Successful sequential immune epigenetic therapy of erythrodermic mycosis fungoidesessful sequential immune epigenetic therapy with the resistant course of erythrodermic mycosis fungoides

Cover Page


Cite item

Full Text

Abstract

Mucosis fungoidea (МF) belongs to the class of epidermotropic T-cell lymphomas. MF is represented by over 10 sub-types only in terms of its clinical manifestations, with one of them being erythrodermic MF (EMF). This disease is characterized by diverse symptomatology in the form of erythroderma and intense skin itch, aggressive сlinical course and unfavorable prognosis. The disease prognosis also correlates with age, previous history of long-term systemic gluco-corticosteroid treatment (GCS), increased activity of lactate dehydrogenase (LDH) and hypereosinophilia. The choice of MF treatment is determined by the disease stage and somatic status of the patient. In EMF, a therapy combining various effective preparations and taking into account the specifics of the given case is required. Extracorporeal photopheresis (ECP) is frequently an approach of choice; however, it has demonstrated the highest efficacy in Sezary disease or in EFM associated with leucemization. Application of new pharmaceuticals (monoclonal antibodies, epigenetic agents) in combination or in sequence with immune therapy is a promising direction, particularly for treating patients older than 75 years. In this paper, we describe the clinical case of an elderly patient suffering from EMF without peripheral blood leukemia with multimodal factors of unfavorable prognosis, such as age, increased lactate dehy drogenase activity, history of prolonged inefficient treatment with gluco-cortecosteroid preparations and eosinophilia. A long-term positive response to the treatment using sequential immune epigenetic therapy has not been achieved, although the treatment tolerability and the patient's life quality were satisfactory.

About the authors

L. G. Gorenkova

National Hematology Research Center, Ministr y of Healthcare of the Russian Federation

Author for correspondence.
Email: l.aitova@mail.ru

Lilia G. Gorenkova — Cand. Sci. (Medicine), Researcher, Clinical Research Department of Hemoblastosis Chemotherapy

Zykovsky Novy proezd, 4, Moscow, 125167

Russian Federation

S. K. Kravchenko

National Hematology Research Center, Ministr y of Healthcare of the Russian Federation

Email: fake@neicon.ru

Sergey K. Kravchenko — Cand. Sci. (Medicine), Associate Professor, Head of the Clinical Research Department of Hemoblastosis Chemotherapy

Zykovsky Novy proezd, 4, Moscow, 125167

Russian Federation

A. M. Kovrigina

National Hematology Research Center, Ministr y of Healthcare of the Russian Federation

Email: fake@neicon.ru

Alla M. Kovrigina — Dr. Sci. (Biology), Professor, Head of the Pathological Anatomy Department

Zykovsky Novy proezd, 4, Moscow, 125167

Russian Federation

O. A. Kolomeitsev

N. N. Blokhin Russian Cancer Research Center, Ministr y of Healthcare of the Russian Federation

Email: fake@neicon.ru

Oleg A. Kolomeitsev — Oncohematologist

Kashirskoye shosse, 23, Moscow, 115478

Russian Federation

References

  1. Willemze R., Jaffe E. S., Burg G., et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105:3768–3785.
  2. Fink-Puches R., Zenahlik P., Back B., et al. Primary cutaneous lymphomas: applicability of current classification schemes (European Organization for Research anad Treatment of Cancer, World Health Organization) based on clinicopathologic features observed in a large group of patients. Blood. 2002;99:800–805.
  3. Ralfkiaer E., Cerroni L., Sander C. A., et al. Mycosis fungoides. In Swerdlow SH, Campo E, Pileri SA et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19;127(20):2375–2390. doi: 10.1182/blood-2016-01-643569
  4. Criscione V. D., Weinstock M. A. Incidence of cutaneous T-cell lymphoma in the United States, 1973–2002. Arch Dermatol. 2007;143:854–859.
  5. Saunes M., Lund Nilsen T. I., Johannesen T. B. Incidence of primary cutaneous T0cell lymphoma in Norway. Br J Dermatol. 2009;160:376–379.
  6. Hodak E., Klein T., Gabay B., et al. Familial mycosis fungoides: report of 6 kindreds and a study of the HLA system. J Am Acad Dermatol. 2005;52:393–402.
  7. Rodriguez-Gil Y., Palencia S. I., Lopez-Rios F., et al. Mycosis fungoides after solid organ transplantation: report of 2 new cases. Am J Dermatopathol. 2008;30:150–155.
  8. Amin A., Burkhart C., Groben P., et al. Primary cutaneous T-cell lymphoma following organ transplantion in a 16-year-old boy. Ped Dermatol. 2009;26:112–113.
  9. Vakeva L., Pukkala E., Ranki A. Increased risk of secondary cancers in patients with primary cutaneous T cell lymphoma. J Invest Dermatol. 2000;115:62–65.
  10. Swerdlow S. H., Campo E., Pileri S. A. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375–2390. doi: 10.1182/blood-2016-01-643569
  11. Kelley A., Rakhshandra T., Roland L., et al. Overall survival in erythrodermic cutaneous T-cell lymphoma: an analysis of prognostic factors in a cohort of patients with erythrodermic cutaneous T-cell lymphoma. International Journal of Dermatology. 2009;48:243–252.
  12. Laharanne E., Oumouhou N., Bonnet F., et al. Genome-wide analysis of cutaneous T-cell lymphomas identifies three clinically relevant classes. J Invest Dermatol. 2010;130:1707–1718.
  13. Van Doorn R., van Kester M. S., Dijkman R., et al. Oncogenomic analysis of mycosis fungoides reveals major differences with Sezary syndrome. Blood. 2009;113:127–136.
  14. Campbell J. J., Clark R. A., Watanabe R., et al. Sezary syndrome and mycosis fungoides arise from distinct clinical behaviors. Blood. 2010;116:761–777.
  15. Российские клинические рекомендации по диагностике и лечению лимфопролиферативных заболеваний. Под ред. проф. И. В. Поддубной, проф. В. Г. Савченко. М.: ООО «Буки Веди», 2016. С. 85–91
  16. Горенкова Л. Г., Пенская Е. А., Кравченко С. К. Лечение резистентных форм грибовидного микоза и синдрома Сезари. Клиническая онкогематология. 2017;10(3):366–71. doi: 10.21320/2500-2139-2017-103-366-371
  17. Olsen E. A., Rook A. H., Zic J., et al. Sezary syndrome: immunopathogenesis, literature review of therapeutic options, and recommendations for therapy by the United States Cutaneous Lymphoma Consortium (USCLC). J Am Acad Dermatol. 2011; 64:352–404.
  18. Quaglino P., Maule M., Prince H. M., et al. Global patterns of care in advanced stage mycosis fungoides/Sezary syndrome: a multicenter retrospective follow-up study from the Cutaneous Lymphoma International Consortium. Annals of Oncology. 2017;28:2517–2525.
  19. Edelson R., Berger C., Gasparro F. P., et al. Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy. N Engl J Med. 1987;316:297–303.
  20. Kim K. Y. et al. Anti-CCR4 monoclonal antibody, mogamulizumab, demonstrates significant improvement in PFS compared to vorinostat in patients with previously treated cutaneous T-cell lymphoma (CTCL): results from the Phase III MAVORIC Study. In Press, 2017.
  21. Kim Y. H., Bishop K., Varghese A., et al. Prognostic factors in erythrodermic mycosis fungoides and the Sezary syndrome. Arch Dermatol. 1995;131:1003–1008.
  22. Tancrede-Bohin E., Ionescu M. A., de la Salmoniere P., et al. Prognostic value of blood eosinophilia in primary cutaneous T-cell lymphomas. Arch Dermatol. 2004;140:1297–1302.
  23. Lorenzo Cerroni. Mycosis fungoides — clinical and histopathologic features differential diagnosis and treatment. Seminars in cutaneous medicine and surgery. 2018 March;37:1–9.
  24. Сыдиков А. А., Заславский Д. В., Зайцев В. С., Насыров Р. А. Об эволюции взглядов на группы парасориазов Брока. Современные проблемы науки и образования. 2013;5:317
  25. Stowel J. C., Huot R. I., Van Voast L. The synthesis of N-hydroxyN’-phenyloctanediamide and its inhibitory effect on proliferation of AXC rat prostate cancer cells. L Med Chem.1995;38(8):1411–1413.
  26. Olsen Elise A., Kim Youn H., Kuzel Timothy M., et al. Phase IIB multicenter trial of vorinostat in patients with persistent, progressive, or treatment refractory cutaneous T-cell lymphoma. Journal of clinical oncology. 2007;25(21):3009–3015.
  27. Keehn C. A., Belongie I. P., Shistik G., et al. The diagnosis, staging and treatment options for mycosis fungoides. Cancer Control. 2007;14(2):102–111.
  28. Litvinov I., Cordeiro B., Fredholm S., et al. Analysis of STAT 4 expression in cutaneous T-cell lymphoma (CTCL) patients and patient-derived cell lines. Cell Cycle. 2014:13(18):2975–2982.
  29. Massone C., Kodama K., Keri H., Cerroni L. Histopathologic features of early (patch) lesions of mycosis fungoides:a morphologic study on 745 biopsy specimens from 427 patients. Am L Surg Pathol. 2005;29(4):550–560.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2018 Gorenkova L.G., Kravchenko S.K., Kovrigina A.M., Kolomeitsev O.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 60448 от 30.12.2014.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies