A new study is the largest cohort of patients with advanced-stage cutaneous T-cell lymphomas mycosis fungoides (stage IIB to IV) or Sezary syndrome has identified four prognostic markers of aggressive disease. The researchers used these markers to develop a prognostic index to help stratify high-risk patients. The findings are published online ahead of print in the Journal of Clinical Oncology (doi: 10.1200/JCO.2015.61.7142).
"This model identifies high-risk patients who have a five-year survival rate of only 28 percent, compared with 68 percent for low-risk patients," explained Julia Scarisbrick, MBChB, FRCP, MD, Consultant Dermatologist & Lead of the Cutaneous Lymphoma Service at University Hospital Birmingham. "Being able to identify those high risk patients will allow us to select patients for more intensive treatment regimens with the aim of improving patient survival-or knowing whom to refer to special centers for treatment."
The study analyzed staging data and outcomes for 1,275 patients with advanced mycosis fungoides or Sezary syndrome from 29 international cancer centers. The data showed four prognostic markers for worse survival in the patient cohort:
* Stage IV disease;
* Age greater than 60;
* Large-cell transformation in skin (defined as more than 25 percent of atypical lymphocytes or clusters of cells having diameter of more than four times that of normal lymphocytes); and
* Increased lactate dehydrogenase in blood.
The patients in the study cohort all had stages IIB to IV disease and were diagnosed in 2007 or later. The patients' age ranged from eight to 98 (with a median age of 63). The cohort included more men than women (a 1.7 to 1 ratio), but there was no survival difference between sexes.
Rare, Aggressive Disease
Commenting via email for this article, Scarisbrick said: "Cutaneous lymphoma is rare and requires sites to work together for improved research. This is the first large-scale international collaboration from 29 sites specializing [in CTCL] spanning five continents.
"Currently there is no curative therapy for mycosis fungoides and Sezary syndrome, the outcome in advanced disease is poor, and the morbidity associated with skin lesions causes a reduction in quality of life," she added. "In order to improve survival we need to identify those patients with a poor outcome for more aggressive therapies such as bone marrow transplantation."