Diagnosing mycosis fungoides after initiation of therapy with dupilumab: a case report and literature review

Yan, Di; Ramachandran, Vignesh; Weston, Gillian; Kim, Randie H.; Latkowski, Jo‐Ann

doi:10.1111/ijd.16641

Cited by 3 publications

(2 citation statements)

References 5 publications

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“…Other cytokines that may be potential targets have been revealed to be harmful to patients, such as the IL-4/IL-13 inhibitor Dupilumab [34,132,133,171]. As mentioned above, the administration of Dupilumanb in misdiagnosed MF/SS had the opposite action on patients, with the development of a more aggressive disease.…”

Section: Discussionmentioning

confidence: 99%

“…Theoretically, by blocking IL-4 immune suppressive action, a reawakening of patients' immune systems should be expected. However, in the literature, cases of misdiagnosed MF treated with dupilumab are available, featuring a dramatic disease progression [35,132,133]. It has been hypothesized that dupilumab action may paradoxically activate the JAK/STAT pathway, leading to results opposite to those expected.…”

Section: Il-4 In Mf/ssmentioning

confidence: 99%

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The Role of Cytokines in Cutaneous T Cell Lymphoma: A Focus on the State of the Art and Possible Therapeutic Targets

Guglielmo,

Zengarini,

Agostinelli

et al. 2024

Cells

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Cutaneous T cell lymphomas (CTCLs), encompassing mycosis fungoides (MF) and Sézary syndrome (SS), present a complex landscape influenced by cytokines and cellular responses. In this work, the intricate relationship between these inflammatory proteins and disease pathogenesis is examined, focusing on what is known at the clinical and therapeutic levels regarding the most well-known inflammatory mediators. An in-depth look is given to their possible alterations caused by novel immunomodulatory drugs and how they may alter disease progression. From this narrative review of the actual scientific landscape, Interferon-gamma (IFN-γ) emerges as a central player, demonstrating a dual role in both promoting and inhibiting cancer immunity, but the work navigates through all the major interleukins known in inflammatory environments. Immunotherapeutic perspectives are elucidated, highlighting the crucial role of the cutaneous microenvironment in shaping dysfunctional cell trafficking, antitumor immunity, and angiogenesis in MF, showcasing advancements in understanding and targeting the immune phenotype in CTCL. In summary, this manuscript aims to comprehensively explore the multifaceted aspects of CTCL, from the immunopathogenesis and cytokine dynamics centred around TNF-α and IFN-γ to evolving therapeutic modalities. Including all the major known and studied cytokines in this analysis broadens our understanding of the intricate interplay influencing CTCL, paving the way for improved management of this complex lymphoma.

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Section: Discussionmentioning

confidence: 99%

Section: Il-4 In Mf/ssmentioning

confidence: 99%

The Role of Cytokines in Cutaneous T Cell Lymphoma: A Focus on the State of the Art and Possible Therapeutic Targets

Guglielmo,

Zengarini,

Agostinelli

et al. 2024

Cells

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Increased Risk of Cutaneous T‐Cell Lymphoma Development after Dupilumab Use for Atopic Dermatitis

Mandel,

Mehta,

Hafer

et al. 2024

Dermatologic Therapy

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There have been several reports of dupilumab use and the development of CTCL; however, the risk of CTCL development has not been adequately evaluated at the population level. The objective of this study is to determine whether dupilumab administration for AD is associated with an increased risk of developing CTCL and to identify at‐risk populations within this group. This retrospective cohort study used TriNetX, a deidentified medical record database including over 107 million patients, to identify eligible patients. Treatment and control groups were evaluated for the development of CTCL. Patients of any age with a documented diagnosis of AD were included. The treatment cohort included individuals treated with dupilumab, while the control cohort included AD patients treated with alternative therapies. Selected biologics were excluded from both groups. Subgroup analyses were performed to evaluate three age groups and to identify whether the risk of CTCL development was higher within a given time frame after starting dupilumab. We identified a total of 1,181,533 patients with AD. Of these, 19,612 patients were prescribed dupilumab. Both treatment and control groups included 19,612 patients matched for age, race, and sex. The mean age was 32.3 years (P = 0.96), and females accounted for approximately 52% (P = 0.93) in both groups. Patients treated with dupilumab for AD had an increased relative risk (RR) of developing CTCL compared to those never treated with dupilumab (RR = 4.59, 95% confidence interval 2.459–8.567, P < 0.0001). Subgroup analysis revealed that about half of the CTCL cases after dupilumab therapy (54.5%, 30/55) occurred in patients over the age of 60 years. In contrast, all CTCL cases (100%, 12/12) within the untreated cohort were observed in individuals over the age of 60. Of the patients diagnosed with CTCL following dupilumab use, the majority (62%, 34/55) were diagnosed within the first year. Overall, we find that the use of dupilumab for treating AD is associated with an increased relative risk of developing CTCL. This risk is highest in the first year of therapy and in adult patients. These findings suggest exercising caution in treating select groups of patients with dupilumab.

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The Role of Cytokines in Cutaneous T-cell Lymphoma: Focus on the State of the Art and Possible Therapeutic Targets

Guglielmo,

Zengarini,

Agostinelli

et al. 2024

Preprint

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Cutaneous T-cell lymphomas (CTCLs), encompassing mycosis fungoides (MF) and Sézary syndrome (SS), present a complex landscape influenced by cytokines and cellular responses. In this work, the intricate relationship between these inflammatory proteins and disease pathogenesis is examined, focusing on what is known at a clinical and therapeutic level regarding the most well-known inflammatory mediators. An in-depth look has been given to their possible alterations caused by novel immunomodulatory drugs and how they may alter disease progression.From this narrative review of the actual scientific landscape, Interferon-gamma (IFN-γ) emerges as a central player, demonstrating a dual role in both promoting and inhibiting cancer immunity, but the work navigates through all the major Interleukins known in inflammatory environments.Immunotherapeutic perspectives are elucidated, highlighting the crucial role of the cutaneous microenvironment in shaping dysfunctional cell trafficking, antitumor immunity, and angiogenesis in MF, showcasing advancements in understanding and targeting the immune phenotype in CTCL.In summary, this manuscript aims to comprehensively explore the multifaceted aspects of CTCL, from the immunopathogenesis and cytokine dynamics centred around TNF-α and IFN-γ to evolving therapeutic modalities. Including all the major known and studied cytokines in this analysis broadens our understanding of the intricate interplay influencing CTCL, paving the way for improved management of this complex lymphoma.

show abstract

Diagnosing mycosis fungoides after initiation of therapy with dupilumab: a case report and literature review

Cited by 3 publications

References 5 publications

The Role of Cytokines in Cutaneous T Cell Lymphoma: A Focus on the State of the Art and Possible Therapeutic Targets

The Role of Cytokines in Cutaneous T Cell Lymphoma: A Focus on the State of the Art and Possible Therapeutic Targets

Increased Risk of Cutaneous T‐Cell Lymphoma Development after Dupilumab Use for Atopic Dermatitis

The Role of Cytokines in Cutaneous T-cell Lymphoma: Focus on the State of the Art and Possible Therapeutic Targets

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