Progression of undiagnosed cutaneous lymphoma after anti-tumor necrosis factor alpha therapy

Publication date: Available online 4 January 2018
Source:Journal of the American Academy of Dermatology
Author(s): Maria Estela Martinez-Escala, Alba L. Posligua, Heather Wickless, Audrey Rutherford, Kimberly A. Sable, Belen Rubio-Gonzalez, Xiaolong A. Zhou, Jason B. Kaplan, Barbara Pro, Jaehyuk Choi, Christiane Querfeld, Steven T. Rosen, Joan Guitart
BackgroundCutaneous lymphoma (CL) diagnosed after anti-tumor necrosis factor (TNF)α therapy has been reported in the literature, yet a clear link between both events remains elusive.ObjectiveTo review our experience with CL diagnosed during or after the use of anti-TNFα therapies.MethodsThis is a multicenter retrospective study and a literature review.ResultsTwenty-two cases, including 20 cutaneous T-cell lymphomas (CTCL) and 2 cutaneous B-cell lymphomas (CBCL), were identified. In the CTCL group, 75% of the patients received an anti-TNFα agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (IIB – IVA) was commonly seen at time of diagnosis requiring aggressive therapy, including stem cell transplant in three patients. Two patients diagnosed with CBCL had an indolent course. A total of 31 cases were gathered from a literature search.LimitationsThis is a retrospective study.ConclusionsOur findings suggest that most of the identified patients were misdiagnosed as having psoriasis or eczema; therefore, a comprehensive morphological and molecular review of skin biopsies and peripheral blood should be considered prior to initiation of anti-TNFα therapy in patients with poorly defined dermatitis or atypical presentations of "psoriasis".