Skip to main content

Cutaneous T-Cell Lymphoma: Mycosis Fungoides and Sézary Syndrome

  • Chapter
  • First Online:
  • 512 Accesses

Abstract

Cutaneous T-cell lymphomas (CTCLs) represent a wide range of clinical entities with differing pathogenesis and responses to treatment. This chapter will review the most common classifications of CTCL, which include mycosis fungoides (MF), MF variants, and Sézary syndrome (SS). Clinical and pathologic staging systems will be discussed in detail along with the implication of staging on clinical outcomes. Current therapy approaches consist of topical, systemic, or combined therapies depending on stage of disease and comorbidities. Due to the complexity of disease presentations and therapy selections available, assessment and treatment recommendations are best delivered by a multidisciplinary team.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Vij A, Duvic M. Prevalence and severity of pruritus in cutaneous T cell lymphoma. Int J Dermatol. 2012;51(8):930–4.

    Article  PubMed  Google Scholar 

  2. Willemze R, Jaffe E, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105(10):3768–85.

    Article  CAS  PubMed  Google Scholar 

  3. Trautinger F, Eder J, Assaf C, Bagot M, Cozzio A, Dummer R, et al. European organisation for research and treatment of cancer consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome – update 2017. Eur J Cancer. 2017;77:57–74.

    Article  PubMed  Google Scholar 

  4. Alibert J-L. Description des maladies de la peau : observées à l’Hôpital Saint-Louis, et exposition des meilleures méthodes suivies pour leur traitement. Barrois l’aîné et fils. Bruxelles: Wahlen; 1825.

    Google Scholar 

  5. Sezary A, Bouvrain Y. Erythrodermie avec présence de cellules monstrueses dans le derme et dans lang circulant. Bull Soc Fr Dermatol Syphiligr. 1938;45:254–60.

    Google Scholar 

  6. Lutzner M. Cutaneous T-cell lymphomas: the Sézary syndrome, mycosis fungoides, and related disorders. Ann Intern Med. 1975;83(4):534.

    Article  CAS  PubMed  Google Scholar 

  7. Criscione V, Weinstock M. Incidence of cutaneous T-cell lymphoma in the United States, 1973–2002. Arch Dermatol. 2007;143(7):854–9.

    Article  PubMed  Google Scholar 

  8. Morales Suárez-Varela MM, Olsen J, Kaerlev L, Guénel P, Arveux P, Wingren G, et al. Are alcohol intake and smoking associated with mycosis fungoides? A European multicentre case–control study. Eur J Cancer. 2001;37(3):392–7.

    Article  PubMed  Google Scholar 

  9. Whittemore AS, Holly EA, Lee I-M, Abel EA, Adams RM, Nickoloff BJ, et al. Mycosis fungoides in relation to environmental exposures and immune response: a case-control study. JNCI J Natl Cancer Inst. 1989;81(20):1560–7.

    Article  CAS  PubMed  Google Scholar 

  10. Morales-Suarez-Varela MM, Olsen J, Johansen P, Kaerlev L, Guenel P, Arveux P, et al. Occupational sun exposure and mycosis fungoides: a European multicenter case-control study. J Occup Environ Med. 2006;48(4):390–3.

    Article  PubMed  Google Scholar 

  11. Tuyp E, Burgoyne A, Aitchison T, MacKie R. A case-control study of possible causative factors in mycosis fungoides. Arch Dermatol. 1987;123(2):196–200.

    Article  CAS  PubMed  Google Scholar 

  12. Clark RA, Chong B, Mirchandani N, Brinster NK, Yamanaka K –i, Dowgiert RK, et al. The vast majority of CLA+ T cells are resident in normal skin. J Immunol. 2006;176(7):4431–9.

    Article  CAS  PubMed  Google Scholar 

  13. Reiss Y, Proudfoot AE, Power CA, Campbell JJ, Butcher EC. CC chemokine receptor (CCR)4 and the CCR10 ligand cutaneous T cell–attracting chemokine (CTACK) in lymphocyte trafficking to inflamed skin. J Exp Med. 2001;194(10):1541–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Homey B, Alenius H, Müller A, Soto H, Bowman EP, Yuan W, et al. CCL27–CCR10 interactions regulate T cell–mediated skin inflammation. Nat Med. 2002;8(2):157.

    Article  CAS  PubMed  Google Scholar 

  15. Marusina AI, Ono Y, Merleev AA, Shimoda M, Ogawa H, Wang EA, et al. CD4+ virtual memory: antigen-inexperienced T cells reside in the naïve, regulatory, and memory T cell compartments at similar frequencies, implications for autoimmunity. J Autoimmun. 2017;77(Supplement C):76–88.

    Article  CAS  PubMed  Google Scholar 

  16. Kueberuwa G, Gornall H, Alcantar-Orozco EM, Bouvier D, Kapacee ZA, Hawkins RE, et al. CCR7+ selected gene-modified T cells maintain a central memory phenotype and display enhanced persistence in peripheral blood in vivo. J Immunother Cancer. 2017;5(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bingaman AW, Patke DS, Mane VR, Ahmadzadeh M, Ndejembi M, Bartlett ST, et al. Novel phenotypes and migratory properties distinguish memory CD4 T cell subsets in lymphoid and lung tissue. Eur J Immunol. 2005;35(11):3173–86.

    Article  CAS  PubMed  Google Scholar 

  18. Campbell JJ, Clark RA, Watanabe R, Kupper TS. Sézary syndrome and mycosis fungoides arise from distinct T-cell subsets: a biologic rationale for their distinct clinical behaviors. Blood. 2010;116(5):767–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Laharanne E, Oumouhou N, Bonnet F, Carlotti M, Gentil C, Chevret E, et al. Genome-wide analysis of cutaneous T-cell lymphomas identifies three clinically relevant classes. J Invest Dermatol. 2010;130(6):1707–18.

    Article  CAS  PubMed  Google Scholar 

  20. van Doorn R, van Kester MS, Dijkman R, Vermeer MH, Mulder AA, Szuhai K, et al. Oncogenomic analysis of mycosis fungoides reveals major differences with Sézary syndrome. Blood. 2009;113(1):127–36.

    Article  CAS  PubMed  Google Scholar 

  21. Geskin LJ. Cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome). In: Kaushansky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ, et al., editors. Williams hematology. 9th ed. New York: McGraw-Hill Education; 2015.

    Google Scholar 

  22. van Doorn R, Haselen CWV, van Voorst Vader PC, Geerts M-L, Heule F, de Rie M, et al. Mycosis fungoides: disease evolution and prognosis of 309 Dutch patients. Arch Dermatol. 2000;136(4):504–10.

    PubMed  Google Scholar 

  23. Naraghi ZS, Seirafi H, Valikhani M, Farnaghi F, Kavusi S, Dowlati Y. Assessment of histologic criteria in the diagnosis of mycosis fungoides. Int J Dermatol. 2003;42(1):45–52.

    Article  PubMed  Google Scholar 

  24. Pimpinelli N, Olsen EA, Santucci M, Vonderheid E, Haeffner AC, Stevens S, et al. Defining early mycosis fungoides. J Am Acad Dermatol. 2005;53(6):1053–63.

    Article  PubMed  Google Scholar 

  25. Vergier B, Beylot-Barry M, Beylot C, de Mascarel A, Delaunay M, de Muret A, et al. Pilotropic cutaneous T-cell lymphoma without mucinosis. A variant of mycosis fungoides? French Study Group of Cutaneous Lymphomas. Arch Dermatol. 1996;132(6):683–7.

    Article  CAS  PubMed  Google Scholar 

  26. van Doorn R, Scheffer E, Willemze R. Follicular mycosis fungoides, a distinct disease entity with or without associated follicular mucinosis: a clinicopathologic and follow-up study of 51 patients. Arch Dermatol. 2002;138(2):191–8.

    PubMed  Google Scholar 

  27. Kempf W, Ostheeren-Michaelis S, Paulli M, Lucioni M, Wechsler J, Audring H, et al. Granulomatous mycosis fungoides and granulomatous slack skin: a multicenter study of the Cutaneous Lymphoma Histopathology Task Force Group of the European Organization for Research and Treatment of Cancer (EORTC). Arch Dermatol. 2008;1:144(12).

    Google Scholar 

  28. Li JY, Pulitzer MP, Myskowski PL, Dusza SW, Horwitz S, Moskowitz A, et al. A case-control study of clinicopathologic features, prognosis, and therapeutic responses in patients with granulomatous mycosis fungoides. J Am Acad Dermatol. 2013;69(3):366–374.e4.

    Article  PubMed  Google Scholar 

  29. Clarijs M, Poot F, Laka A, Pirard C, Bourlond A. Granulomatous slack skin: treatment with extensive surgery and review of the literature. Dermatol Basel. 2003;206(4):393–7.

    Article  Google Scholar 

  30. van Haselen CW, Toonstra J, van der Putte SJC, van Dongen JJM, van Hees CLM, van Vloten WA. Granulomatous slack skin: report of three patients with an updated review of the literature. Dermatol Basel. 1998;196(4):382–91.

    Article  Google Scholar 

  31. Wieselthier JS, Koh HK. Sézary syndrome: diagnosis, prognosis, and critical review of treatment options. J Am Acad Dermatol. 1990;22(3):381–401.

    Article  CAS  PubMed  Google Scholar 

  32. Taswell HF, Winkelmann RK. Sézary syndrome – a malignant reticulemic erythroderma. JAMA. 1961;177(7):465–72.

    Article  CAS  PubMed  Google Scholar 

  33. Lutzner MA, Jordan HW. The ultrastructure of an abnormal cell in Sézary’s syndrome. Blood. 1968;31(6):719–26.

    Article  CAS  PubMed  Google Scholar 

  34. Boonk SE, Zoutman WH, Marie-Cardine A, van der Fits L, Out-Luiting JJ, Mitchell TJ, et al. Evaluation of immunophenotypic and molecular biomarkers for Sézary syndrome using standard operating procedures: a multicenter study of 59 patients. J Invest Dermatol. 2016;136(7):1364–72.

    Article  CAS  PubMed  Google Scholar 

  35. Klemke CD, Booken N, Weiss C, Nicolay JP, Goerdt S, Felcht M, et al. Histopathological and immunophenotypical criteria for the diagnosis of Sézary syndrome in differentiation from other erythrodermic skin diseases: a European Organisation for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force Study of 9. Br J Dermatol. 2015;173(1):93–105.

    Article  CAS  PubMed  Google Scholar 

  36. Hristov AC, Vonderheid EC, Borowitz MJ. Simplified flow cytometric assessment in mycosis fungoides and Sézary syndrome. Am J Clin Pathol Chic. 2011;136(6):944–53.

    Article  Google Scholar 

  37. Muche JM, Lukowsky A, Asadullah K, Gellrich S, Sterry W. Demonstration of frequent occurrence of clonal T cells in the peripheral blood of patients with primary cutaneous T-cell lymphoma. Blood. 1997;90(4):1636–42.

    Article  CAS  PubMed  Google Scholar 

  38. Preesman AH, Schrooyen SJ, Toonstra J, van der Putte SCJ, Rademakers LHPM, Willemze R, et al. The diagnostic value of morphometry on blood lymphocytes in erythrodermic actinic reticuloid. Arch Dermatol. 1995;131(11):1298–303.

    Article  CAS  PubMed  Google Scholar 

  39. Rosenthal CJ, Noguera CA, Coppola A, Kapelner SN. Pseudolymphoma with mycosis fungoides manifestations, hyperresponsiveness to diphenylhydantoin, and lymphocyte disregulation. Cancer. 1982;49(11):2305–14.

    Article  CAS  PubMed  Google Scholar 

  40. Vonderheid EC, Bernengo MG, Burg G, Duvic M, Heald P, Laroche L, et al. Update on erythrodermic cutaneous T-cell lymphoma: report of the international society for cutaneous lymphomas. J Am Acad Dermatol. 2002;46(1):95–106.

    Article  PubMed  Google Scholar 

  41. Lamberg SI, Bunn PA. Cutaneous T-cell lymphomas: summary of the Mycosis Fungoides Cooperative Group-National Cancer Institute Workshop. Arch Dermatol. 1979;115(9):1103–5.

    Article  CAS  PubMed  Google Scholar 

  42. Bunn PA, Lamberg SI. Report of the committee on staging and classification of cutaneous T-cell lymphomas. Cancer Treat Rep. 1979;63(4):725–8.

    PubMed  Google Scholar 

  43. Olsen E, Vonderheid E, Pimpinelli N, Willemze R, Kim Y, Knobler R, et al. 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). Blood. 2007;110(6):1713–22.

    Article  CAS  PubMed  Google Scholar 

  44. Kim YH, Willemze R, Pimpinelli N, Whittaker S, Olsen EA, Ranki A, et al. TNM classification system for primary cutaneous lymphomas other than 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). Blood. 2007;110(2):479–84.

    Article  CAS  PubMed  Google Scholar 

  45. Kim YH, Liu HL, Mraz-Gernhard S, Varghese A, Hoppe RT. Long-term outcome of 525 patients with mycosis fungoides and Sézary syndrome: clinical prognostic factors and risk for disease progression. Arch Dermatol. 2003;139(7):857–66.

    Article  PubMed  Google Scholar 

  46. Zackheim HS, Amin S, Kashani-Sabet M, McMillan A. Prognosis in cutaneous T-cell lymphoma by skin stage: long-term survival in 489 patients. J Am Acad Dermatol. 1999;40(3):418–25.

    Article  CAS  PubMed  Google Scholar 

  47. Sausville EA, Worsham GF, Matthews MJ, Makuch RW, Fischmann AB, Schechter GP, et al. Histologic assessment of lymph nodes in mycosis fungoides/sézary syndrome (cutaneous T-cell lymphoma): clinical correlations and prognostic import of a new classification system. Hum Pathol. 1985;16(11):1098–109.

    Article  CAS  PubMed  Google Scholar 

  48. Fuks ZY, Bagshaw MA, Farber EM. Prognostic signs and the management of the mycosis fungoides. Cancer. 1973;32(6):1385–95.

    Article  CAS  PubMed  Google Scholar 

  49. Rappaport H, Thomas LB. Mycosis fungoides: the pathology of extracutaneous involvement. Cancer. 1974;34(4):1198–229.

    Article  CAS  PubMed  Google Scholar 

  50. Bosse T, Nout RA, McAlpine JN, McConechy MK, Britton H, Hussein YR, et al. Molecular classification of grade 3 endometrioid endometrial cancers identifies distinct prognostic subgroups. Am J Surg Pathol. 2018;42:561–8.

    PubMed  PubMed Central  Google Scholar 

  51. Bunn PA. Prospective staging evaluation of patients with cutaneous T-cell lymphomas: demonstration of a high frequency of extracutaneous dissemination. Ann Intern Med. 1980;93(2):223.

    Article  PubMed  Google Scholar 

  52. Clendenning WE, Rappaport HW. Report of the committee on pathology of cutaneous T cell lymphomas. Cancer Treat Rep. 1979;63(4):719–24.

    CAS  PubMed  Google Scholar 

  53. Scheffer E, Meijer CJLM, van Vloten WA. Dermatopathic lymphadenopathy and lymph node involvement in mycosis fungoides. Cancer. 1980;45(1):137–48.

    Article  CAS  PubMed  Google Scholar 

  54. Vonderheid EC, Diamond LW, Van Vloten WA, Scheffer E, Meijer CJLM, Cashell AW, et al. Lymph node classification systems in cutaneous T-cell lymphoma. Evidence for the utility of the working formulation of non-Hodgkin’s lymphomas for clinical usage. Cancer. 1994;73(1):207–18.

    Article  CAS  PubMed  Google Scholar 

  55. Sibaud V, Beylot-Barry M, Thiébaut R, Parrens M, Vergier B, Delaunay M, et al. Bone marrow histopathologic and molecular staging in epidermotropic T-cell lymphomas. Am J Clin Pathol. 2003;119(3):414–23.

    Article  PubMed  Google Scholar 

  56. Agar NS, Wedgeworth E, Crichton S, Mitchell TJ, Cox M, Ferreira S, et al. Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer Staging Proposal. J Clin Oncol. 2010;28(31):4730–9.

    Article  PubMed  Google Scholar 

  57. Scarisbrick JJ, Prince HM, Vermeer MH, Quaglino P, Horwitz S, Porcu P, et al. Cutaneous lymphoma international consortium study of outcome in advanced stages of mycosis fungoides and Sézary syndrome: effect of specific prognostic markers on survival and development of a prognostic model. J Clin Oncol. 2015;33(32):3766–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Jawed SI, Myskowski PL, Horwitz S, Moskowitz A, Querfeld C. Primary cutaneous T-cell lymphoma (mycosis fungoides and Sézary syndrome): part I. Diagnosis: clinical and histopathologic features and new molecular and biologic markers. J Am Acad Dermatol. 2014;70(2):205.e1–205.e16.

    Article  Google Scholar 

  59. Diamandidou E, Colome-Grimmer M, Fayad L, Duvic M, Kurzrock R. Transformation of mycosis fungoides/Sezary syndrome: clinical characteristics and prognosis. Blood. 1998;92(4):1150–9.

    Article  CAS  PubMed  Google Scholar 

  60. Arulogun SO, Prince HM, Ng J, Lade S, Ryan GF, Blewitt O, et al. Long-term outcomes of patients with advanced-stage cutaneous T-cell lymphoma and large cell transformation. Blood. 2008;112(8):3082–7.

    Article  CAS  PubMed  Google Scholar 

  61. Benner MF, Jansen PM, Vermeer MH, Willemze R. Prognostic factors in transformed mycosis fungoides: a retrospective analysis of 100 cases. Blood. 2012;119(7):1643–9.

    Article  CAS  PubMed  Google Scholar 

  62. Pulitzer M, Myskowski PL, Horwitz SM, Querfeld C, Connolly B, Li J, et al. Mycosis fungoides with large cell transformation: clinicopathological features and prognostic factors. Pathology (Phila). 2014;46(7):610–6.

    Google Scholar 

  63. Scarisbrick JJ, Kim YH, Whittaker SJ, Wood GS, Vermeer MH, Prince HM, et al. Prognostic factors, prognostic indices and staging in mycosis fungoides and Sézary syndrome: where are we now? Br J Dermatol. 2014;170(6):1226–36.

    Article  CAS  PubMed  Google Scholar 

  64. Talpur R, Sui D, Gangar P, Dabaja BS, Duvic M. Retrospective analysis of prognostic factors in 187 cases of transformed mycosis fungoides. Clin Lymphoma Myeloma Leuk. 2016;16(1):49–56.

    Article  PubMed  Google Scholar 

  65. Kaye FJ, Bunn PA, Steinberg SM, Stocker JL, Ihde DC, Fischmann AB, et al. A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides. N Engl J Med. 1989;321(26):1784–90.

    Article  CAS  PubMed  Google Scholar 

  66. Stevens SR, Ke MS, Parry EJ, Mark J, Cooper KD. Quantifying skin disease burden in mycosis fungoides–type cutaneous T-cell lymphomas: the Severity-Weighted Assessment Tool (SWAT). Arch Dermatol [Internet]. 2002 Jan 1 [cited 2019 Jan 16];138(1):42–8. Available from: http://archderm.jamanetwork.com/article.aspx?doi=10.1001/archderm.138.1.42.

  67. Olsen EA, Whittaker S, Kim YH, Duvic M, Prince HM, Lessin SR, et al. Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol. 2011;29(18):2598–607.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Zackheim HS, Kashani-Sabet M, Amin S. Topical corticosteroids for mycosis fungoides: experience in 79 patients. Arch Dermatol. 1998;134(8):949–54.

    Article  CAS  PubMed  Google Scholar 

  69. Zackheim HS. Treatment of patch-stage mycosis fungoides with topical corticosteroids. Dermatol Ther. 2003;16(4):283–7.

    Article  PubMed  Google Scholar 

  70. Vonderheid EC, Tan ET, Kantor AF, Shrager L, Micaily B, Van Scott EJ. Long-term efficacy, curative potential, and carcinogenicity of topical mechlorethamine chemotherapy in cutaneous T cell lymphoma. J Am Acad Dermatol. 1989;20(3):416–28.

    Article  CAS  PubMed  Google Scholar 

  71. Ramsay DL, Halperin PS, Zeleniuch-Jacquotte A. Topical mechiorethamine therapy for early stage mycosis fungoides. J Am Acad Dermatol. 1988;19(4):684–91.

    Article  CAS  PubMed  Google Scholar 

  72. Kim YH, Jensen RA, Watanabe GL, Varghese A, Hoppe RT. Clinical stage IA (limited patch and plaque) mycosis fungoides: a long-term outcome analysis. Arch Dermatol. 1996;132(11):1309–13.

    Article  CAS  PubMed  Google Scholar 

  73. Kim YH, Martinez G, Varghese A, Hoppe RT. Topical nitrogen mustard in the management of mycosis fungoides: update of the Stanford experience. Arch Dermatol. 2003;139(2):165–73.

    CAS  PubMed  Google Scholar 

  74. Kim YH. Management with topical nitrogen mustard in mycosis fungoides. Dermatol Ther. 2003;16(4):288–98.

    Article  PubMed  Google Scholar 

  75. Heald P, Mehlmauer M, Martin AG, Crowley CA, Yocum RC, Reich SD. Topical bexarotene therapy for patients with refractory or persistent early-stage cutaneous T-cell lymphoma: results of the phase III clinical trial. J Am Acad Dermatol. 2003;49(5):801–15.

    Article  PubMed  Google Scholar 

  76. Breneman D, Duvic M, Kuzel T, Yocum R, Truglia J, Stevens VJ. Phase 1 and 2 trial of bexarotene gel for skin-directed treatment of patients with cutaneous T-cell lymphoma. Arch Dermatol. 2002;138(3):325–32.

    Article  CAS  PubMed  Google Scholar 

  77. Olsen EA, Hodak E, Anderson T, Carter JB, Henderson M, Cooper K, et al. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: a consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol. 2016;74(1):27–58.

    Article  PubMed  Google Scholar 

  78. Herrmann JJ, Roenigk HH, Hurria A, Kuzel TM, Samuelson E, Rademaker AW, et al. Treatment of mycosis fungoides with photochemotherapy (PUVA): long-term follow-up. J Am Acad Dermatol. 1995;33(2, Part 1):234–42.

    Article  CAS  PubMed  Google Scholar 

  79. Roenigk HH, Kuzel TM, Skoutelis AP, Springer E, Yu G, Caro W, et al. Photochemotherapy alone or combined with interferon alpha-2a in the treatment of cutaneous T-cell lymphoma. J Invest Dermatol. 1990;95(6 Suppl):198S–205S.

    Article  PubMed  Google Scholar 

  80. Querfeld C, Rosen ST, Kuzel TM, Kirby KA, Roenigk HH, Prinz BM, et al. Long-term follow-up of patients with early-stage cutaneous T-cell lymphoma who achieved complete remission with psoralen plus UV-A monotherapy. Arch Dermatol. 2005;141(3):305–11.

    Article  PubMed  Google Scholar 

  81. Stern RS, Nichols KT, Väkevä LH. Malignant melanoma in patients treated for psoriasis with methoxsalen (psoralen) and ultraviolet A radiation (PUVA). The PUVA Follow-Up Study. N Engl J Med. 1997;336(15):1041–5.

    Article  CAS  PubMed  Google Scholar 

  82. Stern RS. PUVA Follow-Up Study. The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: a 30-year prospective study. J Am Acad Dermatol. 2012;66(4):553–62.

    Article  CAS  PubMed  Google Scholar 

  83. Gupta AK, Anderson TF. Psoralen photochemotherapy. J Am Acad Dermatol. 1987;17(5 Pt 1):703–34.

    Article  CAS  PubMed  Google Scholar 

  84. Hearn RMR, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol. 2008;159(4):931–5.

    Article  CAS  PubMed  Google Scholar 

  85. Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol. 2005;44(5):355–60.

    Article  PubMed  Google Scholar 

  86. Wilson LD, Kacinski BM, Jones GW. Local superficial radiotherapy in the management of minimal stage IA cutaneous T-cell lymphoma (mycosis fungoides). Int J Radiat Oncol Biol Phys. 1998;40(1):109–15.

    Article  CAS  PubMed  Google Scholar 

  87. Piccinno R, Caccialanza M, Percivalle S. Minimal stage IA mycosis fungoides. Results of radiotherapy in 15 patients. J Dermatol Treat. 2009;20(3):165–8.

    Article  CAS  Google Scholar 

  88. Micaily B, Miyamoto C, Kantor G, Lessin S, Rook A, Brady L, et al. Radiotherapy for unilesional mycosis fungoides. Int J Radiat Oncol. 1998;42(2):361–4.

    Article  CAS  Google Scholar 

  89. Cotter GW, Baglan RJ, Wasserman TH, Mill W. Palliative radiation treatment of cutaneous mycosis fungoides – a dose response. Int J Radiat Oncol Biol Phys. 1983;9(10):1477–80.

    Article  CAS  PubMed  Google Scholar 

  90. Neelis KJ, Schimmel EC, Vermeer MH, Senff NJ, Willemze R, Noordijk EM. Low-dose palliative radiotherapy for cutaneous B- and T-cell lymphomas. Int J Radiat Oncol Biol Phys. 2009;74(1):154–8.

    Article  PubMed  Google Scholar 

  91. Thomas TO, Agrawal P, Guitart J, Rosen ST, Rademaker AW, Querfeld C, et al. Outcome of patients treated with a single-fraction dose of palliative radiation for cutaneous T-cell lymphoma. Int J Radiat Oncol Biol Phys. 2013;85(3):747–53.

    Article  PubMed  Google Scholar 

  92. Ysebaert L, Truc G, Dalac S, Lambert D, Petrella T, Barillot I, et al. Ultimate results of radiation therapy for T1-T2 mycosis fungoides (including reirradiation). Int J Radiat Oncol Biol Phys. 2004;58(4):1128–34.

    Article  PubMed  Google Scholar 

  93. Jones GW, Kacinski BM, Wilson LD, Willemze R, Spittle M, Hohenberg G, et al. Total skin electron radiation in the management of mycosis fungoides: consensus of the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group. J Am Acad Dermatol. 2002;47(3):364–70.

    Article  PubMed  Google Scholar 

  94. Navi D, Riaz N, Levin YS, Sullivan NC, Kim YH, Hoppe RT. The Stanford University experience with conventional-dose, total skin electron-beam therapy in the treatment of generalized patch or plaque (T2) and tumor (T3) mycosis fungoides. Arch Dermatol. 2011;147(5):561–7.

    Article  PubMed  Google Scholar 

  95. Quiros PA, Kacinski BM, Wilson LD. Extent of skin involvement as a prognostic indicator of disease free and overall survival of patients with T3 cutaneous T-cell lymphoma treated with total skin electron beam radiation therapy. Cancer. 1996;77(9):1912–7.

    Article  CAS  PubMed  Google Scholar 

  96. Budgin JB, Richardson SK, Newton SB, Wysocka M, Zaki MH, Benoit B, et al. Biological effects of bexarotene in cutaneous T-cell lymphoma. Arch Dermatol. 2005;141(3):315–21.

    Article  CAS  PubMed  Google Scholar 

  97. Zhang C, Hazarika P, Ni X, Weidner DA, Duvic M. Induction of apoptosis by bexarotene in cutaneous T-cell lymphoma cells: relevance to mechanism of therapeutic action. Clin Cancer Res. 2002;8(5):1234–40.

    CAS  PubMed  Google Scholar 

  98. Qu L, Tang X. Bexarotene: a promising anticancer agent. Cancer Chemother Pharmacol. 2010;65(2):201–5.

    Article  CAS  PubMed  Google Scholar 

  99. Duvic M, Hymes K, Heald P, Breneman D, Martin AG, Myskowski P, et al. Bexarotene is effective and safe for treatment of refractory advanced-stage cutaneous T-cell lymphoma: multinational phase II-III trial results. J Clin Oncol. 2001;19(9):2456–71.

    Article  CAS  PubMed  Google Scholar 

  100. Duvic M, Martin AG, Kim Y, Olsen E, Wood GS, Crowley CA, et al. Phase 2 and 3 clinical trial of oral bexarotene (Targretin capsules) for the treatment of refractory or persistent early-stage cutaneous T-cell lymphoma. Arch Dermatol. 2001;137(5):581–93.

    CAS  PubMed  Google Scholar 

  101. Sherman SI, Gopal J, Haugen BR, Chiu AC, Whaley K, Nowlakha P, et al. Central hypothyroidism associated with retinoid X receptor-selective ligands. N Engl J Med. 1999;340(14):1075–9.

    Article  CAS  PubMed  Google Scholar 

  102. Hughes CFM, Khot A, McCormack C, Lade S, Westerman DA, Twigger R, et al. Lack of durable disease control with chemotherapy for mycosis fungoides and Sézary syndrome: a comparative study of systemic therapy. Blood. 2015;125(1):71–81.

    Article  CAS  PubMed  Google Scholar 

  103. Kuzel TM, Roenigk HH, Samuelson E, Herrmann JJ, Hurria A, Rademaker AW, et al. Effectiveness of interferon alfa-2a combined with phototherapy for mycosis fungoides and the Sézary syndrome. J Clin Oncol. 1995;13(1):257–63.

    Article  CAS  PubMed  Google Scholar 

  104. Chiarion-Sileni V, Bononi A, Fornasa CV, Soraru M, Alaibac M, Ferrazzi E, et al. Phase II trial of interferon-alpha-2a plus psolaren with ultraviolet light A in patients with cutaneous T-cell lymphoma. Cancer. 2002;95(3):569–75.

    Article  CAS  PubMed  Google Scholar 

  105. Schrump DS. Cytotoxicity mediated by histone deacetylase inhibitors in cancer cells: mechanisms and potential clinical implications. Clin Cancer Res. 2009;15(12):3947–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Lemoine M, Younes A. Histone deacetylase inhibitors in the treatment of lymphoma. Discov Med. 2010;10(54):462–70.

    PubMed  Google Scholar 

  107. Akilov OE, Grant C, Frye R, Bates S, Piekarz R, Geskin LJ. Low-dose electron beam radiation and romidepsin therapy for symptomatic cutaneous T-cell lymphoma lesions. Br J Dermatol. 2012;167(1):194–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  108. Duvic M, Talpur R, Ni X, Zhang C, Hazarika P, Kelly C, et al. Phase 2 trial of oral vorinostat (suberoylanilide hydroxamic acid, SAHA) for refractory cutaneous T-cell lymphoma (CTCL). Blood. 2007;109(1):31–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Olsen EA, Kim YH, Kuzel TM, Pacheco TR, Foss FM, Parker S, et al. Phase IIB multicenter trial of vorinostat in patients with persistent, progressive, or treatment refractory cutaneous T-cell lymphoma. J Clin Oncol. 2007;25(21):3109–15.

    Article  CAS  PubMed  Google Scholar 

  110. Piekarz RL, Frye R, Turner M, Wright JJ, Allen SL, Kirschbaum MH, et al. Phase II multi-institutional trial of the histone deacetylase inhibitor romidepsin as monotherapy for patients with cutaneous T-cell lymphoma. J Clin Oncol. 2009;27(32):5410–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  111. Whittaker SJ, Demierre M-F, Kim EJ, Rook AH, Lerner A, Duvic M, et al. Final results from a multicenter, international, pivotal study of romidepsin in refractory cutaneous T-cell lymphoma. J Clin Oncol. 2010;28(29):4485–91.

    Article  CAS  PubMed  Google Scholar 

  112. Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for apheresis: the seventh special issue: therapeutic apheresis-guidelines 2016. J Clin Apher. 2016;31(3):149–338.

    PubMed  Google Scholar 

  113. Alfred A, Taylor PC, Dignan F, El-Ghariani K, Griffin J, Gennery AR, et al. The role of extracorporeal photopheresis in the management of cutaneous T-cell lymphoma, graft-versus-host disease and organ transplant rejection: a consensus statement update from the UK Photopheresis Society. Br J Haematol. 2017;177(2):287–310.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Edelson R, Wu Y, Schneiderman J. American council on ECP (ACE): why now? J Clin Apher. 2018;33:464–8.

    Article  PubMed  Google Scholar 

  115. Katz J, Janik JE, Younes A. Brentuximab vedotin (SGN-35). Clin Cancer Res. 2011;17(20):6428–36.

    Article  CAS  PubMed  Google Scholar 

  116. Thomas A, Teicher BA, Hassan R. Antibody–drug conjugates for cancer therapy. Lancet Oncol. 2016;17(6):e254–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  117. Prince HM, Kim YH, Horwitz SM, Dummer R, Scarisbrick J, Quaglino P, et al. Brentuximab vedotin or physician’s choice in CD30-positive cutaneous T-cell lymphoma (ALCANZA): an international, open-label, randomised, phase 3, multicentre trial. Lancet. 2017;390(10094):555–66.

    Article  CAS  PubMed  Google Scholar 

  118. Ginaldi L, De Martinis M, Matutes E, Farahat N, Morilla R, Dyer MJ, et al. Levels of expression of CD52 in normal and leukemic B and T cells: correlation with in vivo therapeutic responses to Campath-1H. Leuk Res. 1998;22(2):185–91.

    Article  CAS  PubMed  Google Scholar 

  119. Querfeld C, Mehta N, Rosen ST, Guitart J, Rademaker A, Gerami P, et al. Alemtuzumab for relapsed and refractory erythrodermic cutaneous T-cell lymphoma: a single institution experience from the Robert H. Lurie Comprehensive Cancer Center. Leuk Lymphoma. 2009;50(12):1969–76.

    Article  CAS  PubMed  Google Scholar 

  120. Lundin J, Hagberg H, Repp R, Cavallin-Ståhl E, Fredén S, Juliusson G, et al. Phase 2 study of alemtuzumab (anti-CD52 monoclonal antibody) in patients with advanced mycosis fungoides/Sézary syndrome. Blood. 2003;101(11):4267–72.

    Article  CAS  PubMed  Google Scholar 

  121. Kennedy GA, Seymour JF, Wolf M, Januszewicz H, Davison J, McCormack C, et al. Treatment of patients with advanced mycosis fungoides and Sezary syndrome with alemtuzumab. Eur J Haematol. 2003;71(4):250–6.

    Article  CAS  PubMed  Google Scholar 

  122. Thursky KA, Worth LJ, Seymour JF, Prince HM, Slavin MA. Spectrum of infection, risk and recommendations for prophylaxis and screening among patients with lymphoproliferative disorders treated with alemtuzumab. Br J Haematol. 2006;132(1):3–12.

    Article  PubMed  Google Scholar 

  123. Bernengo MG, Quaglino P, Comessatti A, Ortoncelli M, Novelli M, Lisa F, et al. Low-dose intermittent alemtuzumab in the treatment of Sezary syndrome: clinical and immunologic findings in 14 patients. Haematologica. 2007;92(6):784–94.

    Article  CAS  PubMed  Google Scholar 

  124. Alinari L, Geskin L, Grady T, Baiocchi RA, Bechtel MA, Porcu P. Subcutaneous alemtuzumab for Sézary syndrome in the very elderly. Leuk Res. 2008;32(8):1299–303.

    Article  CAS  PubMed  Google Scholar 

  125. Ni X, Langridge T, Duvic M. Depletion of regulatory T cells by targeting CC chemokine receptor type 4 with mogamulizumab. OncoImmunology. 2015;4(7):e1011524.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  126. Kim YH, Bagot M, Pinter-Brown L, Rook AH, Porcu P, Horwitz SM, et al. Mogamulizumab versus vorinostat in previously treated cutaneous T-cell lymphoma (MAVORIC): an international, open-label, randomised, controlled phase 3 trial. Lancet Oncol. 2018;19(9):1192–204.

    Article  CAS  PubMed  Google Scholar 

  127. Duvic M, Pinter-Brown LC, Foss FM, Sokol L, Jorgensen JL, Challagundla P, et al. Phase 1/2 study of mogamulizumab, a defucosylated anti-CCR4 antibody, in previously treated patients with cutaneous T-cell lymphoma. Blood. 2015;125(12):1883–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  128. Quereux G, Marques S, Nguyen J-M, Bedane C, D’incan M, Dereure O, et al. Prospective multicenter study of Pegylated liposomal doxorubicin treatment in patients with advanced or refractory mycosis fungoides or Sézary syndrome. Arch Dermatol. 2008;144(6):727–33.

    Article  CAS  PubMed  Google Scholar 

  129. Pulini S, Rupoli S, Goteri G, Pimpinelli N, Alterini R, Tassetti A, et al. Pegylated liposomal doxorubicin in the treatment of primary cutaneous T-cell lymphomas. Haematologica. 2007;92(5):686–9.

    Article  CAS  PubMed  Google Scholar 

  130. Dummer R, Quaglino P, Becker JC, Hasan B, Karrasch M, Whittaker S, et al. 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. J Clin Oncol. 2012;30(33):4091–7.

    Article  CAS  PubMed  Google Scholar 

  131. Duvic M, Talpur R, Wen S, Kurzrock R, David CL, Apisarnthanarax N. Phase II evaluation of gemcitabine monotherapy for cutaneous T-cell lymphoma. Clin Lymphoma Myeloma. 2006;7(1):51–8.

    Article  CAS  PubMed  Google Scholar 

  132. Jidar K, Ingen-Housz-Oro S, Beylot-Barry M, Paul C, Chaoui D, Sigal-Grinberg M, et al. Gemcitabine treatment in cutaneous T-cell lymphoma: a multicentre study of 23 cases. Br J Dermatol. 2009;161(3):660–3.

    Article  CAS  PubMed  Google Scholar 

  133. Pellegrini C, Stefoni V, Casadei B, Maglie R, Argnani L, Zinzani PL. Long-term outcome of patients with advanced-stage cutaneous T cell lymphoma treated with gemcitabine. Ann Hematol. 2014;93(11):1853–7.

    Article  CAS  PubMed  Google Scholar 

  134. Zackheim HS, Kashani-Sabet M, McMillan A. Low-dose methotrexate to treat mycosis fungoides: a retrospective study in 69 patients. J Am Acad Dermatol. 2003;49(5):873–8.

    Article  PubMed  Google Scholar 

  135. Zackheim HS, Epstein EH. Low-dose methotrexate for the Sézary syndrome. J Am Acad Dermatol. 1989;21(4 Pt 1):757–62.

    Article  CAS  PubMed  Google Scholar 

  136. Duvic M, Kim YH, Zinzani PL, Horwitz SM. Results from a phase I/II open-label, dose-finding study of pralatrexate and oral bexarotene in patients with relapsed/refractory cutaneous T-cell lymphoma. Clin Cancer Res. 2017;23(14):3552–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  137. Bigler RD, Crilley P, Micaily B, Brady LW, Topolsky D, Bulova S, et al. Autologous bone marrow transplantation for advanced stage mycosis fungoides. Bone Marrow Transplant. 1991;7(2):133–7.

    CAS  PubMed  Google Scholar 

  138. Duarte RF, Canals C, Onida F, Gabriel IH, Arranz R, Arcese W, et al. Allogeneic hematopoietic cell transplantation for patients with mycosis fungoides and Sézary syndrome: a retrospective analysis of the Lymphoma Working Party of the European Group for blood and marrow transplantation. J Clin Oncol. 2010;28(29):4492–9.

    Article  PubMed  Google Scholar 

  139. Duarte RF, Servitje O, Sureda A. Haematopoietic stem cell transplantation for patients with primary cutaneous T-cell lymphoma. Bone Marrow Transplant. 2008;41(7):597–604.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne W. Beaven .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Voorhees, T.J., Bowers, E.V., Kelsey, C.R., Park, Y., Beaven, A.W. (2020). Cutaneous T-Cell Lymphoma: Mycosis Fungoides and Sézary Syndrome. In: Dittus, C. (eds) Novel Therapeutics for Rare Lymphomas. Springer, Cham. https://doi.org/10.1007/978-3-030-25610-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-25610-4_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-25609-8

  • Online ISBN: 978-3-030-25610-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics