Aggressive cutaneous T-cell lymphomas after TNFα blockade
Aggressive cutaneous T-cell lymphomas after TNFα blockade
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DOI：
10.1016/j.jaad.2004.03.047
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发表时间：
2004-10-01
影响因子：
13.8
通讯作者：
Kupper, TS
中科院分区：
文献类型：
--
作者：
Adams, AE;Zwicker, J;Kupper, TS
TNF α的药理学阻断已经成为治疗几种免疫介导的疾病（包括类风湿性关节炎、克罗恩病和银肩病关节炎）的高效方法。（1，2，3）依那西普（肿瘤坏死因子受体2（TNFR 2）的重组细胞外结构域）和英夫利昔单抗（一种人源化鼠抗体）均可结合TNF α并阻断其与细胞表面受体的相互作用。最近，已经清楚的是，TNF α作用的阻断是深刻的免疫抑制，并可能导致结核病和组织胞浆菌病的再活化，以及B细胞淋巴瘤的出现。（4，5，6）在这份报告中，我们描述了两例皮肤和系统性T细胞淋巴瘤，在TNF α阻断的情况下进展迅速。这两个案件的特点是发病迅速，爆发性的临床过程中，广泛的皮肤和全身参与，并在几个月内死亡的诊断。
Pharmacologic blockade of TNFalpha has been a highly effective approach to treating several immunologically mediated diseases, including rheumatoid arthritis, Crohn's disease, and psoriatic arthritis.(1,2,3) Both etanercept, the recombinant extracellular domain of the tumor necrosis factor receptor 2 (TNFR2), and infliximab, a humanized murine antibody, bind TNFalpha and block its interaction with cell surface receptors. Recently, it has become clear that blockade of TNFalpha action is profoundly immunosuppressive, and may result in reactivation of tuberculosis and histoplasmosis, as well as the emergence of B-cell lymphomas.(4,5,6) In this report, we describe two cases of cutaneous and systemic T-cell lymphoma that progressed rapidly in the setting of TNFalpha blockade. Both cases were characterized by rapid onset, a fulminant clinical course with extensive cutaneous and systemic involvement, and death within months of diagnosis.