scholarly journals Strategies to Optimize Adherence in Patients with Mycosis Fungoides

Cells ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 113
Author(s):  
Warren H. Chan ◽  
Daniel J. Lewis ◽  
Madeleine Duvic ◽  
Steven R. Feldman
Keyword(s):  
Treatment Failure ◽  
Cell Lymphoma ◽  
Patient Adherence ◽  
Cutaneous T Cell Lymphoma ◽  
The Past ◽  
Suboptimal Adherence ◽  
Common Skin ◽  
Promising Area ◽  
Skin Conditions ◽  
The Impact

Patient adherence to medications for common skin conditions has been extensively studied over the past two decades, and suboptimal adherence is a primary contributor to treatment failure. The impact of sub-par adherence in cutaneous T-cell lymphoma (CTCL) patients has been largely unexplored, and promoting adherence in this patient population may represent a promising area of consideration for improving treatment outcomes. We apply patient adherence strategies that have been studied in dermatology to CTCL and provide concrete examples of how these strategies can be used to improve adherence in the CTCL setting. Through the implementation of small changes in how we present and counsel about therapeutic options to our patients, we can maximize patient adherence, which has the potential to optimize therapy regimens and reduce treatment failure.

‘We're all carrying a burden that we're not sharing’: a qualitative study of the impact of cutaneous T-cell lymphoma on the family

2015 ◽  
Vol 172 (6) ◽  
pp. 1581-1592 ◽  
Author(s):  
L.E. Selman ◽  
T. Beynon ◽  
E. Radcliffe ◽  
S. Whittaker ◽  
D. Orlowska ◽  
...  
Keyword(s):  
T Cell ◽  
Qualitative Study ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Cutaneous T Cell Lymphoma ◽  
The Family ◽  
The Impact

scholarly journals Multicentric Cutaneous Crohn's Disease: A Case Report and Review of Literature

1990 ◽  
Vol 4 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Robert Prokopetz ◽  
J Barrie Ross ◽  
Peter Smith ◽  
Joseph J Sidorov
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Crohn's Disease ◽  
Erythema Nodosum ◽  
Skin Lesions ◽  
Review Of Literature ◽  
Histological Features ◽  
The Past ◽  
Common Skin ◽  
Skin Conditions

A patient presented with skin lesions at sites not contiguous with Crohn's disease of the bowel and with specific histological features of Crohn's disease occurring two weeks from the onset of bowel symptoms. Currently a number of nonspecific skin conditions such as erythema nodosum, pyoderma gangrenosum and erythema multiforme are accepted as being the most common skin manifestations of Crohn's disease. It is likely, however, that specific lesions of Crohn's disease in the skin have been underdiagnosed either because of lack of biopsy or misinterpretation of the histology. Twenty-three cases with specific Crohn's disease in the skin have been recorded in the past 25 years, since the condition has been recognized. Sarcoidosis has been a common misdiagnosis. The literature relating to multicentric Crohn's disease is reviewed and attention drawn to its protean and masquerading features. An argument is made for the use of the term 'multicentric' rather than 'metastatic' in relation to cutaneous Crohn's disease.

scholarly journals Primary Cutaneous Peripheral T-Cell Lymphoma Not Otherwise Specified: A Rapidly Progressive Variant of Cutaneous T-Cell Lymphoma

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Kimberly Aderhold ◽  
Lisa Carpenter ◽  
Krysta Brown ◽  
Anthony Donato
Keyword(s):  
T Cell ◽  
Mycosis Fungoides ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Rapid Progression ◽  
Entire Body ◽  
Cutaneous T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Multiple Biopsies ◽  
Skin Conditions

Primary Cutaneous Peripheral T-Cell Lymphoma NOS (PTL-NOS) is a rare, progressive, fatal dermatologic disease that presents with features similar to many common benign plaque-like skin conditions, making recognition of its distinguishing features critical for early diagnosis and treatment (Bolognia et al., 2008). A 78-year-old woman presented to ambulatory care with a single 5 cm nodule on her shoulder that had developed rapidly over 1-2 weeks. Examination was suspicious for malignancy and a biopsy was performed. Biopsy results demonstrated CD4 positivity, consistent with Mycosis Fungoides with coexpression of CD5, CD47, and CD7. Within three months her cancer had progressed into diffuse lesions spanning her entire body. As rapid progression is usually uncharacteristic of Mycosis Fungoides, her diagnosis was amended to PTL-NOS. Cutaneous T-Cell Lymphoma (CTCL) should be suspected in patients with patches, plaques, erythroderma, or papules that persist or multiply despite conservative treatment. Singular biopsies are often nondiagnostic, requiring a high degree of suspicion if there is deviation from the anticipated clinical course. Multiple biopsies are often necessary to make the diagnosis. Physicians caring for patients with rapidly progressive, nonspecific dermatoses with features described above should keep more uncommon forms of CTCL in mind and refer for early biopsy.

Survival Among Lymphoma Patients Over the Past Three Decades: A Single Institution Based Retrospective Review From 1976 to 2006.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4527-4527
Author(s):  
Monika Joshi ◽  
Hassan S Sheikh ◽  
Fabian Camacho ◽  
Lisa A Hand ◽  
Michael G. Bayerl ◽  
...  
Keyword(s):  
T Cell ◽  
Malignant Lymphoma ◽  
Cell Lymphoma ◽  
T Cell Lymphoma ◽  
Low Grade ◽  
High Grade ◽  
Cutaneous T Cell Lymphoma ◽  
Intermediate Grade ◽  
The Past ◽  
Improvement In Survival

Abstract Abstract 4527 Background The incidence of lymphoma has doubled in the past 3 decades in the US and most western countries. Since the advent of multi-drug chemotherapy, studies have shown improvement in survival in specific diagnostic groups such as diffuse large B-cell lymphomas. However, there have been few studies showing the impact of evolving therapies on survival for the total burden of lymphoma patients. We assessed survival for an aggregate population of all patients presenting with lymphoma to a regional tertiary university hospital over the past 3 decades. Goal To assess the magnitude of improvement in survival for patients with lymphoma over the past 3 decades. Methods We analyzed data from the Penn State Hershey Medical Center Cancer Registry, selecting all cases diagnosed with lymphoma by ICD-0-3 codes from Jan 1st 1976 to Dec 31st 2006. Five and ten year (yr) absolute survival rates during five time periods [group (gp) 1: 1976-1980, gp 2: 1981-1985, gp 3: 1986-1990, gp 4: 1996-2000, gp 5: 2001-2006] were obtained by using conventional period analysis (PA). In addition, a period Cox Proportional Model (CPH) was fit to the data, allowing for survival risk estimates of 5 yr survival, statistical testing of time periods, and adjustments for age at diagnosis. SAS v 9.1 was used to obtain estimates, with Brenner's PERIOD macro used for PA and PHREG used for CPH. Results Of 2843 patients, Hodgkin's lymphoma accounted for 17%, high grade lymphoma 4%, intermediate grade lymphoma 29%, low grade lymphoma 17%, cutaneous T-cell lymphoma 6%, chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) 13%, malignant lymphoma not otherwise specified (NOS) 14%. Median age was 56 yr and mean was 52 yr with a standard deviation (SD) of 20.9 yr. Median follow up was 4 yr and mean was 6 yr with SD 6.5 yr. Approximately 25% (N=700) survived beyond 10 yr. CPH adjusted for age demonstrated a 5 yr improvement among all lymphomas of 8%, Hazard Ratio (HR)=1.31, 95%, p=0.0192, between gp 5 and gp 1. Consistent improvements in 5 yr survival were detected for intermediate grade lymphoma (15%, HR=1.5, p=0.0219), high grade lymphoma (40%, HR=12.83, p<0.0001), and malignant lymphoma NOS (19%, HR=1.8, p=0.069) comparing gp 5 to gp 1. Changes in survival rates for Hodgkin's lymphoma, low grade lymphoma, CLL/SLL, and cutaneous T-cell lymphoma were not significant. Results for conventional PA were similar. There was a 7% improvement in 5 yr survival between gp 5 and gp 1 for all patients with lymphoma. However, improvement in 10 yr survival between available time intervals was minimal. For the PA, significant improvement in 5 yr survival was seen for intermediate grade lymphoma (24%), high grade lymphoma (28%), malignant lymphoma NOS (19%) comparing gp 5 to gp 1. Interestingly, cutaneous T-cell lymphoma showed a descriptive decline in both 5 yr and 10 yr survival of 29% and 14% respectively. Conclusion There has been a significant improvement of 8% in overall 5 yr survival in lymphoma patients over the past 3 decades after adjusting for age. There was an improvement in survival in both intermediate and high grade groups. There was a trend towards declining survival in cutaneous T cell lymphoma. This could be attributed to diagnostic drift with changing classification and to the fewer number of cases diagnosed in the earlier years as compared to later years. Disclosures: No relevant conflicts of interest to declare.

Juvenile-Onset Hypopigmented Mycosis Fungoides Mimicking Vitiligo

2009 ◽  
Vol 13 (4) ◽  
pp. 230-233 ◽  
Author(s):  
Jennifer T. Ngo ◽  
Martin J. Trotter ◽  
Richard M. Haber
Keyword(s):  
Mycosis Fungoides ◽  
Cell Lymphoma ◽  
Pediatric Population ◽  
Cutaneous T Cell Lymphoma ◽  
Juvenile Onset ◽  
The Past ◽  
Inflammatory Dermatoses ◽  
Uncommon Condition ◽  
Autoimmune Vitiligo ◽  
Hispanic Male

Background: Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma and typically affects older adults. It is estimated that less than 5% of MF cases are of juvenile onset. An uncommon hypopigmented variant of MF exists, which has been more commonly observed in dark-skinned individuals and predominantly in juvenile-onset cases. Methods: We describe an 8-year-old otherwise healthy Hispanic male who, by 6 months of age, had developed asymptomatic hypopigmented patches on the lower legs, thighs, and buttocks, which have evolved over the past 7 years. This condition had previously been misdiagnosed as vitiligo. Recent immunohistologic and molecular biology studies are consistent with MF. Results and Conclusions: Given that hypopigmented MF is an uncommon condition, it may not be clinically suspected in the pediatric population. Histopathologic, immunophenotypic, and/or molecular biologic studies are sometimes equivocal, with findings similar to inflammatory dermatoses or autoimmune vitiligo, which may initially lead to a misdiagnosis, as in this patient's case.

scholarly journals Cell of Origin Impacts Δsuvmax Cutoff for Prediction of Relapse in Patients with Diffuse Large B-Cell Lymphoma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 23-24
Author(s):  
Carolina Feres ◽  
Leonardo Javier Arcuri ◽  
Larissa LC Teixeira ◽  
Mariana Nassif Kerbauy ◽  
Denise Cunha Pasqualin ◽  
...  
Keyword(s):  
High Risk ◽  
Treatment Failure ◽  
B Cell ◽  
Roc Curve ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
The Impact ◽  
Large B Cell

Introduction:The role of interim positron emission tomography (PET) as a predictor for progression free survival (PFS) in patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. The incorporation of volumetric and quantitative parameters aims to improve the identification of patients with high risk for treatment failure. Recently, the role of ΔSUVmax, defined as the reduction between the maximum uptake at initial PET and interim-PET (iPET) has been tested as a predictor for PFS. In most studies, a cutoff of 66% reduction successfully identified patients at high risk for treatment failure. We aimed to analyze the role of ΔSUVmax in predicting relapse in a cohort of Brazilian patients with DLBCL, and the impact of COO in this analysis. Methods:We retrospectively analyzed a cohort of patients with DLBCL from Sao Paulo, Brazil. All diagnosis were made by the same hemepathologists, and COO was defined using Hans algorithm. PET scans were obtained at baseline and after 2-3 cycles (iPET) of CHOP-like chemoimmunotherapy. All PET-CTs were read by the same physician, blinded for COO and patient's clinical features. ΔSUVmax was calculated by the difference in % between initial PET SUVmax and iPET. Initially, a cutoff of 66% reduction was used for analysis, but due to low number of patients not achieving a 66% reduction in the activated B-cell (ABC) subgroup, the optimal cutoff was selected based on the ROC curve. ResultsA total of 54 patients were available for analysis. Median age of all patients was 61 years old, and 61% of patients had a germinal center B-Cell (GCB) phenotype. The median maximum uptake at baseline was 31 for the germinal B-cell (GCB) and 34.1 for the activated B-Cell (ABC) phenotype. For all patients, ΔSUVmax &lt;66 was strongly related to relapse (HR=0.065, p=0.0005). In the GCB cohort (n=33), ΔSUVmax &lt;66 was also strongly related to relapse (H=0.02, p=0.0004). In the ABC cohort (n=21), only one patient failed to achieve ΔSUVmax&gt;66. A ROC curve identified a ΔSUVmax&gt;90 as a better cutoff for relapse, and patients not achieving 90% reduction had a higher risk for relapse (p=0.03). MYC/Bcl-2 expression was also compared, and ΔSUVmax &lt;66 was related to events in both double-expressors (DE, p=0.0003) and in non-DE(p=0.036) ConclusionA reduction &lt;66% in SUVmax from baseline PET to iPET was strongly related to the risk of relapse in a cohort of 54 patients with DLBCL. However, the cutoff of 66% was only significant in patients with GCB DLBCL, mostly due to the low number of ABC patients who did not reach a 66% in SUVmax. For ABC patients, a ΔSUVmax&gt;90 improved the identification of patients at high risk for relapse. Larger cohort of patients are needed to validate our exploratory findings. Figure Disclosures No relevant conflicts of interest to declare.

Epidemiology and Clinical Characteristics ofAcinetobacterPeritoneal Dialysis-Related Peritonitis in Hong Kong—with a Perspective on Multi-Drug and Carbapenem Resistance

2017 ◽  
Vol 37 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Philip Hei Li ◽  
Vincent C.C. Cheng ◽  
Terence Yip ◽  
Desmond Y.H. Yap ◽  
Sing-Leung Lui ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Clinical Characteristics ◽  
Antibiotic Sensitivity ◽  
Carbapenem Resistance ◽  
Multidrug Resistant ◽  
Progressive Increase ◽  
The Past ◽  
Carbapenem Resistant ◽  
Acinetobacter Spp ◽  
The Impact

BackgroundAcinetobacter spp. is an important cause of peritoneal dialysis (PD)-related peritonitis, but studies on Acinetobacter peritonitis have been scarce. In view of the rising concern of carbapenem-resistant Acinetobacter (CRA) and multidrug-resistant Acinetobacter (MDRA) infections, we conducted this study on the incidence of Acinetobacter peritonitis and the impact of CRA and MDRA on its outcome.MethodsWe retrospectively evaluated the clinical characteristics, prevalence, antibiotic sensitivity patterns, outcomes, and factors associated with treatment failure over the past 16 years in our patients with Acinetobacter PD-related peritonitis.ResultsOut of 2,389 episodes of peritonitis, there were 66 episodes (3%) of Acinetobacter peritonitis occurring in 59 patients. Twelve episodes were caused by MDRA (18%), of which 5 were CRA (8%). There was a progressive increase in the incidence of MDRA and CRA infections over the study period. Most isolates were sensitive to sulbactam combinations (ampicillin-sulbactam [95.4%] and cefoperazone-sulbactam [93.9%]), aminoglycosides (amikacin [92.4%], tobramycin [90.9%], and gentamicin [89.4%]), and carbapenems (imipenem [92.2%]). There was 1 case of relapse. Fifteen episodes resulted in catheter removal (23%), and 7 patients died (11%). Hypoalbuminemia (odds ratio [OR] = 0.85, p = 0.006) and carbapenem resistance (OR = 18.2, p = 0.049) were significantly associated with higher rates of treatment failure.ConclusionBoth carbapenem resistance and hypoalbuminemia were significantly associated with treatment failure. Up to 80% of peritonitis episodes by CRA resulted in catheter loss or mortality. Sulbactam combinations and/or aminoglycosides remained effective for the majority of Acinetobacter isolates. There seemed to be an increasing relative incidence of MDRA and CRA infections over the past 16 years.

Design and Characterization of a Novel, Reverse Prodrug Histone Deacetylase Inhibitor for Cutaneous T-Cell Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4759-4759
Author(s):  
James E. Bradner ◽  
Edward F. Greenberg ◽  
Stuart L. Schreiber ◽  
Ralph Mazitschek
Keyword(s):  
T Cell ◽  
Histone Deacetylase ◽  
Cell Lymphoma ◽  
Topical Administration ◽  
The United States ◽  
T Cell Lymphoma ◽  
High Dose ◽  
Aliphatic Chain ◽  
Cutaneous T Cell Lymphoma ◽  
The Impact

Abstract Cutaneous T-Cell Lymphoma (CTCL) comprises a group of related lymphoproliferative disorders characterized by the presence of malignant lymphocytes in the skin. The most common variant is Mycosis Fungoides (MF), which affects approximately 500 patients per year in the United States. Though most patients with MF enjoy a normal life expectancy, they experience chronic morbidity due to the symptomatic and cosmetic manifestations of epidermotropism: erythematous patches, elevated plaques, alopecia, and cellulitis. Many patients will experience progressive disease with lymph node infiltration, tumor and a leukemic phase termed the Sezary Syndrome. The lack of a survival benefit offered by clinical trials of combination chemotherapy and radiation supports the current standard of initial topical therapy for most patients with CTCL. Topical or skin-directed approaches widely offered include: nitrogen mustards (meclorethamine or carmustine), corticosteroids, oral psoralen with UVA radiation, UVB phototherapy and electron beam irradiation. Recent, early phase clinical studies of histone deacetylase inhibitors (HDACi) have illustrated a remarkable activity among patients with advanced CTCL. The structural dissimilarity of these ligands supports an on-target antineoplastic effect. Unfortunately, the frequently severe side effects associated with the systemic delivery of these nonselective ligands may limit their downstream clinical utility in the majority of patients with this disease, even with topical administration. We therefore devised a chemical strategy to achieve high dose-intensity at the site of cutaneous disease following topical administration with limited systemic exposure. Suberohydroxamic acid phenyl ester (SHAPE) is a first-in-class reverse prodrug inhibitor of histone deacetylases. Between the aliphatic chain and aromatic capping element of this canonical HDACi, we positioned an ester bond so as to promote presystemic metabolism by serum esterases. Preclinical studies of this ligand demonstrate potent activity against nuclear and cytosolic HDAC proteins. Doses required to achieve maximal histone hyperacetylation in human cancer cell tissue culture are comparable to vorinostat (SAHA; Merck & Co., Rahway, NJ) and MS-275 (Berlex Pharmaceuticals, Montville, NJ). These studies support the stability of SHAPE in the intracellular environment amid cellular esterases. The rapid metabolism (t-½ less than 5 minutes) by serum esterases has been established biochemically using continuous spectrophotometry, and is mediated by both butyrylcholinesterase and paraoxonase. Tolerability and preliminary activity have recently been demonstrated in an IL-7 transgenic mouse model of CTCL supporting clinical development as a therapeutic strategy in humans. Application to premalignant, neoplastic and inflammatory conditions of the oropharynx is being explored. Further studies characterizing the impact of SHAPE on T-cell function are also ongoing, to assess utility in conditions such as psoriasis and cutaneous graft-versus-host disease.

Fluorescent potentiometric dyes for membrane-potential imaging

1994 ◽  
Vol 52 ◽  
pp. 166-167
Author(s):  
Leslie M. Loew
Keyword(s):  
Membrane Potential ◽  
Single Cells ◽  
Quantitative Imaging ◽  
Optical Recording ◽  
Biological Processes ◽  
Major Focus ◽  
The Past ◽  
Excitable Systems ◽  
Major Application ◽  
The Impact

A major application of potentiometric dyes has been the multisite optical recording of electrical activity in excitable systems. After being championed by L.B. Cohen and his colleagues for the past 20 years, the impact of this technology is rapidly being felt and is spreading to an increasing number of neuroscience laboratories. A second class of experiments involves using dyes to image membrane potential distributions in single cells by digital imaging microscopy - a major focus of this lab. These studies usually do not require the temporal resolution of multisite optical recording, being primarily focussed on slow cell biological processes, and therefore can achieve much higher spatial resolution. We have developed 2 methods for quantitative imaging of membrane potential. One method uses dual wavelength imaging of membrane-staining dyes and the other uses quantitative 3D imaging of a fluorescent lipophilic cation; the dyes used in each case were synthesized for this purpose in this laboratory.

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