OncoLog, Volume 61, Number 2, February 2016 Page: 2
This periodical is part of the collection entitled: Texas State Publications and was provided to The Portal to Texas History by the UNT Libraries Government Documents Department.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
Cutaneous T Cell Lymphomas
[Continued from page 1]In the patient with refractory mycosis fungoides shown on page 1, reductions in involved lymph nodes (arrows) can be seen in com
puted tomography scans taken before (left), after 6 cycles (center), and after 15 cycles (right) of combination therapy with the oral
retinoid bexarotene and the intravenous chemotherapeutic drug pralatrexate.too, can be erythrodermic and often
mistaken for psoriasis or eczema. This is
problematic because many of the anti-
psoriatic agents used to treat psoriasis
or eczema are very immunosuppressive
and can exacerbate Sezary syndrome or
promote opportunistic infections.
Therefore, Dr. Duvic said, CTCL
should be suspected in patients whose
lesions resemble psoriasis or eczema but
do not respond to treatment or occur in
sun-shielded regions of the skin. When
CTCL is suspected, a biopsy of the in-
volved sites-if 1 month has passed
since treatment with topical steroids,
which rid the skin of lymphocytes-
should be performed to make the cor-
rect diagnosis. In addition, full skin
examinations are essential to detecting
mycosis fungoides when the disease is
suspected, as it tends to develop on un-
exposed areas. Finally, flow cytometry
of a blood sample can detect atypical
T cells indicative of CTCL.
In other cases, lesions that appear to
be malignant may in fact be benign. For
example, the benign form of CD30-pos-
itive anaplastic large T cell lymphoma,
lymphomatoid papulosis, appears as a
solitary papule that usually resolves
without intervention in 3-4 months.
But the malignant form of the disease
can be associated with Hodgkin disease,
mycosis fungoides, or cutaneous ana-
plastic large T cell lymphoma. A soli-
tary lesion resembling lymphomatoid
papulosis typically is removed surgically
for biopsy; however, the benign and
malignant forms appear identical on
biopsy. Therefore, the differential diag-nosis is a clinical one, and aggressive
cancer treatment is withheld unless fur-
ther lesions appear to confirm malig-
nancy.
Treatment
The correct diagnosis of CTCL is
essential to effectively treating the
disease, as treatments vary according
to the type and extent of the disease.
For patients with mycosis fungoides or
Sezary syndrome, treatment depends
on the disease stage and consists of
skin-directed therapy, including radia-
tion therapy, with or without systemic
therapy.
Treatment by disease characteristics
For patients with early-stage myco-
sis fungoides involving 10% or less of
the body, the primary treatment is topi-
cal steroids, which have response rates
of around 70%, with or without photo-
therapy. For patients with more than
10% skin involvement, topical steroids
may be combined with more intensive
phototherapy in the form of narrow-
"Most cancer
patients have disease
on the inside, but
CTCL is a disease
that patients wear
every day."
- Dr. Madeleine Duvicband ultraviolet B radiation or with
psoralen plus ultraviolet A radiation.
Retinoids such as the vitamin A deriv-
ative bexarotene, which may be ad-
ministered topically or orally, and/or
topical chemotherapy with nitrogen
mustard may also be used in these pa-
tients.
Patients with refractory mycosis fun-
goides involving more than 10% of the
skin may require additional systemic
therapy. Such patients may receive oral
retinoids such as bexarotene or acitretin
with or without interferon-alpha or in-
terferon-gamma. Histone deacetylase
(HDAC) inhibitors, such as oral vorin-
ostat or intravenous romidepsin, may
also be used to help manage refractory
mycosis fungoides or anaplastic large
T cell lymphoma. Although only about
30% of CTCL patients have even a
partial response to HDAC inhibitors,
these agents do reduce itching, a major
issue in these patients.
First-line systemic therapy for Sezary
syndrome, a disease characterized by
Sezary T lymphocytes in the blood, in-
cludes photopheresis plus interferon or
bexarotene. In photopheresis, T lym-
phocytes collected from the patient's
peripheral blood are exposed to a pho-
tosensitizing agent and then ultraviolet
light to damage their DNA. Once rein-
troduced into the patient, the photo-
chemically damaged abnormal cells are
taken up by macrophages, which then
trigger an immune response against the
disease. Sezary syndrome patients may
also receive sequential single-agent
chemotherapy.2 OncoLog February 2016
Upcoming Pages
Here’s what’s next.
Search Inside
This issue can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Periodical.
University of Texas M.D. Anderson Cancer Center. OncoLog, Volume 61, Number 2, February 2016, periodical, February 2016; Houston, Texas. (https://texashistory.unt.edu/ark:/67531/metapth839415/m1/2/?rotate=90: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.