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Carmustine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Carmustine is a nonspecific nitrosurea derivative and alkylating antineoplastic agent. It alkylates and cross-links DNA during all phases of the cell cycle, resulting in disruption of DNA function, cell cycle arrest, and apoptosis. This agent also carbamoylates proteins, including DNA repair enzymes, resulting in an enhanced cytotoxic effect. Carmustine is indicated for the treatment of brain tumors, multiple myeloma, Hodgkin’s disease and non-Hodgkin’s lymphomas. It may also be administered topically in the treatment of cutaneous T-cell lymphoma (1).
Immunophenotypic Markers
Published in Wojciech Gorczyca, Atlas of Differential Diagnosis in Neoplastic Hematopathology, 2014
Monoclonal antibody therapy has emerged in the last decade as a promising approach in treating B- and T-cell malignancies. Alemtuzumab (Campath) is a humanized monoclonal antibody directed against the CD52 antigen. Similarly to rituximab, Campath eliminates cells through antibody-dependent cell-mediated cellular toxicity, complement activation, and apoptosis. CD52 is expressed on all normal and most malignant T lymphocytes and majority of mature B-cell lymphoproliferations. Campath has been used in B-CLL, T-PLL, and low-grade non-HLs. Campath has the activity in T-cell malignancies, particularly in T-PLL and in patients with predominantly blood and BM disease. An overall response is observed in 76% of patients with T-PLL and 100% of patients with cutaneous T-cell lymphoma. Durable remissions have been seen in heavily pretreated patients and up to two-thirds of patients who had T-PLL. In T-PLL, the response to Campath is significantly better than that reported with other therapies, suggesting that the drug can be used as a first-line therapy in this aggressive disease. Campath may also have a role in purging MRD following other chemotherapy and prior to transplantation. In B-CLL patients who relapsed after fludarabine, Campath can induce responses leading to MRD-negative remission. Treatment with Campath may be associated with significant hematologic toxicity and infectious complications.
The Histopathology of Eczema
Published in Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld, Atopic Dermatitis and Eczematous Disorders, 2014
Cynthia M. Magro, A. Neil Crowson, Molly E. Dyrsen, Martin C. Mihm
Nevertheless, there are cases in which a fairly exuberant inflammatory cell infiltrate may be present. In such cases, the distinction from cutaneous T-cell lymphoma may be difficult. There are helpful clues, however, which could define potential morphological discriminators of atopic eczema from cutaneous T-cell lymphoma. If there is prominent inflammation, the pattern of migration in the epidermis is often a directed one in the setting of atopic eczema. There is preferential migration of inflammatory cells to involve the suprapapillary plates, hair follicles, and acrosyringium. The collagen assumes a vertical orientation instead of the classic laminated parallel pattern seen in cutaneous T-cell lymphoma. Although spongiosis can be seen in cutaneous T-cell lymphoma, the presence of supervening Langerhans cell-rich vesicles is characteristic for atopic eczema and is less common in the setting of cutaneous T-cell lymphoma, but there are eczematous variants of cutaneous T-cell lymphoma.
Lupus profundus-associated SLE: complete remission with combination antimalarial therapy
Published in Scandinavian Journal of Rheumatology, 2023
AU Daly, C Riddell, E Ball, D Boyle, C McCourt, D O’Kane
Management at the time of presentation to our clinic was limited to wound dressings twice weekly and opiate analgesia. On examination, a single, tender, poorly defined, indurated, ulcerated plaque was observed on the central lower back. Despite the overlap in presentation with morphoea, the surface (epidermal) change evident in this patient (erythema, scale, and dyspigmentation) favoured lupus profundus with overlying discoid lupus erythematosus (DLE). The differential diagnosis of cutaneous T-cell lymphoma was considered and rejected as indurated plaques in this condition are typically painless, multifocal, and located on the lower limbs. Hydroxychloroquine 200 mg twice daily was commenced, with a partial response (reduction in size of the plaque but resolution of ulceration not achieved) and mepacrine 100 mg once daily was added 11 months later. Complete healing of the ulceration (Figure 1(C) and (D)) and resolution of systemic symptoms enabled her return to work after a prolonged absence. Our patient’s disease remains quiescent 12 months later. The alopecia has resolved and there is no clinical or serological evidence of active SLE. She no longer requires analgesia.
Cancer risk in patients with psoriasis: should we be paying more attention?
Published in Expert Review of Clinical Immunology, 2020
Nikolai Dyrberg Loft, Sofie Vaengebjerg, Lone Skov
One possible contributing factor for the observed associations might be surveillance bias. Patients with psoriasis visit a dermatologist frequently and as dermatologists are experts in identifying NMSC, this might in part explain the overrepresentation. Few studies have a reference group with a skin disease, which could overcome this issue. Again, for cutaneous T-cell lymphoma (CTCL) surveillance bias might explain some of the increased risk seen. Patients with psoriasis who present with a newly developed atypical plaque or patch are advised to do a skin biopsy with the possibility of CTCL [176]. This underlines the difficulty in the differentiation of CTCL and psoriasis in some cases; thus, misdiagnosis could potentially also explain some of the increased risk. However, for surveillance bias to be dominating, one would also expect the risk of MM to be increased in patients with psoriasis, which is not the case [15,16]. Moreover, surveillance bias cannot explain the increased risk of some solid and hematologic cancers.
Harnessing immunotherapy for pediatric T-cell malignancies
Published in Expert Review of Clinical Immunology, 2020
Caroline Diorio, David T. Teachey
T-cell malignancies are cancers of T-cell precursors. They can be divided broadly in to T-cell leukemias and peripheral T-cell lymphomas. In children, the most common T-cell malignancy is T-cell acute lymphoblastic leukemia (T-ALL), which represents approximately 15% of pediatric ALL cases[18]. Approximately one third of pediatric non-Hodgkin lymphomas are T-lymphoblastic lymphoma (T-LBL), which shares an immunophenotype with T-ALL[19]. T-ALL is distinguished from T-LBL based on the degree of bone marrow involvement: patients with T-LBL have <25% bone marrow involvement[19]. Pediatric T-ALL is a distinct entity from adult T-cell leukemia (ATL), which is a primarily human T cell leukemia/lymphotropic virus type 1 (HTLV-1) driven cancer[20]. HTLV-1 related leukemias are extremely rare in the pediatric population. By far the most common peripheral T-cell lymphoma in children is anaplastic large cell lymphoma (ALCL). In adults, cutaneous T-cell lymphomas make up a significant portion of T-cell malignancies; these conditions are very rarely seen in the pediatric population.