Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor-alpha therapy.
Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor-alpha therapy.
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DOI：
10.1016/j.jaad.2017.12.068
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发表时间：
2018-06
影响因子：
13.8
通讯作者：
Guitart J
中科院分区：
文献类型：
--
作者：
Martinez-Escala ME;Posligua AL;Wickless H;Rutherford A;Sable KA;Rubio-Gonzalez B;Zhou XA;Kaplan JB;Pro B;Choi J;Querfeld C;Rosen ST;Guitart J
文献报道了抗肿瘤坏死因子 (TNF)α 治疗后诊断出的皮肤淋巴瘤 (CL)，但这两个事件之间的明确联系仍然难以捉摸。回顾我们在使用抗 TNFα 疗法期间或之后诊断 CL 的经验。这是一项多中心回顾性研究和文献综述。确定了 22 例，包括 20 例皮肤 T 细胞淋巴瘤 (CTCL) 和 2 例皮肤 B 细胞淋巴瘤 (CBCL)。在 CTCL 组中，75% 的患者因推测的炎症性皮肤病而接受了抗 TNFα 药物治疗。蕈样肉芽肿和 Sézary 综合征是最常见的 CTCL 亚型。晚期疾病（IIB – IVA）常见于诊断时需要积极治疗，包括三名患者的干细胞移植。两名诊断为 CBCL 的患者病程呈惰性。通过文献检索，共收集到31个病例。这是一项回顾性研究。我们的研究结果表明，大多数已识别的患者被误诊为患有牛皮癣或湿疹；因此，对于不明确的皮炎或不典型的“银屑病”患者，在开始抗 TNFα 治疗之前，应考虑对皮肤活检和外周血进行全面的形态学和分子学检查。
Cutaneous lymphoma (CL) diagnosed after anti-tumor necrosis factor (TNF)α therapy has been reported in the literature, yet a clear link between both events remains elusive. To review our experience with CL diagnosed during or after the use of anti-TNFα therapies. This is a multicenter retrospective study and a literature review. Twenty-two cases, including 20 cutaneous T-cell lymphomas (CTCL) and 2 cutaneous B-cell lymphomas (CBCL), were identified. In the CTCL group, 75% of the patients received an anti-TNFα agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (IIB – IVA) was commonly seen at time of diagnosis requiring aggressive therapy, including stem cell transplant in three patients. Two patients diagnosed with CBCL had an indolent course. A total of 31 cases were gathered from a literature search. This is a retrospective study. Our findings suggest that most of the identified patients were misdiagnosed as having psoriasis or eczema; therefore, a comprehensive morphological and molecular review of skin biopsies and peripheral blood should be considered prior to initiation of anti-TNFα therapy in patients with poorly defined dermatitis or atypical presentations of “psoriasis”.
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