Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy

Maria Estela Martinez-Escala, Alba L. Posligua, Heather Wickless, Audrey Rutherford, Kimberly A. Sable, Belen Rubio-Gonzalez, Alan Zhou, Jason B. Kaplan, Barbara Pro, Jaehyuk Choi, Christiane Querfeld, Steven T. Rosen, Joan Guitart*

*Corresponding author for this work

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Cutaneous lymphoma diagnosed after anti–tumor necrosis factor-α therapy (anti–TNF-α) has been reported in the literature, yet a clear link between both events remains elusive. Objective: To review our experience with cutaneous lymphoma diagnosed during or after the use of anti–TNF-α therapies. Methods: This is a multicenter retrospective study and a literature review. Results: A total of 22 cases, including 20 cutaneous T-cell lymphomas (CTCLs) and 2 cutaneous B-cell lymphomas, were identified. In the CTCL group, 75% of the patients received an anti–TNF-α agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (stage IIB to IVA) was commonly seen at time of diagnosis and required aggressive therapy, including stem cell transplant in 3 patients; 2 patients in whom cutaneous B-cell lymphomas was diagnosed had an indolent course. A total of 31 cases were gathered from a literature search. Limitations: This is a retrospective study. Conclusions: Our findings suggest that the disease of most of the identified patients was misdiagnosed as psoriasis or eczema; therefore, a comprehensive morphologic and molecular review of skin biopsy specimens and peripheral blood samples should be considered before initiation of anti–TNF-α therapy in patients with poorly defined dermatitis or atypical presentations of psoriasis.

Original languageEnglish (US)
Pages (from-to)1068-1076
Number of pages9
JournalJournal of the American Academy of Dermatology
Volume78
Issue number6
DOIs
StatePublished - Jun 1 2018

Fingerprint

Lymphoma
Necrosis
Skin
Cutaneous T-Cell Lymphoma
B-Cell Lymphoma
Psoriasis
Therapeutics
Retrospective Studies
Mycosis Fungoides
Eczema
Dermatitis
Diagnostic Errors
Multicenter Studies
Stem Cells
Transplants
Biopsy

Keywords

  • anti–tumor necrosis factor-α agents
  • cutaneous lymphoma
  • immunosuppression
  • large cell transformation
  • psoriasiform dermatitis
  • spongiotic dermatitis

ASJC Scopus subject areas

  • Dermatology

Cite this

Martinez-Escala, M. E., Posligua, A. L., Wickless, H., Rutherford, A., Sable, K. A., Rubio-Gonzalez, B., ... Guitart, J. (2018). Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy. Journal of the American Academy of Dermatology, 78(6), 1068-1076. https://doi.org/10.1016/j.jaad.2017.12.068
Martinez-Escala, Maria Estela ; Posligua, Alba L. ; Wickless, Heather ; Rutherford, Audrey ; Sable, Kimberly A. ; Rubio-Gonzalez, Belen ; Zhou, Alan ; Kaplan, Jason B. ; Pro, Barbara ; Choi, Jaehyuk ; Querfeld, Christiane ; Rosen, Steven T. ; Guitart, Joan. / Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy. In: Journal of the American Academy of Dermatology. 2018 ; Vol. 78, No. 6. pp. 1068-1076.
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abstract = "Background: Cutaneous lymphoma diagnosed after anti–tumor necrosis factor-α therapy (anti–TNF-α) has been reported in the literature, yet a clear link between both events remains elusive. Objective: To review our experience with cutaneous lymphoma diagnosed during or after the use of anti–TNF-α therapies. Methods: This is a multicenter retrospective study and a literature review. Results: A total of 22 cases, including 20 cutaneous T-cell lymphomas (CTCLs) and 2 cutaneous B-cell lymphomas, were identified. In the CTCL group, 75{\%} of the patients received an anti–TNF-α agent for a presumed inflammatory skin condition. Mycosis fungoides and S{\'e}zary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (stage IIB to IVA) was commonly seen at time of diagnosis and required aggressive therapy, including stem cell transplant in 3 patients; 2 patients in whom cutaneous B-cell lymphomas was diagnosed had an indolent course. A total of 31 cases were gathered from a literature search. Limitations: This is a retrospective study. Conclusions: Our findings suggest that the disease of most of the identified patients was misdiagnosed as psoriasis or eczema; therefore, a comprehensive morphologic and molecular review of skin biopsy specimens and peripheral blood samples should be considered before initiation of anti–TNF-α therapy in patients with poorly defined dermatitis or atypical presentations of psoriasis.",
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Martinez-Escala, ME, Posligua, AL, Wickless, H, Rutherford, A, Sable, KA, Rubio-Gonzalez, B, Zhou, A, Kaplan, JB, Pro, B, Choi, J, Querfeld, C, Rosen, ST & Guitart, J 2018, 'Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy', Journal of the American Academy of Dermatology, vol. 78, no. 6, pp. 1068-1076. https://doi.org/10.1016/j.jaad.2017.12.068

Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy. / Martinez-Escala, Maria Estela; Posligua, Alba L.; Wickless, Heather; Rutherford, Audrey; Sable, Kimberly A.; Rubio-Gonzalez, Belen; Zhou, Alan; Kaplan, Jason B.; Pro, Barbara; Choi, Jaehyuk; Querfeld, Christiane; Rosen, Steven T.; Guitart, Joan.

In: Journal of the American Academy of Dermatology, Vol. 78, No. 6, 01.06.2018, p. 1068-1076.

Research output: Contribution to journalArticle

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T1 - Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy

AU - Martinez-Escala, Maria Estela

AU - Posligua, Alba L.

AU - Wickless, Heather

AU - Rutherford, Audrey

AU - Sable, Kimberly A.

AU - Rubio-Gonzalez, Belen

AU - Zhou, Alan

AU - Kaplan, Jason B.

AU - Pro, Barbara

AU - Choi, Jaehyuk

AU - Querfeld, Christiane

AU - Rosen, Steven T.

AU - Guitart, Joan

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Cutaneous lymphoma diagnosed after anti–tumor necrosis factor-α therapy (anti–TNF-α) has been reported in the literature, yet a clear link between both events remains elusive. Objective: To review our experience with cutaneous lymphoma diagnosed during or after the use of anti–TNF-α therapies. Methods: This is a multicenter retrospective study and a literature review. Results: A total of 22 cases, including 20 cutaneous T-cell lymphomas (CTCLs) and 2 cutaneous B-cell lymphomas, were identified. In the CTCL group, 75% of the patients received an anti–TNF-α agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (stage IIB to IVA) was commonly seen at time of diagnosis and required aggressive therapy, including stem cell transplant in 3 patients; 2 patients in whom cutaneous B-cell lymphomas was diagnosed had an indolent course. A total of 31 cases were gathered from a literature search. Limitations: This is a retrospective study. Conclusions: Our findings suggest that the disease of most of the identified patients was misdiagnosed as psoriasis or eczema; therefore, a comprehensive morphologic and molecular review of skin biopsy specimens and peripheral blood samples should be considered before initiation of anti–TNF-α therapy in patients with poorly defined dermatitis or atypical presentations of psoriasis.

AB - Background: Cutaneous lymphoma diagnosed after anti–tumor necrosis factor-α therapy (anti–TNF-α) has been reported in the literature, yet a clear link between both events remains elusive. Objective: To review our experience with cutaneous lymphoma diagnosed during or after the use of anti–TNF-α therapies. Methods: This is a multicenter retrospective study and a literature review. Results: A total of 22 cases, including 20 cutaneous T-cell lymphomas (CTCLs) and 2 cutaneous B-cell lymphomas, were identified. In the CTCL group, 75% of the patients received an anti–TNF-α agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (stage IIB to IVA) was commonly seen at time of diagnosis and required aggressive therapy, including stem cell transplant in 3 patients; 2 patients in whom cutaneous B-cell lymphomas was diagnosed had an indolent course. A total of 31 cases were gathered from a literature search. Limitations: This is a retrospective study. Conclusions: Our findings suggest that the disease of most of the identified patients was misdiagnosed as psoriasis or eczema; therefore, a comprehensive morphologic and molecular review of skin biopsy specimens and peripheral blood samples should be considered before initiation of anti–TNF-α therapy in patients with poorly defined dermatitis or atypical presentations of psoriasis.

KW - anti–tumor necrosis factor-α agents

KW - cutaneous lymphoma

KW - immunosuppression

KW - large cell transformation

KW - psoriasiform dermatitis

KW - spongiotic dermatitis

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Martinez-Escala ME, Posligua AL, Wickless H, Rutherford A, Sable KA, Rubio-Gonzalez B et al. Progression of undiagnosed cutaneous lymphoma after anti–tumor necrosis factor-alpha therapy. Journal of the American Academy of Dermatology. 2018 Jun 1;78(6):1068-1076. https://doi.org/10.1016/j.jaad.2017.12.068