ABSTRACT
Extracorporeal photopheresis (ECP) is an established, safe, and effective treatment for cutaneous T-cell lymphoma (CTCL). There is no published literature reviewing the clinical efficacy of ECP at varying frequencies or the ideal duration of therapy. The SARS-CoV-2 pandemic necessitated a reduced frequency of ECP for patients with CTCL at our center. We performed a retrospective chart review of patients with CTCL receiving ECP at the Penn Dermatology Photopheresis Service (PDPS) on March 1, 2020, and followed up their course until January 31, 2021. Our retrospective cohort study suggests that one day of ECP with extending duration between treatments can be considered an alternative maintenance regimen in appropriate patients with stable disease on concomitant multimodality immunomodulatory therapy.
ABSTRACT
Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
ABSTRACT
Mycosis fungoides is the most common cutaneous T-cell lymphoma. It presents a diagnostic challenge due to resemblance with many other dermatologic conditions. The disease typically follows a progression from patches to plaques to skin-based tumors with potential for visceral involvement. Diagnosis is made by clinical presentation and histology. When early diagnosis is made, there is an estimated 88% five-year survival. This report details a 60-year-old Black man diagnosed with stage IIIA mycosis fungoides with a severe degree of cutaneous involvement. This case is unique due to the aggressive large cell transformation and rapid progression to death within 18 months of diagnosis. We highlight the challenge of diagnosing, treating, and monitoring the therapeutic response of mycosis fungoides. Finally, this case calls for a multi-disciplinary approach to treatment and to include mycosis fungoides on the differential diagnosis for patients presenting with a variety of vague, recurrent cutaneous symptoms, especially with patchy dyspigmentation or plaques.
ABSTRACT
Background: Per label, mogamulizumab (Moga) is administered on days 1, 8, 15, and 22 of the first 28-day cycle (loading) and on days 1 and 15 of each subsequent cycle (maintenance) for adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) after ≥1 prior systemic therapy. During the COVID-19 pandemic, professional organizations suggested dosing intervals for systemic cancer therapies be extended to limit in-person visits. This study examined the real-world use of Moga before and during the COVID-19 pandemic in the United States. Methods: Using the Symphony Health Solutions database, adults with ≥1 diagnosis (dx) of MF or SS (ICD-10 CM: C84.0x or C84.1x) and ≥1 Moga claim during 10/1/2018-5/6/2021 were identified. Within the MF (no SS dx) and SS (any SS dx) cohorts, patients were divided into 2 subgroups based on their Moga initiation date: 10/1/2018-3/31/2020 (pre COVID-19) and 4/1/2020-5/6/2021 (COVID-19). Patient characteristics and dosing intervals between Moga doses 1-4 (loading) and between subsequent doses (maintenance) were examined. Results: Overall, 154 MF and 204 SS patients initiated Moga during the study period (mean age: 66.8 and 69.2 years;male: 64% and 55%, respectively). In the MF cohort, 98 and 56 patients were in the “pre COVID-19” and “COVID-19” subgroups. The mean dosing interval was shorter among patients in the “COVID-19” subgroup for both the loading (9.1 vs. 13.2 days) and maintenance doses (15.2 vs. 16.1 days) (Table). In the SS cohort, 121 and 83 patients were in the “pre COVID-19” and “COVID-19” subgroups. Mean loading (9.0 vs. 11.1 days) and maintenance (15.0 vs. 16.8 days) dosing intervals were shorter for patients included in the “COVID-19” subgroup. Conclusions: Among MF and SS patients, dosing intervals for Moga in loading and maintenance were not extended during the 1st year of the COVID-19 compared to pre COVID-19. There was a trend towards closer concordance with the label during COVID-19.
ABSTRACT
Objectives: Mycosis Fungoides (MF) and Sézary syndrome (SS) are the two most common subtypes of cutaneous T cell lymphomas. Given their low prevalence, real-world treatment patterns of existing and newly approved therapies for MF and SS remain unknown, especially during the COVID pandemic. This study examined treatment patterns among patients with MF or SS between 2018-2020 in the United States. Methods: Patients in the Symphony Health Solutions database were classified into 6 groups: ≥1 MF diagnosis (no SS diagnosis) in 2018, 2019, and 2020, and ≥1 SS diagnosis in 2018, 2019, 2020, respectively. Utilization of treatments recommended by the current National Comprehensive Cancer Network guidelines was examined: skin-directed therapy (SDT;topical, local radiation, total skin electron beam therapy, or phototherapy), systemic therapy (extracorporeal photopheresis [ECP], parenteral, or oral), and bone marrow transplant (BMT). Results: Overall(mean age;male), 10,527(62.9 years;54.6%), 10,078(63.2 years;54.3%) and 9,414(63.2 years;53.9%) patients had ≥1 MF diagnosis and 869(66.3 years;54.4%), 882(66.9 years;54.8%) and 853(67.3 years;55.6%) patients had ≥1 SS diagnosis in 2018, 2019 and 2020, respectively. From 2018-2020, 56.1-56.6% of MF (SDT 52.1-52.5%;systemics 12.1-13.5%;BMT 0.1-0.2%) and 64.6-68.8% of SS patients (SDT 48.9-52.9%;systemics 41.8-46.5%;BMT 0.8-1.5%) had ≥1 treatment claims. Among MF patients with any systemic therapies, bexarotene was the most common in 2018 (28.1%) and 2019 (27.5%), methotrexate in 2020 (27.2%), and mogamulizumab (2018 MF/SS approval) the 6th most common in 2019 (6.8%) and 2020 (6.6%). Among SS patients with any systemic therapies, ECP was the most common in 2018 (40.8%) and 2019 (33.3%), and mogamulizumab in 2020 (29.2%). Conclusions: Using claims from 2018-2020, approximately half of MF and SS patients had SDT each year, without major change during the COVID pandemic. Since 2018 in SS, there was an increasing systemic usage, with increasing mogamulizumab but decreasing ECP usage.
ABSTRACT
The most common variant of cutaneous T-cell lymphomas (CTCL) is mycosis fungoides (MF). Patients with MF often experience a chronic course of disease. The spontaneous regression (SR) of MF is rare, and the factors that predict SR have not been recognized yet. Here, we are reporting a case of persistent MF who had prominent remission after COVID-19. This case report supports the possible antineoplastic effect of SARS-CoV-2. Understanding the underlying etiology of such effect can result in development of new target therapies for MF.
ABSTRACT
Duri ng t he current coronavi rus di sease 2019 (COVID-19) pandemic, patients with malignancies like primary cutaneous lymphomas (PCLs) are considered at high risk for severe disease progression given their underlying condition. Mycosis fungoides (MF) is a type of PCL that often needs lifelong treatments, including immunosuppressive drugs that predispose patients to catastrophic COVID-19 outcomes. Accordingly, several issues are to be addressed in the management of patients with MF. First of all, patients with this chronic condition may lose access to healthcare services such as phototherapy and inpatient treatments like electron beam therapy. Secondly, the patients’ anxiety of becoming infected while referring for the follow-up visits might impair their adherence to treatments. Finally, the current situation may affect the management strategies of dermatologists adopted for MF patients. We decided to perform this teledermatology study to assess the clinical condition of patients with MF in our referral center. We also evaluated patients’ perceived anxiety during the COVID-19 pandemic based on the Corona Disease Anxiety Scale (CDAS). Our results demonstrated that lockdown could influence adherence to treatment modalities (especially phototherapy) in these patients. © 2021 Iranian Society of Dermatology.
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The objective of this review is to provide an update on narrowband ultraviolet B (NB-UVB) as a treatment for various skin conditions. NB-UVB works by suppressing the cutaneous cell-mediated immune response and has been shown to be an efficacious and clinically tolerable treatment for a range of inflammatory dermatoses. A literature search was conducted by advanced searches of PubMed for NB-UVB treatment of dermatologic skin diseases with a focus on reports from 2010 to 2021, including both office-based and home-based phototherapy (HBPT). Data were prioritized based on studies with a high level of evidence using the Oxford Evidence-Based Medicine guidance. We found that NB-UVB continues to serve as an effective form of therapy for several cutaneous conditions, including vitiligo, psoriasis, atopic dermatitis, mycosis fungoides, and other inflammatory dermatoses. The recent introduction of Janus kinase inhibitors in combination with NB-UVB suggests future promise in the treatment of vitiligo. Despite its rise in popularity, a decline was seen in office-based NB-UVB treatment during the coronavirus disease 2019 pandemic. Options are available to deliver NB-UVB at home with comparable efficacy to office-based treatments. In conclusion, for a select group of patients and conditions, NB-UVB continues to serve as an effective treatment modality with minimal side effects, with HBPT serving as an option to improve patient compliance.