Romidepsin in the treatment of cutaneous T-cell lymphoma.

2011

Jain S, Zain J.

Source

NYU Cancer Institute, Division of Hematology and Medical Oncology, NYU Langone Medical Center, New York, NY, USA.

Abstract

The most common subtypes of primary cutaneous T-cell lymphoma (CTCL) are mycosis fungoides and Sézary syndrome. Clinical manifestations and prognosis in CTCL are highly variable. Improving the management of this incurable disease with limited toxicity is an active area of research. Romidepsin is a novel, well-tolerated histone deacetylase inhibitor with promising activity against advanced stages of CTCL. In November 2009, it was approved by the US Food and Drug Administration for the treatment of CTCL in patients who have received at least one prior systemic therapy. This review focuses on the activity, pharmacology, and safety of romidepsin for the treatment of CTCL.

Dovepress

Pruritus in cutaneous T-cell lymphoma: A review.

Han 2012

Ahern K, Gilmore ES, Poligone B.

Source

Department of Dermatology, University of Rochester School of Medicine, Rochester, New York.

Abstract

BACKGROUND:

Pruritus can be a distressing and even debilitating symptom for patients with cutaneous T-cell lymphoma(CTCL). To date, few studies have evaluated the pathophysiology of this symptom. Because of this, therapy for pruritus in CTCL has mainly relied on those therapies that target and treat the lymphoma. For patients living with CTCL that relapses or becomes refractory to treatment, and who continue to experience severe itch, this lymphoma-targeted treatment may not be enough to combat their pruritus. Therefore, other itch-targeted therapies are needed for use in this disease.

OBJECTIVE:

We sought to evaluate the current evidence regarding the mechanism of action and treatments for pruritus associated with CTCL.

METHODS:

An explicit and thorough search was restricted to all peer-reviewed literature available through MEDLINE (1950 to September 2011) and PubMed. Search terms used were "pruritus," "cutaneous T-cell lymphoma," "CTCL," "mycosis fungoides," "MF," and "Sézary syndrome." All studies that involved pruritus in CTCL, mycosis fungoides, or Sézary syndrome were evaluated by all 3 authors.

RESULTS:

The current literature helps to identify therapies and possible mechanisms for treating patients with CTCL-associated pruritus.

LIMITATION:

Most studies were preclinical. Only studies involving mechanisms of action or treatment were included.

CONCLUSION:

A guideline is necessary to assist in the treatment of pruritus in CTCL and additional studies are necessary to uncover the exact mechanism or mechanisms of action.

Abbreviations used

• CTCL, cutaneous T-cell lymphoma;
• ECP, extracorporeal photopheresis;
• GRP, gastrin-releasing peptide;
• IFN, interferon;
• IL, interleukin;
• MF, mycosis fungoides;
• PBMC, peripheral blood mononuclear cells;
• PUVA, psoralen plus ultraviolet A;
• SS, Sézary syndrome;
• UV, ultraviolet

Elsevier

Use of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators.

Jan 2012

Cho RJ, McCalmont TH, Ai WZ, Fox LP, Treseler P, Pincus LB.

Source

Department of Dermatology, University of California, San Francisco, CA, USA Department of Pathology, University of California, San Francisco, CA, USA Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA, USA.

Abstract

In lymph nodes, classical Hodgkin lymphoma can typically be distinguished from non-Hodgkin lymphoma (NHL) by the presence of Hodgkin and Reed-Sternberg cells that co-express CD30 and CD15. However, anaplastic large cell lymphoma(ALCL) and diffuse large B-cell lymphoma (DLBCL) can show identical features, and some cases of classical Hodgkinlymphoma lack CD15 expression, rendering them difficult to differentiate from CD30-positive NHL. The differential diagnosis of cutaneous Hodgkin lymphoma similarly includes ALCL and DLBCL, and, additionally, tumors of mycosis fungoides. Recent studies have shown that classical Hodgkin lymphoma is of B-cell origin in virtually all cases, and shows at least focal weak expression of the B-cell marker PAX5 and often focal weak expression and no expression of the B-cell markers Oct-2 and BOB.1, respectively. All three of these markers are almost invariably absent in T-cell lymphomas and are strongly expressed in B-cell lymphomas. We report a 40-year-old man with classical Hodgkin lymphoma who developed cutaneousnodules. A biopsy from one revealed Hodgkin/Reed-Sternberg cells with a similar immunophenotype to the diagnostic lymph node biopsy, namely CD30+/CD15+, diffusely but weakly PAX5+, focally weakly Oct-2+ and lacking BOB.1 expression, thereby confirming a diagnosis of cutaneous Hodgkin lymphoma. To our knowledge, this is the first report of the expression pattern of the combination of PAX5, Oct-2 and BOB.1 in the context of cutaneous involvement by Hodgkin lymphoma. Cho RJ, McCalmont TH, Ai WZ, Fox LP, Treseler P, Pincus LB. Case report demonstrating use of an expanded immunohistochemical panel to distinguish cutaneous Hodgkin lymphoma from histopathologic imitators.

PubMed

Romidepsin in the treatment of cutaneous T-cell lymphoma

Romidepsin in the treatment of cutaneous T-cell lymphoma

2011

Jain S, Zain J.

Source

NYU Cancer Institute, Division of Hematology and Medical Oncology, NYU Langone Medical Center, New York, NY, USA.

Abstract

The most common subtypes of primary cutaneous T-cell lymphoma (CTCL) are mycosis fungoides and Sézary syndrome. Clinical manifestations and prognosis in CTCL are highly variable. Improving the management of this incurable disease with limited toxicity is an active area of research. Romidepsin is a novel, well-tolerated histone deacetylase inhibitor with promising activity against advanced stages of CTCL. In November 2009, it was approved by the US Food and Drug Administration for the treatment of CTCL in patients who have received at least one prior systemic therapy. This review focuses on the activity, pharmacology, and safety of romidepsin for the treatment of CTCL.

Dovepress

Cutaneous T-Cell Lymphomas: A Review of New Discoveries and Treatments.

Feb 2012

Bloom T, Kuzel TM, Querfeld C, Guitart J, Rosen ST.

Source

Rush Medical College, 600 S. Paulina Street, Chicago, IL, 60612, USA, tara_a_bloom@rush.edu.

Abstract

OPINION STATEMENT:

Treatment regimens of patients with CTCL vary widely based on clinician preference and patient tolerance. Skin directed therapies are recommended for patients with early stage IA and IB MF, with combinations used in refractory cases. While no regimen has been proven to prolong survival in advanced stages, immunomodulatory regimens should be used initially to reduce the need for cytotoxic therapies. In more advanced stages of disease, treatment efforts should strive for palliation and improvement of quality of life. With many new therapies and strategies on the horizon, the future looks promising for CTCL patients. Unfortunately, other than allogeneic HCT, there are no potential curative therapies for CTCL. Clinical trials are currently underway to identify new therapies to improve quality of life for patients, and researchers are hard at work to identify novel pathways and genes for prognostication and as targets for therapies. Importantly, collaborative clinical trials to enhance rates of accrual need to be conducted, and improved interpretation of data via standardizing end points and response criteria should be an emphasis. Recently, the International Society for CutaneousLymphomas (ISCL), the United States Cutaneous Lymphoma Consortium (USCLC), and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) met to develop consensus guidelines to facilitate collaboration on clinical trials. These proposed guidelines consist of: recommendations for standardizing general protocol design; a scoring system for assessing tumor burden in skin, lymph nodes, blood, and viscera; definition of response in skin, nodes, blood, and viscera; a composite global response score; and a definition of end points. Although these guidelines were generated by consensus panels, they have not been prospectively or retrospectively validated through analysis of large patient cohorts.

PubMed