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Giornale Italiano di Dermatologia e Venereologia 2019 Dec 04

DOI: 10.23736/S0392-0488.19.06510-6

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Second neoplasm in cutaneous T-cell lymphoma patients: a marker of worse prognosis?

Alessandro PILERI 1 , Alba GUGLIELMO 1, Fabio FULIGNI 2, Irene LASTRUCCI 3, Annalisa PATRIZI 1, Nicola PIMPINELLI 3, on behalf of the Lymphoma Italian Foundation (Fondazione Italiana Linfomi, FIL), Cutaneous Lymphoma Task Force (Commissione Linfomi Cutanei)

1 Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy; 2 Department of Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Canada; 3 Dermatology Unit, Department of Health Sciences, University of Florence Medical School, Florence, Italy


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BACKGROUND: Epidemiologic studies have shown that cutaneous T-cell lymphoma (CTCL) patients have an increased risk of the development of a second neoplasm (SN). The aim of our study was to evaluate the risk of SN and to correlate any possible change in CTCL course after the diagnosis of a subsequent neoplasm.
METHODS: A ten-year retrospective study was carried out in two centres (Bologna and Florence) all the patients who developed a SN six months at least after a CTCL were included. Two groups were selected: Group 1 featuring patients who developed a SN and Group 2 characterised by patients affected by MF age and sex-matched with Group 1 (control group). Data concerning any stage change after SN, time between MF and SN onset, modified Severity Weighted Assessment Tool (mSWAT) score before and after SN, concerning Group 1 and after a median time of 36 months in Group 2 were analysed.
RESULTS: Thirteen patients were detected. Before SN onset, early MF patients were mainly present, while SN cases in advanced-stage (ten patients) were observed. SN type predominant was lung cancer, along with prostate and pancreatic cancer, while isolated cases presenting with vulvar, colon, mammalian, prostate cancer along with Hodgkin’s Lymphoma. Mean mSWAT at MF diagnosis and after SN showed a significant difference (p value=0.0037). After SN diagnosis, nine patients experienced an MF stage progression and ten patient died at follow up.
CONCLUSIONS: In all the instances, statistical analysis showed that mean mSWAT score before/after SN diagnosis had a significantly difference (p value=0.0037) suggesting that patients with a SN may have a worse clinical outcome. By secreting immunosuppressive cytokines or recruiting immunosuppressive cells, a sort of mutual help between the two neoplasms may be prompted. Our data suggest that SN development in MF patients may be regarded as a worse prognostic marker.


KEY WORDS: Mycosis fungoides; Second neoplasm; Prognosis

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