Cutaneous T-cell lymphoma: 2014 update on diagnosis, risk-stratification, and management

Am J Hematol. 2014 Aug;89(8):837-51. doi: 10.1002/ajh.23756.

Abstract

Disease overview: Cutaneous T-cell lymphomas are a heterogenous group of T-cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis Fungoides (MF) or Sézary Syndrome (SS).

Diagnosis: The diagnosis of MF or SS requires the integration of clinical and histopathologic data.

Risk-adapted therapy: TNMB (tumor, node, metastasis, and blood) staging remains the most important prognostic factor in MF/SS and forms the basis for a "risk-adapted," multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin-directed therapies is preferred, as both disease-specific and overall survival for these patients is favorable. In contrast, patients with advanced-stage disease with significant nodal, visceral or blood involvement are generally approached with biologic-response modifiers or histone deacetylase inhibitors prior to escalating therapy to include systemic, single-agent chemotherapy. Multiagent chemotherapy (e.g., CHOP) may be employed for those patients with extensive visceral involvement requiring rapid disease control. In highly selected patients, allogeneic stem-cell transplantation may be considered.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Disease Management
  • Histone Deacetylase Inhibitors / therapeutic use*
  • Humans
  • Immunologic Factors / therapeutic use*
  • Mycosis Fungoides / diagnosis*
  • Mycosis Fungoides / immunology
  • Mycosis Fungoides / mortality
  • Mycosis Fungoides / therapy*
  • Neoplasm Staging
  • Photopheresis
  • Prognosis
  • Risk Assessment
  • Sezary Syndrome / diagnosis*
  • Sezary Syndrome / immunology
  • Sezary Syndrome / mortality
  • Sezary Syndrome / therapy*
  • Stem Cell Transplantation
  • Survival Analysis
  • T-Lymphocytes / drug effects
  • T-Lymphocytes / immunology
  • T-Lymphocytes / pathology
  • Transplantation, Autologous

Substances

  • Antineoplastic Agents
  • Histone Deacetylase Inhibitors
  • Immunologic Factors