Paediatric Mycosis Fungoides: Clinical Variants, Treatment Modalities and Response to Therapy

Authors

  • Orna Mirmovich Morvay Department of dermatology, Rambam Health Care Campus, Haifa, Israel
  • Michal Ramon Department of dermatology, Rambam Health Care Campus, Haifa, Israel
  • Ziad Khamaysi Department of dermatology, Rambam Health Care Campus, Haifa, Israel
  • Emily Avitan-Hersh Department of dermatology, Rambam Health Care Campus, Haifa, Israel

DOI:

https://doi.org/10.2340/actadv.v103.6557

Keywords:

mycosis fungoides, folliculotropic, paediatric, cutaneous lymphoma, phototherapy

Abstract

Mycosis fungoides is a rare cutaneous lymphoma in the paediatric population. The aim of this study was to examine the epidemiological, clinical, and histological characteristics, as well as the treatment modalities and response to therapy of paediatric patients with mycosis fungoides. This retrospective cohort study reviewed the records of 37 paediatric patients treated at Rambam Medical Center, Israel, between 2013 and 2021. Extracted data included epidemiology, clinical presentation, histological reports, infiltrate clonality status, treatment modalities and response to therapy. The mean follow-up period was 60 months. All patients were diagnosed with stage IA or IB disease. Folliculotropic mycosis fungoides was the most prevalent variant (49%). Most patients were treated with phototherapy (90%), with a response rate of 85%, and a complete response rate of 55% after the first course. There were no significant differences in response to phototherapy between the folliculotropic or other variants (p = 0.072). Similarly, delayed diagnosis, atopic diathesis, clonality, phototherapy type or number of treatments, were not associated with response to therapy, while protracted phototherapy was associated with prolonged remission. In conclusion, mycosis fungoides in the paediatric population is an indolent disease with a favourable prognosis and potentially prolonged response to phototherapy.

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References

Ceppi F, Pope E, Ngan B, Abla O. Primary cutaneous lymphomas in children and adolescents. Pediatr Blood Cancer 2016; 63: 1886-1894.

https://doi.org/10.1002/pbc.26076 DOI: https://doi.org/10.1002/pbc.26076

Assaf C, Gellrich S, Steinhoff M, Nashan D, Weisse F, Dippel E, et al. Cutaneous lymphomas in Germany: an analysis of the Central Cutaneous Lymphoma Registry of the German Society of Dermatology (DDG). J Dtsch Dermatol Ges 2007; 5: 662-668.

https://doi.org/10.1111/j.1610-0387.2007.06337.x DOI: https://doi.org/10.1111/j.1610-0387.2007.06337.x

Jung JM, Lim DJ, Won CH, Chang SE, Lee MW, Lee WJ. Mycosis fungoides in children and adolescents: a systematic review. JAMA Dermatol 2021; 157: 431-438.

https://doi.org/10.1001/jamadermatol.2021.0083 DOI: https://doi.org/10.1001/jamadermatol.2021.0083

Hodak E, Amitay-Laish I, Feinmesser M, Davidovici B, David M, Zvulunov A, et al. Juvenile mycosis fungoides: cutaneous T-cell lymphoma with frequent follicular involvement. J Am Acad Dermatol 2014; 70: 993-1001.

https://doi.org/10.1016/j.jaad.2013.12.029 DOI: https://doi.org/10.1016/j.jaad.2013.12.029

Virmani P, Levin L, Myskowski PL, Flores E, Marchetti MA, Lucas AS, et al. clinical outcome and prognosis of young patients with mycosis fungoides. Pediatr Dermatol 2017; 34: 547-553.

https://doi.org/10.1111/pde.13226 DOI: https://doi.org/10.1111/pde.13226

Wu JH, Cohen BA, Sweren RJ. Mycosis fungoides in pediatric patients: clinical features, diagnostic challenges, and advances in therapeutic management. Pediatr Dermatol 2020; 37: 18-28.

https://doi.org/10.1111/pde.14026 DOI: https://doi.org/10.1111/pde.14026

Reiter O, Amitay-Laish I, Oren-Shabtai M, Feinmesser M, Ben-Amitai D, Hodak E. Paediatric mycosis fungoides - characteristics, management and outcomes with particular focus on the folliculotropic variant. J Eur Acad Dermatol Venereol 2022; 36: 671-679.

https://doi.org/10.1111/jdv.17971 DOI: https://doi.org/10.1111/jdv.17971

Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127: 2375-2390.

https://doi.org/10.1182/blood-2016-01-643569 DOI: https://doi.org/10.1182/blood-2016-01-643569

Larocca C, Kupper T, Mycosis fungoides and Sézary syndrome: an update. Hematol Ocol Clin North Am 2019; 33: 103-120.

https://doi.org/10.1016/j.hoc.2018.09.001 DOI: https://doi.org/10.1016/j.hoc.2018.09.001

Nuckols JD, Shea CR, Horenstein MG, Burchette JL, Prieto VG. Quantitation of intraepidermal T-cell subsets in formalin-fixed, paraffin-embedded tissue helps in the diagnosis of mycosis fungoides, J Cutan Pathol 1999; 26: 169-175.

https://doi.org/10.1111/j.1600-0560.1999.tb01824.x DOI: https://doi.org/10.1111/j.1600-0560.1999.tb01824.x

Boccara O, Blanche S, de Prost Y, Brousse N, Bodemer C, Fraitag S, Cutaneous hematologic disorders in children, Pediatr Blood Cancer 2012; 58: 226-232.

https://doi.org/10.1002/pbc.23103 DOI: https://doi.org/10.1002/pbc.23103

Boulos S, Vaid R, Aladily TN, Ivan DS, Talpur R, Duvic M. Clinical presentation, immunopathology, and treatment of juvenile-onset mycosis fungoides: a case series of 34 patients. J Am Acad Dermatol 2014; 71: 1117-1126.

https://doi.org/10.1016/j.jaad.2014.07.049 DOI: https://doi.org/10.1016/j.jaad.2014.07.049

Koh M J-A, Chong W-S. Narrow-band ultraviolet B phototherapy for mycosis fungoides in children. Clin Exp Dermatol 2014; 39: 474-478.

https://doi.org/10.1111/ced.12364 DOI: https://doi.org/10.1111/ced.12364

Brazzelli V, Bernacca C, Segal A, Barruscotti S, Bolcato V, Michelerio A, et al. Photo-photochemotherapy in juvenile-onset mycosis fungoides: a retrospective study on 9 patients. J Pediatr Hematol Oncol 2019; 41: 34-37.

https://doi.org/10.1097/MPH.0000000000001277 DOI: https://doi.org/10.1097/MPH.0000000000001277

Krutmann J. Therapeutic photoimmunology: photoimmunological mechanisms in photo(chemo)therapy. J Photochem Photobiol B 1998; 44: 159-164.

https://doi.org/10.1016/S1011-1344(98)00139-0 DOI: https://doi.org/10.1016/S1011-1344(98)00139-0

Nanda A, AlSaleh QA, Al-Ajmi H, Al-Sabah H, Elkashlan M, Al-Shemmari S, et al. Mycosis fungoides in Arab children and adolescents: a report of 36 patients from Kuwait, Pediatr Dermatol 2010; 27: 607-613.

https://doi.org/10.1111/j.1525-1470.2010.01129.x DOI: https://doi.org/10.1111/j.1525-1470.2010.01129.x

Yazganoglu KD, Topkarci Z, Buyukbabani N, Baykal C. Childhood mycosis fungoides: a report of 20 cases from Turkey. J Eur Acad Dermatol Venereol 2013; 27: 295-300.

https://doi.org/10.1111/j.1468-3083.2011.04383.x DOI: https://doi.org/10.1111/j.1468-3083.2011.04383.x

Ramsay DL, Parnes RE, Dubin N. Response of mycosis fungoides to topical chemotherapy with mechlorethamine, Arch Dermatol 1984; 120: 1585-1590.

https://doi.org/10.1001/archderm.120.12.1585 DOI: https://doi.org/10.1001/archderm.120.12.1585

Micaily B, Miyamoto C, Kantor G, Lessin S, Rook A, Brady L, et al. Radiotherapy for unilesional mycosis fungoides. Int J Radiat Oncol Biol Phys 1998; 42: 361-364.

https://doi.org/10.1016/S0360-3016(98)00218-1 DOI: https://doi.org/10.1016/S0360-3016(98)00218-1

Huen AO, Kim EJ. The role of systemic retinoids in the treatment of cutaneous T-cell lymphoma. Dermatol Clin 2015; 33: 715-729.

https://doi.org/10.1016/j.det.2015.05.007 DOI: https://doi.org/10.1016/j.det.2015.05.007

Zackheim HS, Kashani-Sabet M, McMillan A. Low-dose methotrexate to treat mycosis fungoides: a retrospective study in 69 patients, J Am Acad Dermatol 2003; 49: 873-878.

https://doi.org/10.1016/S0190-9622(03)01591-3 DOI: https://doi.org/10.1016/S0190-9622(03)01591-3

Whittaker S, Hoppe R, HM. How I treat mycosis fungoides and Sézary syndrome. Blood 2016; 127: 3142-3153.

https://doi.org/10.1182/blood-2015-12-611830 DOI: https://doi.org/10.1182/blood-2015-12-611830

Ben-Amitai D, Michael D, Feinmesser M, Hodak E. Juvenile mycosis fungoides diagnosed before 18 years of age. Acta Derm Venereol 2003; 83: 451-456.

https://doi.org/10.1080/00015550310020530 DOI: https://doi.org/10.1080/00015550310020530

Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, et al. WHO-EORTC classification for cutaneous lymphomas, Blood 2005; 105: 3768-3785.

https://doi.org/10.1182/blood-2004-09-3502 DOI: https://doi.org/10.1182/blood-2004-09-3502

Hodak E, Amitay-Laish I. Mycosis fungoides: a great imitator. Clin Dermatol 2019; 37: 255-267.

https://doi.org/10.1016/j.clindermatol.2019.01.004 DOI: https://doi.org/10.1016/j.clindermatol.2019.01.004

Walia R, Yeung CCS. An update on molecular biology of cutaneous T cell lymphoma. Front Oncol 2019; 9: 1558.

https://doi.org/10.3389/fonc.2019.01558 DOI: https://doi.org/10.3389/fonc.2019.01558

Ponti R, Quaglino P, Novelli M, Fierro MT, Comessatti A, Peroni A, et al. T-cell receptor gamma gene rearrangement by multiplex polymerase chain reaction/heteroduplex analysis in patients with cutaneous T-cell lymphoma (mycosis fungoides/Sézary syndrome) and benign inflammatory disease: correlation with clinical, histological and immunophenotypical findings. Br J Dermatol 2005; 153: 565-573.

https://doi.org/10.1111/j.1365-2133.2005.06649.x DOI: https://doi.org/10.1111/j.1365-2133.2005.06649.x

Travaglino A, Varricchio S, Pace M, Russo D, Picardi M, Baldo A. Borrelia burgdorferi in primary cutaneous lymphomas: a systematic review and meta-analysis. J Dtsch Dermatol Ges 2020; 18: 1379-1384.

https://doi.org/10.1111/ddg.14289 DOI: https://doi.org/10.1111/ddg.14289

Brunner PM, Guttman-Yassky E, Leung DYM. The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies. J Allergy Clin Immunol 2017; 139: S65-S76.

https://doi.org/10.1016/j.jaci.2017.01.011 DOI: https://doi.org/10.1016/j.jaci.2017.01.011

Zhou H, Luo ZD, Tang XH, Han JD, Gao Q. Folliculotropic mycosis fungoides associated with atopic dermatitis. Australas J Dermatol 2018; 59: e143-e145.

https://doi.org/10.1111/ajd.12607 DOI: https://doi.org/10.1111/ajd.12607

Olsen EA, Hodak E, Anderson T, Carter JB, Henderson M, Cooper K, et al. Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: a consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol 2016; 74: 27-58.

https://doi.org/10.1016/j.jaad.2015.09.033 DOI: https://doi.org/10.1016/j.jaad.2015.09.033

Published

2023-07-14

How to Cite

Mirmovich Morvay, O., Ramon , M. ., Khamaysi, Z. ., & Avitan-Hersh, E. (2023). Paediatric Mycosis Fungoides: Clinical Variants, Treatment Modalities and Response to Therapy. Acta Dermato-Venereologica, 103, adv6557. https://doi.org/10.2340/actadv.v103.6557