Management of Cutaneous T-Cell Lymphoma/Mycosis Fungoides Occurring in the Setting of Solid Organ Transplantation: Report of 2 Cases
Publication date: Available online 24 December 2019Source: Clinical Lymphoma Myeloma and LeukemiaAuthor(s): David B. Griffin, Tamar Hajar, Eric Simpson, Kevin P. White, Michi M. Shinohara
This study assessed QoL measurement changes in patients receiving mogamulizumab versus vorinostat.
In this study, we describe the patient characteristics, treatments and outcomes of 17 tMF patients in COMPLETE: a multicenter, prospective US cohort study of peripheral T-cell lymphoma. Responses were observed with single agents, but survival remains poor. Novel treatment approaches are urgently needed to improve outcomes.
Increasing number of large cells in the peripheral blood of patients with erythrodermic cutaneous T-cell lymphoma may reflect large-cell transformation. We found that flow cytometry accurately detected high-scatter T lymphocytes in initial blood samples from 10 of 19 patients with S ézary syndrome, 1 of 13 patients with erythrodermic mycosis fungoides, and no patient with nonneoplastic inflammatory conditions. The presence of high-scatter lymphocytes suggests a poor prognosis even for patients with advanced disease.
Conclusions Epidemiological studies have repeatedly helped identify definitive triggers for several diseases. As highlighted in this perspective report, previous studies strongly argue for the interplay between intrinsic factors and putative preventable extrinsic triggers/promoters for CTCL. Given the evidence of geographical regional clustering of CTCL patients, CTCL occurrence in unrelated family members and recent evidence implicating S. aureus in the pathogenesis/progression of CTCL, more research is needed to decipher the precise mechanism by which specific environmental exposures may be driving the pathogenesis of t...
Conclusions The major challenges in the development of adoptive cell therapy for T cell tumors, as mentioned above, remain fratricide, T cell aplasia and the potential for leukemic transduction or poor T cell function if used in the autologous setting. Approaches to overcome fratricide include the genetic modification and deletion of the T cell antigen in the case of long-term CAR-T cell persistence or regulated CAR-T expression. To ensure restoration of T cell immunity, transient CAR expression can be achieved incorporation of a CAR suicide gene, transient CAR expression using mRNA electroporation, or short-lived NK cell...
ConclusionThe reason for the association between the high serum copper levels and adverse prognosis is unknown. We hypothesized that interleukin-6 is secreted primarily by non-neoplastic cells at MF skin sites, leading to release of copper by the liver. Local production of interleukin-6 at the lesion sites might conceivably also promote neoplastic cell progression by stimulation of the STAT3 pathway. Further studies on the relationship between activated tumor-associated macrophages, serum copper levels, interleukin-6, or C-reactive protein and prognosis might be informative.
ConclusionThe reason for the association between high serum copper and adverse prognosis is unknown. We hypothesize that IL-6 is secreted primarily by non-neoplastic cells at MF skin sites, leading to release of copper by the liver. Local production of IL-6 at lesion sites conceivably might also promote neoplastic cell progression via stimulation of the STAT3 pathway. Further studies on the relationship between activated tumor-associated macrophages, serum copper, IL-6 or C-reactive protein and prognosis might be informative.
Greater than normal serum copper levels in a subset of patients with early mycosis fungoides lymphoma correlated with a worse prognosis compared with that of patients with normal copper levels. The reason for this association is unknown. We hypothesized that inflammatory cytokines such as interleukin-6 secreted by inflammatory cells in skin lesions might play a role in disease progression.
An above normal serum copper level in a subset of patients with early mycosis fungoides lymphoma correlated with a worse prognosis compared to patients with normal copper levels. The reason for this association is unknown. We hypothesize that inflammatory cytokines such as interleukin-6 secreted by inflammatory cells in skin lesions may play a role in disease progression.
Primary cutaneous lymphomas are a heterogeneous group of lymphoid malignancies and are the second most common group of extranodal non-Hodgkin lymphoma (NHL) following gastrointestinal lymphomas.1 NHL involving the female genitalia is unusual, posing diagnostic and therapeutic challenges.2-4 Rare cases of vulvar NHL presenting as a vulvar mass were mostly diagnosed as diffuse large B-cell lymphoma and had an aggressive course.3,5 Cases of cutaneous T-cell lymphoma (CTCL) involving the vulva have been rarely reported.