New Research Could Change Cutaneous Lymphoma Treatment
Although new research, led by Dr. Pedro Quaglino from the University of Turin Medical School in Italy, is far from finished, his team has already discovered some interesting data trends concerning lymphoma.
Cutaneous lymphoma is a relatively rare disease, accounting for approximately 4% of non-Hodgkin’s lymphoma cases. Of these, mycosis fungoides is the most common type, affecting about 1 in 100,000 people worldwide. Due to its rarity, doctors don’t know enough about this disease to manage it well. The disease usually strikes people during their mid-fifties and is very rare in children. However, it is possible for cutaneous lymphoma to affect individuals at any age.
Dr. Pedro Quaglino has attempted to tackle this challenging disease. He conducted a study called “Early stage prospective cutaneous lymphoma international prognostic index trial,” in which he observed the long-term effects of different treatments for early fungoides. He did this by collecting data from 42 centers in 14 different countries. Their main goal was to identify factors that could affect the disease’s prognosis and improve the quality of life for patients. They analyzed the data for two years, tracking 472 patients, and found that mycosis fungoides was present in 80.7% of participants, while another type, called folliculotropic, was present in only 15.7%. Very few cases appeared in females. Researchers also noted a link between increased age and disease advancement. They hope to continue the study for five years or more.
Catching the disease early offers the best prognosis. Typically, people are expected to survive 35 years if the diagnosis is between stage 1A and 2A. Until this stage, there are no cancer cells inside the lymph nodes. 25% of those in the early stage are likely to progress to a more advanced stage, after which the median survival rate is four years.
Only the skin is involved in early-stage lymphoma, thus superficially limiting the disease. The skin becomes patchy, but there are no signs of a tumor. Once the lymphoma has spread to the lymph nodes, the patient’s life expectancy drops to one year. The treatment options in the earlier stage are quite effective and mostly feature skin-directed therapies chosen by the doctor. This can be done individually or in combination. In the early stages, both options have some favorable responses: they can potentially stop the disease in its tracks by slowing its progression.
In some patients, developing a good treatment plan is a significant challenge. Some may benefit from individualized therapies, but there is no way to tell which one is better. Further study is required to know what characteristics are present in a patient and how they affect treatment responses; as of yet, no conclusions have been drawn as to how effective the treatments are. The selection is done based on the patient’s preference. Currently, a wide range of treatment is available: emollients and topical steroids are some of the epidermal treatments; UV light therapies include phototherapy and extracorporeal photopheresis; and gemcitabine and local radiotherapy are classic cancer treatments. Some systemic therapies are also used. Less frequently used treatments included in the study are electron-beam therapy and topical nitrogen mustard.
In the study, 71 cases of early-stage lymphoma did not progress. The team also discovered some interesting data trends regarding diagnosis: they noted advanced age to be a potentially poor prognostic factor. However, this may not be the case since advanced disease is more commonly found in the elderly. It was noted, though, that early diagnosis could occur in younger individuals.
Phototherapy, topical steroids, and psoralen were commonly prescribed, and, among those, phototherapy had the highest rate of treatment response. The researchers stated that many factors could influence the treatment response rate. Many patients are not aware of the disease since it looks similar to psoriasis and eczema. A delayed diagnosis can greatly affect the disease’s prognosis. Researchers hope to gain more insight to find the best first-line treatment. This will require patients to be studied for longer periods of time. Because the treatment response is better under certain circumstances, experts recommend dermatologists work hard to diagnose the disease as early as possible.