Low-dose high-dose-rate brachytherapy in the treatment of facial lesions of cutaneous T-cell lymphoma

DeSimone, Jennifer; Guenova, Emmanuella; Carter, Joi B.; Chaney, Keri; Aldridge, Julie; Noell, Claire; DoRosario, Andrew; Hansen, Jorgen L.; Kupper, Thomas S.; Devlin, Phillip M.

doi:10.1016/j.jaad.2012.12.975

Cited by 32 publications

(22 citation statements)

References 9 publications

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“…13 The management of advanced MF is currently based on monotherapy or combination therapy, including IFN-a, retinoids (bexarotene), photopheresis, chemotherapy, radiotherapy and targeted therapies such as the monoclonal antibody brentuximab. [35][36][37] Most treatment options only induce remissions of limited duration. [29][30][31] An additional challenge in the management of patients with advanced MF is their severely compromised immunity, with an aberrant T helper 2 phenotype and abnormal natural killer cell, cytotoxic T-cell and dendritic cell function.…”

Section: Discussionmentioning

confidence: 99%

Interferon alfa‐2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement

Doerschner

Pekar-Lukacs²,

Messerli-Odermatt

et al. 2019

Br J Dermatol

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Summary Mycosis fungoides (MF) is a primary cutaneous T‐cell lymphoma with unfavourable prognosis for patients with advanced stages of the disease. Refractory disease and advanced‐stage disease require systemic therapy. We report on a rare case of an atypical predominantly CD8+ folliculotropic MF, a subtype of MF with poorer prognosis, in a 59‐year‐old woman. She was initially diagnosed with MF restricted to the skin, of T3N0M0B0/stage IIB according to the current World Health Organization–European Organisation for Research and Treatment of Cancer classification. First‐line treatment with local percutaneous radiotherapy in combination with systemic interferon alfa‐2a resulted in complete remission. However, 21 months later the disease progressed to T3N0M1B0/stage IVB with development of cerebral manifestation and thus very poor prognosis. Allogeneic stem cell transplantation (SCT) was not a therapeutic option due to the lack of a suitable donor. We initiated methotrexate and cytarabine chemotherapy, followed by high‐dose chemotherapy with thiotepa and carmustine with autologous SCT. Despite rapid response and complete remission of the cerebral lesions, disease recurrence of the skin occurred soon after. Interestingly, readministration of interferon alfa‐2a as a maintenance treatment after the salvage autologous SCT resulted in a durable complete remission during the follow‐up period of currently 17 months after autologous SCT. What's already known about this topic? Mycosis fungoides is a primary cutaneous T‐cell lymphoma with unfavourable prognosis for the advanced stages of the disease. A refractory course of disease requires systemic therapy. What does this study add? We report on an unusual case of a patient with mycosis fungoides with cerebral involvement, in which a durable complete remission was achieved upon autologous stem cell therapy and interferon alfa‐2a maintenance therapy.

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Section: Discussionmentioning

confidence: 99%

Interferon alfa‐2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement

Doerschner

Pekar-Lukacs²,

Messerli-Odermatt

et al. 2019

Br J Dermatol

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“…Recent reports have shown that mucosa‐associated lymphoid tissue (MALT) lymphoma, ALCL, and mycosis fungoides (MF) can be successfully treated to complete remission with a low‐dose radiation that can vary from 4 Gy (MALT), 6 Gy (ALCL), and 12 Gy (MF) . Brachytherapy with a dose of 8 Gy has also been shown to be highly efficacious in treating facial MF …”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11] Brachytherapy with a dose of 8 Gy has also been shown to be highly efficacious in treating facial MF. 12 Studies have shown that intermediate-dose (> 20 Gy) to highdose (> 50 Gy) radiotherapy in pediatric patients can increase secondary cancer risk, such as basal cell carcinoma, since children have enhanced radiosensitivity and expected longevity. 13 However, lowdose radiation has relatively low risk of both acute and long-term toxicities and can still provide a complete remission even when aggressive markers are shown on pathology.…”

Section: Discussionmentioning

confidence: 99%

Primary cutaneous CD4+ small‐ to medium‐sized pleomorphic T‐cell lymphoproliferative disorder in a pediatric patient successfully treated with low‐dose radiation

Kim

Aria

Wilmas

et al. 2018

Pediatric Dermatology

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Primary cutaneous CD4+ small‐ to medium‐sized pleomorphic T‐cell lymphoproliferative disorder (PCSM‐LPD) is a rare and low‐grade form of cutaneous T‐cell proliferation with the average age of diagnosis of 54 years. Because of its rarity, the etiology or exact clinicopathology of PCSM‐LPD remains unclear, with < 10 pediatric cases reported. A 13‐year‐old boy presented to our clinic with a raised tumor with PCSM‐LPD histology and was successfully treated with ultra‐low‐dose radiation therapy. While no standard of care has been established for pediatric PCSM‐LPD, this report represents an example of achieving remission in a pediatric tumor with minimal potential for therapy‐related long‐term toxicity.

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“…We recently conducted a clinical trial aimed to examine the overall clinical response to low-dose high-dose-rate brachytherapy in mycosis fungoides. In 10 patients and 23 facial mycosis fungoides lesions treated with brachytherapy, a complete response occurred in six patients (13 lesions) and a partial response in four patients (10 lesions) [40].…”

Section: Recent Therapeutic Advances In Cutaneous T-cell Lymphomamentioning

confidence: 98%

Recent advances in primary cutaneous T-cell lymphoma

DeSimone

Sodha

Ignatova

et al. 2015

Current Opinion in Oncology

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PURPOSE OF REVIEW Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of skin-homing T-cell neoplasms, which represent approximately 75% of all primary cutaneous lymphomas. Currently available drug therapies, when effective, simply control disease and the only option for curing CTCL is stem cell transplant. RECENT FINDINGS In the last year, there has been an incredible effort made to improve the understanding and treatment of CTCL. Recent findings indicate that epigenetic aberrations are integral to active disease. Furthermore, multiple tumor-derived immunological factors have also been shown to inhibit viability, proliferation, and cytokine production of nonmalignant T cells. Several novel targeted therapies show great potential, most promising being antibody drug conjugates targeting surface markers such as CD30 in some CTCL subtypes. Additional attractive targets involve the global modulation of epigenetic markers such as demethylation agents or HDAC inhibitors, either as single agents or in combination therapies. SUMMARY This is a concise review of recent advances in the field of CTCL with special focus on research articles over the preceding year. Purpose of review Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of skin-homing T-cell neoplasms, which represent approximately 75% of all primary cutaneous lymphomas. Currently available drug therapies, when effective, simply control disease and the only option for curing CTCL is stem cell transplant. Recent findingsIn the last year, there has been an incredible effort made to improve the understanding and treatment of CTCL. Recent findings indicate that epigenetic aberrations are integral to active disease. Furthermore, multiple tumor-derived immunological factors have also been shown to inhibit viability, proliferation, and cytokine production of nonmalignant T cells. Several novel targeted therapies show great potential, most promising being antibody drug conjugates targeting surface markers such as CD30 in some CTCL subtypes. Additional attractive targets involve the global modulation of epigenetic markers such as demethylation agents or HDAC inhibitors, either as single agents or in combination therapies. SummaryThis is a concise review of recent advances in the field of CTCL with special focus on research articles over the preceding year.

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Low-dose high-dose-rate brachytherapy in the treatment of facial lesions of cutaneous T-cell lymphoma

Cited by 32 publications

References 9 publications

Interferon alfa‐2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement

Interferon alfa‐2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement

Primary cutaneous CD4+ small‐ to medium‐sized pleomorphic T‐cell lymphoproliferative disorder in a pediatric patient successfully treated with low‐dose radiation

Recent advances in primary cutaneous T-cell lymphoma

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