Prognosis in cutaneous T-cell lymphoma by skin stage: Long-term survival in 489 patients

Zackheim, Herschel S.; Amin, Smita; Kashani‐Sabet, Mohammed; McMillan, Alex

doi:10.1016/s0190-9622(99)70491-3

Cited by 267 publications

(237 citation statements)

References 14 publications

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“…78 Bone marrow biopsy confirmation of frank lymphoma is a low-yield procedure in MF unless there is evidence of blood or nodal disease 24,38,47,52,61,80 Although it has been suggested that the finding of cytologic atypical lymphoid aggregates in the bone marrow of patients with MF correlates with shorter survival, 24,[81][82][83] multivariate analysis has not demonstrated the independent prognostic value of bone marrow involvement. 23,80,84,85 The ISCL/EORTC recommends performance of a bone marrow biopsy in patients with MF and SS who have B 2 blood involvement (as described in paragraph 4 of "Revisions to the B (blood) rating") or unexplained hematologic abnormalities. Tracking and recording the specific cytologic findings and whether clonality of the TCR gene rearrangement is present will provide further data on whether bone marrow involvement has independent prognostic significance and should be considered as evidence of visceral disease.…”

Section: Revision To M Classificationmentioning

confidence: 99%

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

Olsen,

Vonderheid,

Pimpinelli

et al. 2007

Blood

1,308

1,133

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Section: Revision To M Classificationmentioning

confidence: 99%

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

Olsen,

Vonderheid,

Pimpinelli

et al. 2007

Blood

1,308

1,133

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“…[6][7][8] Accordingly, treatment options for early-stage disease involve skin-directed therapies such as phototherapy, topical nitrogen mustard, or radiotherapy. For patients with intermediate-or early-stage disease with resistance to skin-directed therapies, biologics such as interferon alfa and the rexinoid bexarotene are used.…”

Section: Journal Of Clinical Oncologymentioning

confidence: 99%

Prospective International Multicenter Phase II Trial of Intravenous Pegylated Liposomal Doxorubicin Monochemotherapy in Patients With Stage IIB, IVA, or IVB Advanced Mycosis Fungoides: Final Results From EORTC 21012

Dummer

Quaglino

Becker

et al. 2012

JCO

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PURPOSE: Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma.There is a need for multicenter trials involving defined patient populations using rigorous assessment criteria. We have investigated pegylated liposomal doxorubicin (PLD) in a clearly defined patient population with advanced MF. PATIENTS AND METHODS: Eligible patients had stage IIB, IVA, or IVB MF, refractory or recurrent after at least two previous systemic therapies. Patients were registered to receive a maximum of six cycles of PLD 20 mg/m2 on days 1 and 15, every 28 days (one cycle). The primary end point was response rate (RR). RESULTS: Nine centers recruited 49 eligible patients. The median number of chemotherapy cycles received was five. There were no grade 3 to 4 hematologic toxicities. Grade 3 or 4 nonhematologic/nonbiochemical toxicities included cardiac symptom (2%), allergy/hypersensitivity (2%), constitutional symptom (4%), hand and foot reaction (2%), other dermatologic toxicity (6%), other GI toxicity (4%), infection (4%), pulmonary embolism (2%), and cardiac ischemia (2%). Of 49 patients, 20 (40.8%) were responders (complete clinical response [CCR] or partial response [PR] as overall response): three (6.1%) experienced CCRs, and 17 (34.7%) experienced PRs. A 50% or greater reduction of cutaneous manifestations was observed in 26 (60.5%) of 43 assessable patients. Two early deaths were reported, resulting from related cardiovascular toxicity and disease progression. The lower limit of the one-sided 90% CI for RR was 31.2%. Median time to progression and median duration of response were 7.4 and 6 months, respectively. CONCLUSION: PLD has an acceptable safety profile in patients with advanced MF. The efficacy of PLD seems promising. A B S T R A C T PurposeMycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma. There is a need for multicenter trials involving defined patient populations using rigorous assessment criteria. We have investigated pegylated liposomal doxorubicin (PLD) in a clearly defined patient population with advanced MF. Patients and MethodsEligible patients had stage IIB, IVA, or IVB MF, refractory or recurrent after at least two previous systemic therapies. Patients were registered to receive a maximum of six cycles of PLD 20 mg/m 2 on days 1 and 15, every 28 days (one cycle). The primary end point was response rate (RR). ResultsNine centers recruited 49 eligible patients. The median number of chemotherapy cycles received was five. There were no grade 3 to 4 hematologic toxicities. Grade 3 or 4 nonhematologic/ nonbiochemical toxicities included cardiac symptom (2%), allergy/hypersensitivity (2%), constitutional symptom (4%), hand and foot reaction (2%), other dermatologic toxicity (6%), other GI toxicity (4%), infection (4%), pulmonary embolism (2%), and cardiac ischemia (2%). Of 49 patients, 20 (40.8%) were responders (complete clinical response [CCR] or partial response [PR] as overall response): three (6.1%) experienced CCRs, and 17 (34.7%) experienced PRs. A...

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“…Moreover, patients with stage IA disease do not appear to have a decreased survival compared with an age-, sex-, and race-matched population. 13 Patients with advanced-stage disease (stages IIB, III, and IVA) with tumors, erythroderma, and lymph node or blood involvement but no visceral involvement have a median survival of 5 years from time of presentation. Of note, patients with tumors (T3) have an inferior outcome to those with erythroderma (T4).…”

Section: B2mentioning

confidence: 99%

“…Patients with visceral involvement are rare (stage IVB) and have a median survival of only 2.5 years or less. 9,12,13,15,16 Investigations. The approach to staging the patient is summarized in Table 6 and based on the recommendations of the ISCL.…”

Section: B2mentioning

confidence: 99%

How I treat mycosis fungoides and Sézary syndrome

Prince

Whittaker

Hoppe

2009

Blood

135

109

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The most common subtypes of primary cutaneous T-cell lymphomas are mycosis fungoides (MF) and Sézary syndrome (SS). The majority of patients have indolent disease; and given the incurable nature of MF/SS, management should focus on improving symptoms and cosmesis while limiting toxicity. Management of MF/SS should use a “stage-based” approach; treatment of early-stage disease (IA-IIA) typically involves skin directed therapies that include topical corticosteroids, phototherapy (psoralen plus ultraviolet A radiation or ultraviolet B radiation), topical chemotherapy, topical or systemic bexarotene, and radiotherapy. Systemic approaches are used for recalcitrant early-stage disease, advanced-stage disease (IIB-IV), and transformed disease and include retinoids, such as bexarotene, interferon-α, histone deacetylase inhibitors, the fusion toxin denileukin diftitox, systemic chemotherapy including transplantation, and extracorporeal photopheresis. Examples of drugs under active investigation include new histone deacetylase inhibitors, forodesine, monoclonal antibodies, proteasome inhibitors, and immunomodulatory agents, such as lenalidomide. It is appropriate to consider patients for novel agents within clinical trials if they have failed front-line therapy and before chemotherapy is used.

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Prognosis in cutaneous T-cell lymphoma by skin stage: Long-term survival in 489 patients

Cited by 267 publications

References 14 publications

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

Prospective International Multicenter Phase II Trial of Intravenous Pegylated Liposomal Doxorubicin Monochemotherapy in Patients With Stage IIB, IVA, or IVB Advanced Mycosis Fungoides: Final Results From EORTC 21012

How I treat mycosis fungoides and Sézary syndrome

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