HP, 75010 Paris, France
| | - Martine Bagot
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
- Department of Dermatology, Saint Louis Hospital, AP-HP, 75010 Paris, France
| | - Armand Bensussan
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Jean-Luc Poyet
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
| | - Anne Marie-Cardine
- INSERM U976 Team 1, Onco-Dermatology and Therapies, 75010 Paris, France
- Saint Louis Research Institute, Université Paris Cité, 75010 Paris, France
- Correspondence:
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17
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Grimm SE, Witlox W, Wolff R, Chalker A, Hiligsmann M, Wijnen B, Ahmadu C, Ryder S, Armstrong N, Duffy S, Syndikus I, Kleijnen J, Joore MA. Mogamulizumab for Previously Treated Mycosis Fungoides and Sézary Syndrome: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics 2022; 40:509-518. [PMID: 34664200 PMCID: PMC9095533 DOI: 10.1007/s40273-021-01098-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
The National Institute for Health and Care Excellence (NICE) invited the manufacturer (Kyowa Kirin) of mogamulizumab (Poteligeo®), as part of the single technology appraisal process, to submit evidence for its clinical and cost-effectiveness for previously treated mycosis fungoides (MF) and Sézary syndrome (SS). Kleijnen Systematic Reviews Ltd, in collaboration with Maastricht University Medical Centre, was commissioned to act as the independent evidence review group (ERG). This paper summarises the company submission (CS), presents the ERG's critical review of the clinical and cost-effectiveness evidence in the CS, highlights the key methodological considerations and describes the development of the NICE guidance by the Appraisal Committee. Based on a systematic literature review, one randomised controlled trial, MAVORIC, was identified showing favourable results in patients with MF and SS. However, MAVORIC compared mogamulizumab to vorinostat, which is not standard care in the NHS, and there is uncertainty due to the study design, specifically crossover of patients. Based on a "naïve comparison of results from the vorinostat arm of the MAVORIC study and the physician's choice arm (methotrexate or bexarotene i.e. United Kingdom [UK] standard treatments) of the ALCANZA study as well as comparison to Phase II bexarotene data", the company considered vorinostat to be "a reasonable proxy for current standard of care in the NHS". The ERG considered, based on the limited data available, that the comparability of vorinostat (MAVORIC) and physician's choice (ALCANZA) could not be established. In response to the Appraisal Consultation Document, the company provided an unanchored matched adjusted indirect comparison (MAIC) of mogamulizumab with UK standard care by analysing Hospital Episode Statistics (HES) data. However, given the high risk of bias of an unanchored MAIC, these results needed to be regarded with a considerable degree of caution. The economic analysis suffered from uncertainty because there was no trial evidence on the comparator in the England and Wales National Health Service (NHS), and it was unclear to what extent the trial (MAVORIC) comparator (vorinostat) was comparable to standard care, referred to as established clinical management (ECM) in the NHS. The evidence for overall survival had not reached maturity and was confounded by treatment switching, for which different crossover adjustment methods produced large variations in life years. Caregiver utilities were applied in the analysis, but there was a lack of guidance on their application and whether these were indicated in this appraisal. After consultation, the company updated the economic analysis with the MAIC. Incremental cost-effectiveness ratios comparing mogamulizumab against ECM were (depending on whether the HES or MAVORIC comparison were used) £31,030 or £32,634 per quality-adjusted life years (QALYs) gained according to the company's base case and £38,274 or £80,555 per QALY gained according to the ERG's base case. NICE did not recommend mogamulizumab for treating MF or SS in adults who have had at least one previous systemic treatment. This decision was subsequently appealed, and an appeal decision has been reached.
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Affiliation(s)
- Sabine E Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Willem Witlox
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | | | | | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ben Wijnen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | | | | | | | | | - Isabel Syndikus
- The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Wirral, UK
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, UK
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+ (MUMC+), P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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18
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Abstract
Epigenetic modifications rarely occur in isolation (as single “epigenetic modifications”). They usually appear together and form a network to control the epigenetic system. Cutaneous malignancies are usually affected by epigenetic changes. However, there is limited knowledge regarding the epigenetic changes associated with cutaneous lymphomas. In this review, we focused on cutaneous T-cell lymphomas such as mycosis fungoides, Sézary syndrome, and anaplastic large cell lymphoma. With regard to epigenetic changes, we summarize the detailed chemical modifications categorized into DNA methylation and histone acetylation and methylation. We also summarize the epigenetic modifications and characteristics of the drug for cutaneous T-cell lymphoma (CTCL). Furthermore, we discuss current research on epigenetic-targeted therapy against cutaneous T-cell lymphomas. Although the current method of treatment with histone deacetylase inhibitors does not exhibit sufficient therapeutic benefits in all cases of CTCL, epigenetic-targeted combination therapy might overcome this limitation for patients with CTCL.
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19
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Franceschi J, Ehret M, Visseaux L, Durlach A, Barbe C, Durot É, Grange F. Survival and Prognostic Factors in Patients with Aggressive Cutaneous T-cell Lymphomas. Acta Derm Venereol 2022; 102:adv00676. [PMID: 35083494 PMCID: PMC9558323 DOI: 10.2340/actadv.v102.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aggressive primary cutaneous T-cell lymphomas include advanced-stage mycosis fungoides (stage ≥ IIB mycosis fungoides), Sézary syndrome, gamma/delta cutaneous lymphoma, nasal type lymphoma, aggressive epidermotropic CD8+ T-cell lymphoma and some cutaneous lymphomas not otherwise specified. To evaluate their long-term prognosis, we conducted a retrospective cohort study of 85 patients diagnosed between 2005 and 2020 with advanced-stage mycosis fungoides (n = 48), Sézary syndrome (n = 28) or aggressive non-mycosis fungoides/Sézary syndrome subtypes (n = 9). The median survival times in these 3 groups were 118.7, 45.7 and 11.2 months, respectively, and the 5-year survival rates were 55.3%, 27.8% and 33.3%, respectively. Multivariate analyses in patients with mycosis fungoides/Sézary syndrome identified age ≥ 70 years, Eastern Cooperative Oncology Group Performance Status ≥ 2, and the high-risk group according to the Cutaneous Lymphoma International Consortium prognostic model, as adverse prognostic factors. Seven patients in this mycosis fungoides/Sézary syndrome group were in complete long-term remission after treatment with bexarotene, including 4 patients living without any treatment for 16–101 months.
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Affiliation(s)
- Joséphine Franceschi
- Department of Dermatology, Reims University Hospital, rue du Général Koenig, FR-51100 Reims, France.
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20
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Alenezi F, Girard C, Bessis D, Guillot B, Du-Thanh A, Dereure O. Benefit/risk Ratio of Low-dose Methotrexate in Cutaneous Lesions of Mycosis Fungoides and Sézary Syndrome. Acta Derm Venereol 2021; 101:adv00384. [PMID: 33313939 DOI: 10.2340/00015555-3719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/16/2022] Open
Abstract
Low-dose methotrexate is widely used in mycosis fungoides and Sézary syndrome, but few studies have evaluated this treatment. The aim of this study was to evaluate the benefit/risk ratio of this regimen on skin lesions. A retrospective survey of a series of patients treated for mycosis fungoides or Sézary syndrome with low-dose methotrexate and followed for at least one year in a tertiary referral centre was performed. From a total of 48 patients, complete response and partial response were achieved in 10 (21%) and 25 (52%) patients, respectively, with no significant difference in response rates between mycosis fungoides and Sézary syndrome. Of the responders, 20 out of 35 (57%) relapsed after a median time of 11 months. Forty-four of the total of 48 patients discontinued methotrexate, mainly due to primary or secondary failure and/or limiting toxicity (9 patients). Overall, the benefit/risk ratio of low-dose methotrexate in mycosis fungoides and Sézary syndrome appears favorable and this treat-ment remains a valid option in mycosis fungoides/Sézary syndrome. However, its activity is limited in duration and significant toxicity may occur in some patients.
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Affiliation(s)
- Fawaz Alenezi
- Department of Dermatology, University of Montpellier and INSERM U1058
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21
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Harro CM, Perez-Sanz J, Costich TL, Payne KK, Anadon CM, Chaurio RA, Biswas S, Mandal G, Rigolizzo KE, Sprenger KB, Mine JA, Showe LC, Yu X, Liu K, Rodriguez PC, Pinilla-Ibarz J, Sokol L, Conejo-Garcia JR. Methyltransferase inhibitors restore SATB1 protective activity against cutaneous T cell lymphoma in mice. J Clin Invest 2021; 131:135711. [PMID: 33270606 PMCID: PMC7843215 DOI: 10.1172/jci135711] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 11/25/2020] [Indexed: 12/27/2022] Open
Abstract
Cutaneous T cell lymphoma (CTCL) has a poorly understood etiology and no known cure. Using conditional knockout mice, we found that ablation of the genomic organizer special AT-rich sequence-binding protein 1 (Satb1) caused malignant transformation of mature, skin-homing, Notch-activated CD4+ and CD8+ T cells into progressively fatal lymphoma. Mechanistically, Satb1 restrained Stat5 phosphorylation and the expression of skin-homing chemokine receptors in mature T cells. Notably, methyltransferase-dependent epigenetic repression of SATB1 was universally found in human Sézary syndrome, but not in other peripheral T cell malignancies. H3K27 and H3K9 trimethylation occluded the SATB1 promoter in Sézary cells, while inhibition of SUV39H1/2 methyltransferases (unlike EZH2 inhibition) restored protective SATB1 expression and selectively abrogated the growth of primary Sézary cells more effectively than romidepsin. Therefore, inhibition of methyltransferases that silence SATB1 could address an unmet need for patients with mycosis fungoides/Sézary syndrome, a set of incurable diseases.
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Affiliation(s)
- Carly M. Harro
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Cell Biology, Microbiology, and Molecular Biology, and
- Cancer Biology PhD Program, College of Arts and Sciences, University of South Florida, Tampa, Florida, and H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jairo Perez-Sanz
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Tara Lee Costich
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kyle K. Payne
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Carmen M. Anadon
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ricardo A. Chaurio
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Subir Biswas
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Gunjan Mandal
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kristen E. Rigolizzo
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kimberly B. Sprenger
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jessica A. Mine
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Louise C. Showe
- Molecular & Cellular Oncogenesis Program, The Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Xiaoqing Yu
- Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kebin Liu
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta, Georgia, USA
| | - Paulo C. Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | | | - Jose R. Conejo-Garcia
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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22
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Amatore F, Ortonne N, Lopez M, Orlanducci F, Castellano R, Ingen-Housz-Oro S, De Croos A, Salvado C, Gorvel L, Goubard A, Collette Y, Bouabdallah R, Schiano JM, Bonnet N, Grob JJ, Gaulard P, Bagot M, Bensussan A, Berbis P, Olive D. ICOS is widely expressed in cutaneous T-cell lymphoma, and its targeting promotes potent killing of malignant cells. Blood Adv 2020; 4:5203-5214. [PMID: 33095875 PMCID: PMC7594390 DOI: 10.1182/bloodadvances.2020002395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
The treatment of advanced-stage cutaneous T-cell lymphoma (CTCL) remains an unmet medical need. Mogamulizumab, anti-KIR3DL2, and brentuximab vedotin (BV), an anti-CD30 antibody-drug conjugate (ADC) coupled with monomethyl-auristatin-E (MMAE), provided encouraging results, but new targeted therapies are needed. Inducible T-cell costimulator (ICOS), a T-cell costimulatory receptor, is a promising therapeutic target, not only because it is expressed by malignant T cells in CTCL but also because of its connection with the suppressive activity of regulatory T (Treg) cells. Immunohistochemical analysis revealed that ICOS was widely expressed by malignant cells in skin biopsy specimens from 52 patients with mycosis fungoides and Sézary syndrome (SS), as well as in involved node biopsy specimens from patients with SS. Furthermore, flow cytometry demonstrated its strong expression by circulating tumor cells in all our patients with SS. Percentages of ICOS+ Treg cells were significantly higher in patients with SS than in healthy donors. We then investigated the preclinical efficacy of anti-ICOS ADCs generated by coupling murine anti-ICOS monoclonal antibodies with MMAE and pyrrolobenzodiazepine. In 3 CTCL cell lines (Myla, MJ, and HUT78), we observed a significant dose-dependent decrease in cell viability in the presence of anti-ICOS ADCs. In addition, anti-ICOS-MMAE ADCs had an in vitro and in vivo efficacy superior to BV in a mouse xenograft model (MyLa). Finally, we assessed the efficacy of anti-ICOS ADCs in ICOS+ patient-derived xenografts from patients with SS and angioimmunoblastic T-cell lymphoma. Collectively, our findings provide the preliminary basis for a therapeutic trial.
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Affiliation(s)
- Florent Amatore
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
- Department of Dermatology and Skin Cancers, Hôpital de la Timone, Aix Marseille Université, Marseille, France
- Department of Dermatology, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | | | - Marc Lopez
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Florence Orlanducci
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Rémy Castellano
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
| | | | | | - Laurent Gorvel
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Armelle Goubard
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Yves Collette
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
| | - Réda Bouabdallah
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Marc Schiano
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Nathalie Bonnet
- Department of Dermatology, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Jean-Jacques Grob
- Department of Dermatology and Skin Cancers, Hôpital de la Timone, Aix Marseille Université, Marseille, France
| | | | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris University, INSERM U976, Paris, France; and
| | - Armand Bensussan
- Paris University, INSERM, UMR-976, Institut de Recherche Saint-Louis, Paris, France
| | - Philippe Berbis
- Department of Dermatology, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Daniel Olive
- Centre de Recherche en Cancérologie de Marseille, INSERM U1068, Centre National de la Recherche Scientifique U7258, Aix Marseille Université, Institut Paoli-Calmettes, Marseille, France
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Khodadoust MS, Rook AH, Porcu P, Foss F, Moskowitz AJ, Shustov A, Shanbhag S, Sokol L, Fling SP, Ramchurren N, Pierce R, Davis A, Shine R, Li S, Fong S, Kim J, Yang Y, Blumenschein WM, Yearley JH, Das B, Patidar R, Datta V, Cantu E, McCutcheon JN, Karlovich C, Williams PM, Subrahmanyam PB, Maecker HT, Horwitz SM, Sharon E, Kohrt HE, Cheever MA, Kim YH. Pembrolizumab in Relapsed and Refractory Mycosis Fungoides and Sézary Syndrome: A Multicenter Phase II Study. J Clin Oncol 2020; 38:20-28. [PMID: 31532724 PMCID: PMC6943974 DOI: 10.1200/jco.19.01056] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To assess the efficacy of pembrolizumab in patients with advanced relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS). PATIENTS AND METHODS CITN-10 is a single-arm, multicenter phase II trial of 24 patients with advanced MF or SS. Patients were treated with pembrolizumab 2 mg/kg every 3 weeks for up to 24 months. The primary end point was overall response rate by consensus global response criteria. RESULTS Patients had advanced-stage disease (23 of 24 with stage IIB to IV MF/SS) and were heavily pretreated with a median of four prior systemic therapies. The overall response rate was 38% with two complete responses and seven partial responses. Of the nine responding patients, six had 90% or more improvement in skin disease by modified Severity Weighted Assessment Tool, and eight had ongoing responses at last follow-up. The median duration of response was not reached, with a median response follow-up time of 58 weeks. Immune-related adverse events led to treatment discontinuation in four patients. A transient worsening of erythroderma and pruritus occurred in 53% of patients with SS. This cutaneous flare reaction did not result in treatment discontinuation for any patient. The flare reaction correlated with high PD-1 expression on Sézary cells but did not associate with subsequent clinical responses or lack of response. Treatment responses did not correlate with expression of PD-L1, total mutation burden, or an interferon-γ gene expression signature. CONCLUSION Pembrolizumab demonstrated significant antitumor activity with durable responses and a favorable safety profile in patients with advanced MF/SS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Asa Davis
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | - Yi Yang
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Biswajit Das
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Rajesh Patidar
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Erin Cantu
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Chris Karlovich
- Frederick National Laboratory for Cancer Research, Frederick, MD
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24
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Ugonabo N, Kim R, Chen L, Meehan S, Weed J. Erythroderma with circulating atypical T-cells, likely Sézary syndrome. Dermatol Online J 2019; 25:13030/qt8980h67z. [PMID: 32045168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023] Open
Abstract
The erythrodermic patient is often challenging and requires careful evaluation. Work-up should include an extensive and careful medication history, histological and laboratory testing, and if necessary, molecular studies for the evaluation of underlying malignancy. Herein, we present an erythrodermic patient with repeated biopsies demonstrating a spongiotic process who was found to have circulating atypical T-cells concerning for an underlying erythrodermic T-cell leukemia, most closely related to Sézary syndrome.
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Affiliation(s)
- N Ugonabo
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center, New York, NY.
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25
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Abstract
Mycosis fungoides and Sézary syndrome are the most common subtypes of all primary cutaneous lymphomas and represent complex diseases that require a multidisciplinary assessment by dermatologists, oncologists, and pathologists. Staging and work-up are critical to guarantee an optimal treatment plan that includes skin-directed and/or systemic regimens depending on the clinical stage, tumor burden, drug-related side effect profile, and patient comorbidities. However, there is no cure and patients frequently relapse, requiring repeated treatment courses for disease control. The study of the tumor microenvironment and molecular mechanisms of these rare neoplasms may assist in the development of new immune therapies providing promising treatment approaches tailored for patients with relapse/refractory disease.
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Affiliation(s)
- Christiane Querfeld
- Division of Dermatology, City of Hope, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
- Department of Hematology/Hematopoietic Cell Transplantation, Duarte, USA.
- Department of Pathology, Duarte, USA.
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, CA, USA.
| | - Jasmine Zain
- Department of Hematology/Hematopoietic Cell Transplantation, Duarte, USA
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, CA, USA
| | - Steven T Rosen
- Department of Hematology/Hematopoietic Cell Transplantation, Duarte, USA
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, CA, USA
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26
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Geskin LJ, Akilov OE, Kwon S, Schowalter M, Watkins S, Whiteside TL, Butterfield LH, Falo LD. Therapeutic reduction of cell-mediated immunosuppression in mycosis fungoides and Sézary syndrome. Cancer Immunol Immunother 2018; 67:423-434. [PMID: 29204699 PMCID: PMC8274400 DOI: 10.1007/s00262-017-2090-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 11/05/2017] [Indexed: 12/15/2022]
Abstract
Tumor progression is associated with progressive immunosuppression mediated in part by T regulatory cell(s) (Treg) and/or myeloid-derived suppressor cell(s) (MDSC). Development of strategies to reduce populations of immune cells with suppressive function in cancer patients may enable the induction or recovery of immunity against tumor cells, which may limit or reverse disease progression. With a goal of developing Treg and MDSC neutralizing strategies to treat mycosis fungoides (MF) and Sézary syndrome (SzS), we determined the association between disease stage and suppressor cell populations in patients with MF/SzS, including those responding to therapy. We found elevations in Treg populations, across Treg subtypes, in patients with SzS, and these Treg markedly suppressed proliferation of autologous CD4+CD25- responder T cells. Interestingly, while MDSC numbers were not increased in MF/SzS patients, MDSC from patients with stage IB and above produced significantly more reactive oxygen species than those from stage IA MF patients and control cohorts. Therapy with the CD25-targeting agent denileukin diftitox or IFN-α2b was associated with a reduction in Treg numbers or MDSC function, respectively. These studies identify potential mechanisms of action for these therapies and support the development of coordinated strategies targeting both Treg and MDSC activities in patients with MF/SzS.
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Affiliation(s)
- Larisa J Geskin
- Department of Dermatology, University of Pittsburgh, Suite 500.68 Medical Arts Building, 3708 Fifth Avenue, Pittsburgh, PA, 15213, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Department of Dermatology, Columbia University, New York, NY, USA
| | - Oleg E Akilov
- Department of Dermatology, University of Pittsburgh, Suite 500.68 Medical Arts Building, 3708 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Soonyou Kwon
- Department of Dermatology, University of Pittsburgh, Suite 500.68 Medical Arts Building, 3708 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Michael Schowalter
- Department of Dermatology, University of Pittsburgh, Suite 500.68 Medical Arts Building, 3708 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Simon Watkins
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa L Whiteside
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Lisa H Butterfield
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Louis D Falo
- Department of Dermatology, University of Pittsburgh, Suite 500.68 Medical Arts Building, 3708 Fifth Avenue, Pittsburgh, PA, 15213, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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27
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Abstract
Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of extranodal lymphomas involving the skin. Diagnosis of the two main subtypes of CTCL-mycosis fungoides (MF) and Sézary syndrome (SS)-is based on the International Society for Cutaneous Lymphomas/European Organization for Research and Treatment of Cancer (ISCL/EORTC) classification system, which utilizes clinical, histopathological, molecular biologic, and immunopathologic features. Risk stratification, based on TNMB (tumor, node, metastasis, and blood) staging, provides prognostic information, with limited-stage disease conferring the longest median overall survival. Skin-directed therapies are preferred in the management of limited-stage disease, whereas advanced-stage disease requires systemic therapies. As the mechanisms of CTCL pathogenesis are increasingly understood, new monoclonal antibodies, checkpoint inhibitors, immunomodulatory agents, and small molecules are under investigation and may provide additional therapeutic options for those with advanced CTCL. This review examines the current landscape of targeted therapies in the treatment of CTCLs.
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Affiliation(s)
- Sumana Devata
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, 3A17 N. Ingalis Bldg, 300 N. Ingalis St. SPC 5419, Ann Arbor, MI, 48109-5419, USA.
| | - Ryan A Wilcox
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive, 4310 CC, Ann Arbor, MI, 48109-5936, USA
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28
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Kogge A, Volteau C, Saint-Jean M, Peuvrel L, Brocard A, Knol AC, Renaut JJ, Dréno B, Quéreux G. Vorinostat for refractory or relapsing epidermotropic T-cell lymphoma: a retrospective cohort study of 15 patients. Acta Derm Venereol 2015; 95:72-7. [PMID: 24806744 DOI: 10.2340/00015555-1886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 11/16/2022] Open
Abstract
Since the approval of vorinostat for the treatment of refractory cutaneous epidermotropic T-cell lymphoma (CTCL) in 2006, very little data about this treatment have been published. The aim of this retrospective study was to assess the efficacy and safety of vorinostat in patients with CTCL treated between 2007 and 2013 in our department. Fifteen patients (median age 64 years) were included: 9 with Sézary syndrome and 6 with mycosis fungoides. They were all in progression and the median number of systemic treatments previously administered was 3 (range 1-7). With vorinostat treatment, the best response was partial remission in 5 patients (33%) and stabilization in 4 patients (27%). Six patients experienced disease progression. The mean time to response and response duration were 70 (range 31-140) and 300 days (range 157-663), respectively. The most frequent adverse events were asthenia, weight loss, nausea and anaemia. Vorinostat could be a therapeutic alternative for CTCL after treatment failure.
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Affiliation(s)
- Anne Kogge
- Department of Dermato-Oncology, Nantes University Hospital, INSERM 892, 44093 Nantes, France
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29
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Dummer R, Duvic M, Scarisbrick J, Olsen EA, Rozati S, Eggmann N, Goldinger SM, Hutchinson K, Geskin L, Illidge TM, Giuliano E, Elder J, Kim YH. Final results of a multicenter phase II study of the purine nucleoside phosphorylase (PNP) inhibitor forodesine in patients with advanced cutaneous T-cell lymphomas (CTCL) (Mycosis fungoides and Sézary syndrome). Ann Oncol 2014; 25:1807-1812. [PMID: 24948692 DOI: 10.1093/annonc/mdu231] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Forodesine is a potent inhibitor of purine nucleoside phosphorylase (PNP) that leads to intracellular accumulation of deoxyguanosine triphosphate (dGTP) in T and B cells, resulting in apoptosis. Forodesine has demonstrated impressive antitumor activity in early phase clinical trials in cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS In this phase II study, patients with CTCL who had already failed three or more systemic therapies were recruited. We investigated the response rate, safety and tolerability of oral forodesine treatment in subjects with cutaneous manifestations of CTCL, stages IB, IIA, IIB, III and IVA. The safety population encompassing all stages was used for analysis of accountability, demographics and safety. The efficacy population differed from the safety population by exclusion of stage IB and IIA patients. RESULTS All 144 patients had performance status 0-2. The median duration of CTCL from diagnosis was 53 months (5-516 months). The median number of pretreatments was 4 (range: 3-15). No complete remissions were observed. In the efficacy group of patients, 11% achieved partial remission and 50% had stable disease. The median time to response was 56 days and the median duration of response was 191 days. A total of 96% of all treated patients reported one or more adverse events (AEs) and 33% reported a serious AE. The majority of AEs were classified as mild or moderate in severity. The most commonly reported AEs (>10%) were peripheral edema, fatigue, insomnia, pruritus, diarrhea, headache and nausea. Overall eight patients died during the study: five due to sepsis and infections, one due to a second malignancy (esophageal cancer), one due to disease progression and one due to liver failure. CONCLUSION Oral forodesine at a dose of 200 mg daily is feasible and shows partial efficacy in this highly selected CTCL population and some durable responses.
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Affiliation(s)
- R Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
| | - M Duvic
- Department of Dermatology, MD Anderson Cancer Center, Houston, USA
| | - J Scarisbrick
- Department Dermatology, Hospital Birmingham, Birmingham, UK
| | - E A Olsen
- Department of Dermatology, Duke University Medical Center, Durham, USA
| | - S Rozati
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - N Eggmann
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - S M Goldinger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - L Geskin
- Department of Dermatology, University of Pittsburgh, Pittsburgh, USA
| | - T M Illidge
- School of Cancer and Imaging Sciences, University of Manchester, Manchester, UK
| | - E Giuliano
- Clinical Development, BioCryst Pharmaceuticals, Inc., Durham
| | - J Elder
- Statistics, PharPoint Research, Inc., Chapel Hill
| | - Y H Kim
- Clinical Research, Stanford Cancer Center, Stanford, USA
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30
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Affiliation(s)
- Jason B Kaplan
- Northwestern Medicine Developmental Therapeutics Institute, Northwestern University, 645 N. Michigan Ave, Chicago, IL 60611, USA
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31
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Seyfer SJ, Duvic M. Disappearance of seborrheic keratoses following treatment with methotrexate. Cutis 2013; 92:E2-E3. [PMID: 23961531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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32
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MESH Headings
- Aged
- Alemtuzumab
- Aminopterin/administration & dosage
- Aminopterin/analogs & derivatives
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bexarotene
- Brentuximab Vedotin
- Delayed Diagnosis
- Diagnosis, Differential
- Humans
- Immunoconjugates/therapeutic use
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/physiopathology
- Male
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/drug therapy
- Remission Induction
- Sezary Syndrome/diagnosis
- Sezary Syndrome/drug therapy
- Stem Cell Transplantation
- Tetrahydronaphthalenes/administration & dosage
- Transplantation, Homologous
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33
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Uchi H, Hayashida S, Takahara M, Moroi Y, Furue M. Serum levels of CC chemokine receptor 4 and CXC chemokine receptor 3 ligands in CD8(+) Sézary syndrome. Acta Derm Venereol 2012; 92:280-1. [PMID: 22293715 DOI: 10.2340/00015555-1270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Kelly-Sell MJ, Kim YH, Straus S, Benoit B, Harrison C, Sutherland K, Armstrong R, Weng WK, Showe LC, Wysocka M, Rook AH. The histone deacetylase inhibitor, romidepsin, suppresses cellular immune functions of cutaneous T-cell lymphoma patients. Am J Hematol 2012; 87:354-60. [PMID: 22367792 DOI: 10.1002/ajh.23112] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/27/2011] [Indexed: 11/06/2022]
Abstract
Romidepsin is the second histone deacetylase inhibitor (HDACi) approved for the treatment of advanced stages of cutaneous T-cell lymphoma (CTCL). Recent in vitro data suggest that HDACis suppress immune function although these findings have not been confirmed in patients. Thus, we serially examined the cellular immune function of eight CTCL patients undergoing treatment with three cycles of romidepsin. We measured the patients' natural killer (NK) and dendritic cell (DC) function and performed an in vitro terminal deoxynucleotidyl transferase dUTP nick end labeling assay to measure cellular apoptosis. Patients' NK cell cytolytic activity decreased from baseline to the third cycle of treatment (P = 0.018) but stimulation with a toll-like receptor (TLR) agonist increased this activity (P = 0.018). At baseline, a TLR agonist could both activate patients' DC (P = 0.043) and stimulate interleukin-12 protein production (P = 0.043) but both were suppressed after the first cycle of romidepsin. Finally, we observed increased specificity for romidepsin-induced CD4+ tumor cell apoptosis and dose-dependent increases in cellular apoptosis of healthy cells in multiple lineages (P < 0.05). These findings raise concern that HDACis suppress immune function in CTCL patients and they support the concurrent use of multiple immune stimulatory agents to preserve the host immune response.
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MESH Headings
- Adjuvants, Immunologic/therapeutic use
- Apoptosis/drug effects
- Cells, Cultured/drug effects
- Cells, Cultured/immunology
- Cytotoxicity, Immunologic/drug effects
- Depression, Chemical
- Depsipeptides/adverse effects
- Depsipeptides/pharmacology
- Depsipeptides/therapeutic use
- Drug Screening Assays, Antitumor
- Histone Deacetylase Inhibitors/adverse effects
- Histone Deacetylase Inhibitors/pharmacology
- Histone Deacetylase Inhibitors/therapeutic use
- Humans
- Imidazoles/pharmacology
- Immunity, Cellular/drug effects
- In Vitro Techniques
- Interferon-alpha/pharmacology
- Interleukin-12/pharmacology
- Killer Cells, Natural/drug effects
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Lymphocyte Count
- Lysosomal-Associated Membrane Protein 1/analysis
- Neoplasm Proteins/antagonists & inhibitors
- Quinolines/pharmacology
- Sezary Syndrome/drug therapy
- Sezary Syndrome/immunology
- Skin Neoplasms/drug therapy
- Skin Neoplasms/immunology
- T-Lymphocytes, Regulatory/drug effects
- Toll-Like Receptor 7/agonists
- Toll-Like Receptor 8/agonists
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Affiliation(s)
- Michael J Kelly-Sell
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 , USA.
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35
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Hamada T, Iwatsuki K. [Diagnosis and treatment for cutaneous T-cell lymphomas]. Nihon Rinsho 2012; 70 Suppl 2:537-543. [PMID: 23134012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Toshihisa Hamada
- Department of Dermatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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36
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Stephen S, Morrissey KA, Benoit BM, Kim EJ, Vittorio CC, Nasta SD, Showe LC, Wysocka M, Rook AH. Inhibition of cell-mediated immunity by the histone deacetylase inhibitor vorinostat: implications for therapy of cutaneous T-cell lymphoma. Am J Hematol 2012; 87:226-8. [PMID: 22189940 DOI: 10.1002/ajh.22231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/18/2011] [Indexed: 12/29/2022]
Abstract
Several histone deacetylase inhibitors (HDACi), including vorinostat, have been approved for the therapy of cutaneous T-cell lymphoma (CTCL). Emerging data suggest that HDACi may exert immune suppressive effects which would be disadvantageous for therapy of CTCL. We describe a patient with Sezary syndrome who was monitored for drug-induced immunosuppression while undergoing treatment with vorinostat. Analysis of the patient's natural killer cell function before and after initiation of treatment confirmed inhibition of this important cell-mediated immune function. In addition, the in vitro effects of vorinostat on the immunity of healthy volunteers confirmed that this class of drug can profoundly suppress multiple arms of the cellular immune response. These findings raise concerns of increased susceptibility to infection in this high-risk population.
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Affiliation(s)
- Sasha Stephen
- Department of Dermatology, University of Pennsylvania and the Wistar Institute, Philadelphia, PA 19104, USA.
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Oliveira A, Lobo I, Alves R, Lima M, Selores M. Sezary syndrome presenting with leonine facies and treated with low-dose subcutaneous alemtuzumab. Dermatol Online J 2011; 17:6. [PMID: 22136862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Cutaneous T-cell lymphomas (CTCL) comprise a group of diseases characterized by the accumulation of malignant T cells within the skin. Sezary syndrome represents an aggressive form of CTCL, in which the skin is diffusely affected and the peripheral blood is involved. It is characterized by the triad of generalized erythroderma, lymphadenopathy, and neoplastic T cells (Sezary cells) in the skin, lymph nodes, and peripheral blood. Leonine facies is rare and corresponds to the morphologic manifestation of diffuse dermal infiltration of the face. It can occur in cutaneous T-cell lymphomas that progress during years without therapy. We present the case of a 54-year-old man with Sezary syndrome presenting with leonine facies, unresponsive to conventional therapies; he exhibited a promising response to subcutaneous low-dose alemtuzumab.
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Affiliation(s)
- Ana Oliveira
- Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
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Sokołowska-Wojdyło M, Barańska-Rybak W, Cegielska A, Trzeciak M, Lugowska-Umer H, Gniadecki R. Atopic dermatitis-like pre-Sézary syndrome: role of immunosuppression. Acta Derm Venereol 2011; 91:574-7. [PMID: 21681350 DOI: 10.2340/00015555-1149] [Citation(s) in RCA: 15] [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] [Indexed: 11/16/2022] Open
Abstract
We describe here 4 patients with Sézary syndrome masquerading as adult-onset atopic dermatitis. The patients presented with a clinical picture compatible with wide-spread atopic dermatitis and did not fulfil the criteria for Sézary syndrome (lack of lymphoadenopathy and blood involvement, skin histology without presence of atypical cells). In our patients, overt Sézary syndrome developed after immunosuppressive treatment (including cyclosporine). These cases support the validity of the concept of pre-Sézary syndrome, which is a long-lasting, pre-malignant condition, and which may develop to true malignancy in a state of immunosuppression.
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Ali CM, Sikdar TK, Sultana N, Hoque MR, Ahmed N, Parvez Z, Kamal B, Rahman F. Sezary syndrome. Mymensingh Med J 2011; 20:497-500. [PMID: 21804519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sezary syndrome is a rare form of primary cutaneous T cell lymphoma. A male patient of 37 years old was reported with multiple subcutaneous swelling at different parts of the body which were asymptomatic for the last 2 years. But he had persistent generalized itching, induration in skin surface and erythema for months. The disease was diagnosed by the presence of Sezary cells in the skin biopsy, peripheral blood smears and epidermotrophism of lymphocytes. The patient was treated by CHOP (Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) therapy.
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Affiliation(s)
- C M Ali
- Department of Dermatology, Dhaka Medical College, Dhaka, Bangladesh
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Desar IME, Stevens WBC, Verweij PE, van der Velden WJFM. A Sézary cryptogram. Disseminated cryptococcal infection. Neth J Med 2011; 69:346-349. [PMID: 21934182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- I M E Desar
- Departments of Hematology and Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
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Olsen EA, Whittaker S, Kim YH, Duvic M, Prince HM, Lessin SR, Wood GS, Willemze R, Demierre MF, Pimpinelli N, Bernengo MG, Ortiz-Romero PL, Bagot M, Estrach T, Guitart J, Knobler R, Sanches JA, Iwatsuki K, Sugaya M, Dummer R, Pittelkow M, Hoppe R, Parker S, Geskin L, Pinter-Brown L, Girardi M, Burg G, Ranki A, Vermeer M, Horwitz S, Heald P, Rosen S, Cerroni L, Dreno B, Vonderheid EC. Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol 2011; 29:2598-607. [PMID: 21576639 PMCID: PMC3422534 DOI: 10.1200/jco.2010.32.0630] [Citation(s) in RCA: 450] [Impact Index Per Article: 34.6] [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: 12/16/2022] Open
Abstract
Mycosis fungoides (MF) and Sézary syndrome (SS), the major forms of cutaneous T-cell lymphoma, have unique characteristics that distinguish them from other types of non-Hodgkin's lymphomas. Clinical trials in MF/SS have suffered from a lack of standardization in evaluation, staging, assessment, end points, and response criteria. Recently defined criteria for the diagnosis of early MF, guidelines for initial evaluation, and revised staging and classification criteria for MF and SS now offer the potential for uniform staging of patients enrolled in clinical trials for MF/SS. This article presents consensus recommendations for the general conduct of clinical trials of patients with MF/SS as well as methods for standardized assessment of potential disease manifestations in skin, lymph nodes, blood, and visceral organs, and definition of end points and response criteria. These guidelines should facilitate collaboration among investigators and collation of data from sponsor-generated or investigator-initiated clinical trials involving patients with MF or SS.
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Affiliation(s)
- Elise A Olsen
- Duke University Medical Center, Box 3294, Durham, NC 27710, USA.
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Sanli H, Akay BN, Anadolu R, Ozcan M, Saral S, Akyol A. The efficacy of vorinostat in combination with interferon alpha and extracorporeal photopheresis in late stage mycosis fungoides and Sezary syndrome. J Drugs Dermatol 2011; 10:403-408. [PMID: 21455551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Long-term survival for advanced stages of mycosis fungoides (MF) may be beneficially affected by the use of multimodality therapy. We aim to evaluate the activity of vorinostat in combination with interferon (IFN) alpha and extracorporeal photopheresis (ECP) with persistent, progressive advanced stage MF and Sezary syndrome (SS). PATIENTS AND METHODS Three patients with stage IIB-IVA MF/SS were treated with vorinostat 400 mg/day/po. Vorinostat was added to ongoing ECP and IFN-alpha-2a therapies in all three patients. RESULTS The patient with stage IIB MF achieved a complete response. The patient with SS showed a stable disease of less than 50 percent improvement in body surface area with reduction in the sizes of axillary and inguinal lymph nodes. A partial remission was maintained for 24 weeks in the patient with stage IVA MF, followed by rapid disease progression under treatment which led to cessation of vorinostat treatment due to study criteria as well as serious side effects. CONCLUSION Our experience in this case series is suggestive of the synergistic effect of vorinostat in combination with IFN and ECP and supports the efficacy of vorinostat in inducing prolonged responses in patients with progressive disease and/or stable disease in otherwise progressive and treatment refractory late stage MF/SS.
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Affiliation(s)
- Hatice Sanli
- Department of Dermatology, Ankara University School of Medicine, Turkey
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Sanli H, Akay BN, Ozcan M. Development of Hodgkin's lymphoma under bexarotene treatment for Sézary syndrome and review of the literature. J Drugs Dermatol 2010; 9:1014-1016. [PMID: 20684154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
There are several reports of patients who developed extracutaneous lymphoma after they started bexarotene treatment. The authors report a case in which the initiation of bexarotene therapy for Sézary syndrome was temporally associated with the development of Hodgkin's lymphoma despite improvement in cutaneous signs and symptoms. It is possible that bexarotene may contribute to the development of extracutaneous lymphoma. Although bexarotene therapy may relieve symptoms and signs of cutaneous T-cell lymphoma, careful examination of the lymph nodes during treatment is recommended.
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Affiliation(s)
- Hatice Sanli
- University of Ankara, School of Medicine, Department of Dermatology, Ankara, Turkey
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Dufour C, Cappelli B, Calvillo M, Fioredda F, Tonelli R, Crocchiolo R. Similar favorable outcome of pegfilgrastim overdose in patients with different age and underlying disease. Haematologica 2010; 95:684-5. [PMID: 20053867 DOI: 10.3324/haematol.2009.018333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Vegna ML, Papa G, Defazio D, Pisani F, Coppola G, De Pità O, Puddu P, Ferranti G, Simoni R, Mandelli F. Interferon alpha-2a in cutaneous T-cell lymphoma. Eur J Haematol Suppl 2009; 52:32-5. [PMID: 2279544 DOI: 10.1111/j.1600-0609.1990.tb00903.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
23 newly diagnosed patients affected by cutaneous T-cell lymphoma were treated with sub-cutaneous interferon alpha-2a to evaluate the therapeutic efficacy and the toxicity of this agent. IFN was administered daily with dose escalation from 3 to 18 million units for 12 weeks; thereafter, patients induced into complete (CR) or partial (PR) remission were given IFN at maximal tolerated dose 3 times weekly for 6 or 9 months. The objective tumor response was observed in 17 patients (74%): 8 (35%) were CR and 9 (39%) were PR. A 74-yr-old patient died because of neutropenia and sepsis at the end of induction phase, while receiving IFN at dose of 18 million units. Disease stage is the initial feature predictive of response to IFN therapy. The dose schedule of this study was well tolerated: only 3 patients developed liver toxicity, while leukopenia was evident in 6 patients. Only 2 CR patients have relapsed, 18 and 24 months from response; the remaining 6 CR patients are in continuous complete remission with a median follow-up of 41.8 months. 6 PR patients have progressed from 8 to 17 months after response, and in the 3 PR patients not yet progressed the response duration ranges from 20 to 24 months. In conclusion, interferon alpha-2a is a very effective agent in therapy of untreated cutaneous T-cell lymphoma with an overall response rate of 74%.
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Affiliation(s)
- M L Vegna
- Dipartimento di Biopatologia, Umana, Università La Sapienza, Rome, Italy
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Vinogradova IE, Iliushkina EA, Kaplanskaia IB, Lutsenko IN, Zybunova EE, Kremenetskaia AM, Vorob'ev AI. [Diagnosis and treatment of skin T-cell lymphoma undergoing transformation in lymphosarcoma]. TERAPEVT ARKH 2009; 81:57-61. [PMID: 19708575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM To define complex of parameters characterizing transformation of skin T-cell tumors in lymphosarcoma; to show specific treatment of patients with this transformation. MATERIAL AND METHODS Of 57 patients with primary T-cell lymphomas of the skin (mycosis fungoides, Sezary's disease), we studied 12 patients with transformation of the process into lymphosarcoma by clinical, histological, moleculobiological and immunophenotypical parameters. RESULTS We found that transformation of T-cell lymphoma into lymphosarcoma occurred in different time from the disease onset (2-12 years). In patients with mycosis fungoides (MF) the transformation was local while in those with Sezary's disease (SD) transformation of the tumor clone was determined by appearance of peripheral blood tumor cells rejuvenation. Morphological alterations were accompanied with immunomorphological parameters of progression. Most significant of them were high expression of the proliferative activity marker Ki-67 (10-70%), enhancement of activation (CD30, CD25), loss of some linear T-cell markers. Treatment of lymphosarcoma arising on the background of lingering MF or SD may combine two types of antitumor treatment--intensive and supporting because of coexistence of different clones of one tumor. CONCLUSION Verification of skin T-cell lymphoma diagnosis and its transformation into lymphosarcoma must be based on the evidence from a number of examinations: histological, immunophenotyping, moleculobiological and clinical. Among criteria of the transformation, markers of lymphoproliferative activation are of great importance.
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Nosari A, Tedeschi A, Ricci F, Montillo M. Characteristics and stage of the underlying diseases could determine the risk of opportunistic infections in patients receiving alemtuzumab. Haematologica 2008; 93:e30-1. [PMID: 18245646 DOI: 10.3324/haematol.12465] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Alemtuzumab is usually associated with opportunistic infections. We have treated 67 patients, 8 non-Hodgkin's lymphoma and 59 chronic lymphocytic leukemia (CLL) with campath. Among CLL patients, 6 used alemtuzumab in first line, alone or with chemotherapy, 41 as consolidation therapy and 11 as salvage therapy, 3 alone and 8 with chemotherapy. In our series opportunistic infections were prevalently found in patients submitted to alemtuzumab salvage therapy (33.3%), with or without chemotherapy; in particular 1 pulmonary nocardiosis, 1 tubercolosis. Also during the first line alemtuzumab therapy one case of lysteriosis and one case of HBV reactivation were found (33.3%). No opportunistic infections were diagnosed to our CLL patients in consolidation therapy, when the underlying hematologic disease was reduced or present only as minimal residual disease. A good response of malignancy, namely CLL, to induction therapy, such as a less aggressive schedule of therapy, determine a lower risk of immunosuppression and therefore a low number of opportunistic infections.
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Callet-Bauchu E, Salles G, Gazzo S, Dalle S, Berger F, Hayette S. Identification of a novel e8/a4 BCR/ABL fusion transcript in a case of a transformed Sézary syndrome. Haematologica 2008; 92:1277-8. [PMID: 17768128 DOI: 10.3324/haematol.11341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This report deals with a case of Sézary syndrome, a rare peripheral T-cell lymphoproliferative disorder, in which cytogenetic analysis performed during the disease transformation revealed the presence of a t(9;22) (q34;q11.2) translocation. Molecular analyses identified a new transcript, an e8a4 BCR-ABL fusion mRNA which could be responsible for the disease transformation.
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Kahata K, Hashino S, Takahata M, Fujisawa F, Kondo T, Kobayashi S, Fujita Y, Shimizu H, Imamura M, Asaka M. Durable remission of Sézary syndrome after unrelated bone marrow transplantation by reduced-intensity conditioning. Acta Haematol 2008; 120:14-8. [PMID: 18716396 DOI: 10.1159/000151510] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [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: 02/13/2008] [Accepted: 06/14/2008] [Indexed: 11/19/2022]
Abstract
A 22-year-old Japanese man was diagnosed with Sézary syndrome with large cell transformation. His skin lesions persisted after treatment with 7 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone), psoralen and ultraviolet light A, and total skin electron beam irradiation. He subsequently underwent allogeneic bone marrow transplantation by reduced-intensity conditioning from a human leukocyte antigen-identical unrelated donor. He developed grade II of acute graft-versus-host disease and extensive-type chronic graft-versus-host disease. He has no signs of disease 36 months after the transplantation. The prognosis of patients with advanced stage of mycosis fungoides or Sézary syndrome is very poor. Allogeneic hematopoietic stem cell transplantation, especially by reduced-intensity conditioning, is expected to become a curative treatment option, and graft-versus-tumor effect might play a critical role for sustained remission.
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Affiliation(s)
- Kaoru Kahata
- Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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