Mogamulizumab 20mg/5ml solution for infusion vials

IntroductionDupilumab, a standard treatment for atopic dermatitis (AD), has been associated with cutaneous T-cell lymphomas (CTCL), particularly mycosis fungoides (MF) and Sézary syndrome (SS). Nevertheless, the available data remain heterogeneous.ObjectiveTo characterize the clinical features, timeline and outcomes of dupilumab-related CTCL emergence in order to develop consensus-based recommendations for dupilumab use in CTCL-related settings.MethodsA systematic review was conducted involving 51 studies reporting cases of CTCL in patients treated with dupilumab, followed by a modified delphi process to generate expert consensus recommendations.ResultsData were obtained from 547 patients (mean age: 58 years; SD: 11.5; range: 10-85). New or worsening skin lesions were reported after dupilumab initiation, occurring at a mean of 8.9 months (SD 5.1; range 0.5-27 months). These were diagnosed as MF in 72% of cases, SS in 11% and other CTCL subtypes in 19%, of which 53% were at an early stage (stage ≤IIA). Dupilumab was discontinued in 75% of cases, and 62% received CTCL-directed treatment. Clinical remission was achieved in 44 of the 63 patients with available follow-up. The expert panel reached broad consensus, agreeing that dupilumab may unmask or exacerbate pre-existing CTCL and should be avoided in cases of MF/SS and mogamulizumab-induced rashes. They emphasized the importance of diagnostic vigilance, providing recommendations for skin biopsy, histology and clonality testing before and during treatment, particularly for patients with AD onset after the age of 40 or with atypical features. Dupilumab should be discontinued once CTCL confirmed, and methotrexate or phototherapy considered as alternatives. Cyclosporine and JAK inhibitors are considered unsuitable, and switching to other Th2-targeting biologics is discouraged due to insufficient data.ConclusionDupilumab may unmask or exacerbate CTCL, particularly MF and SS. The consensus-based recommendations offer practical guidance for the safe management of patients.

Abstract licence: CC BY

Mogamulizumab, a monoclonal antibody directed against CC chemokine receptor 4, is approved as a second-line treatment of mycosis fungoides and Sézary syndrome. One of the most common side effects is mogamulizumab-associated rash (MAR), which can present in a variety of clinical and histological types. Clinically, it can be difficult to differentiate between MAR and progression of the underlying disease, so histological examination is crucial for clinicopathological correlation. Current data analyses suggest that MAR is more common in patients with Sézary syndrome and is associated with a significantly better response to treatment, making the distinction from disease progression particularly important. The management of MAR depends on its severity, and therapy may need to be paused. This article presents three cases from our clinic and reviews the current literature on MAR. It emphasizes the importance of understanding MAR in the management of patients with cutaneous lymphomas.

Abstract licence: CC BY-NC

Primary cutaneous lymphomas are a heterogeneous group of lymphoid neoplasms with predominant skin involvement, among which mycosis fungoides (MF) and Sézary syndrome (SS) are the most frequent and clinically challenging entities. This narrative review provides a multidisciplinary, compartment-oriented approach to the diagnosis, staging and management of MF/SS. We summarize the therapeutic principles across the disease continuum, from early-stage, skin-directed management to advanced-stage systemic therapy, including oral retinoids, methotrexate, extracorporeal photopheresis, mogamulizumab, brentuximab vedotin, chemotherapy and allogeneic stem-cell transplantation. We also address large-cell transformation, response assessment, follow-up strategies, and practical issues surrounding treatment maintenance, spacing and discontinuation in a chronic, relapsing disease. Finally, we highlight the importance of supportive care, particularly pruritus control and palliative integration when no further effective options remain, and provide pragmatic algorithms to facilitate real-world clinical decision-making.

Abstract licence: CC BY