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Chemical exposures and demographic associations in cutaneous T-cell lymphoma: a large single institution physician validated cohort study

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Cutaneous T-cell lymphomas (CTCL) are a rare group of T-cell neoplasms which infiltrate the skin and can result in substantial morbidity and mortality. Risk factors for CTCL are still poorly understood though recent studies suggest chemical exposures may play a role in its development. To further characterize patient-centered risk factors for CTCL, especially compared with matched controls, we performed one of the largest prospective cohort survey studies to date to examine patient-reported exposures and health-related quality of life (HRQoL) in association with concurrent clinical disease characteristics. Patient demographics, lifestyle factors, and chemical exposures were collected via clinical data and surveys. Descriptive statistics, ANOVA, Chi-square tests and t tests were utilized to compare patient-reported exposures and HRQoL in patients with CTCL versus matched healthy controls (HC). Statistically significant differences were identified between patients and HC in terms of race (non-white race 22.4% in CTCL patients vs. 18.8% in HC, P = 0.01), and education level (high school or less 41.6% in CTCL patients vs. 14.3% in HC, P = 0.001), but not with Fitzpatrick skin type (P = 0.11) or smoking status (P = 0.28). Notably, 36.0% of the CTCL patients reported exposures to chemicals, a near threefold increased percentage when compared to HC (12.9%). Among various chemical exposures, 27.0% of the CTCL patients specifically reported industrial chemical exposure, a more than two-fold increased percentage when compared to HC (12.9%). Itch and pain were significantly associated with skin disease severity (as evaluated by CTCL-specific mSWAT score) in advanced stage disease (stages IIB–IVB) (r = 0.48 and 0.57, P < 0.05). Itch and body mass index (BMI) were weakly associated with skin disease severity in early-stage disease (stages IA–IIA) (r = 0.27 and 0.20, P < 0.05).

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The clinical data supporting the findings of this study are available upon request.


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The authors would like to thank the patients who contributed to this study.


This study was supported by a Dermatology Foundation Medical Dermatology Career Development Award, Cutaneous Lymphoma Foundation Catalyst Research Grant, an institutional research grant from the American Cancer Society, and an institutional grant from the Northwestern University Clinical and Translational Sciences Institute (NUCATS) and NIH (Grant #KL2TR001424).

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Author Contributions: Conceptualization: XAZ; Data Curation: XAZ, LPC, YP, MN, MJH, TML, FV; Formal Analysis: ZR, XAZ; Funding Acquisition: XAZ; Investigation: XAZ; Methodology: XAZ, ZR; Project administration: XAZ and ZR; Resources: XAZ, JG; Software: ZR, XAZ; Supervision: XAZ, JG; Validation: XAZ; Visualization: YP, LPC, ZR; Writing – original draft: ZR, LPC, YP, XAZ; All authors contributed to the article and approved the submitted version.

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Correspondence to Xiaolong A. Zhou.

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Reviewed and approved by Northwestern University IRB (#STU00209226).

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Ren, Z., Chrisman, L.P., Pang, Y. et al. Chemical exposures and demographic associations in cutaneous T-cell lymphoma: a large single institution physician validated cohort study. Arch Dermatol Res 316, 74 (2024).

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