Italian Real-Life Experience on the Use of Mogamulizumab in Patients with Cutaneous T-Cell Lymphomas

Abstract

Mycosis fungoides and Sèzary syndrome are the most studied subtypes common cutaneous T-cell lymphomas. The current treatment objective is to improve the clinical manifestations of the disease in the affected areas, to relieve symptoms and to halt disease progression. Patients with early-stage mycosis fungoides are usually managed with skin-directed therapies, whereas patients with resistant or advanced-stage mycosis fungoides or Sèzary syndrome often require systemic drugs. Over the last decade, new drugs have been developed, increasing the breadth of treatment options for cutaneous T-cell lymphomas patients. Mogamulizumab is a first-in-class defucosylated humanized IgG1 κ monoclonal antibody, which exerts its anti-tumour action by selectively binding to C-C chemokine receptor 4 and increasing antibody-dependent cellular cytotoxicity activity against malignant T-cells. Several clinical trials showed that mogamulizumab is able to effectively control the cutaneous T-cell lymphomas in each site (skin, blood, lymph nodes and viscera), improving patients' symptoms, function and overall quality of life with a manageable safety profile. In this report, we discuss 12 cases of patients with mycosis fungoides or Sèzary syndrome successfully treated with mogamulizumab in real-life clinical practice in Italy.

Keywords: Sèzary syndrome; cutaneous T- cell lymphoma; mogamulizumab; mycosis fungoides.

Figure 1

Leukocytes (WBC) and lymphocytes (Ly) trend during the treatment with mogamulizumab. Basal value: 12/02/2020. First cycle of mogamulizumab: 12/23/2020. Second cycle of mogamulizumab on 01/21/2021. End of mogamulizumab: 06/01/2021.

Figure 2

Right lesions of the leg before (A) and after (B) four cycles of mogamulizumab.

Figure 3

Diffuse erythema with scaling covering approximately 60% of BSA, onychodystrophy, ectropion, mild palmo-plantar hyperkeratosis.

Figure 4

Epidermotropic infiltrate with Pautrier’s microabscesses with atypical lymphocytes and a patchy lichenoid infiltrate in the papillary dermis.

Figure 5

Already after the first cycle of mogamulizumab the patient achieved prompt clinical response with >90% clearance of skin disease.

Figure 6

Skin involvement before (A) and after (B) therapy with mogamulizumab.

Figure 7

Cytogenetic abnormalities before and after mogamulizumab administration. After the first course of mogamulizumab, the hypothetraploid clone showed by karyotype and confirmed by FISH (A) was cleared and only a second clone remained detectable by FISH (B).

Figure 8

Mogamulizumab-induced lichenoid reaction developed after 15 infusions. An erythematous-desquamative, confluent lichenoid eruption mainly localized on the lower abdomen can be observed. Note how the eruption arose within healthy skin revealing the excellent response obtained by treatment.

Figure 9

Eruptive yellowish papules located on face and forehead. (A–C). Lesions on the forehead and the cheeks. (D). Dermoscopy showing the presence of well-demarcated yellow globule structures, divided by septa constituted by focused reddish capillaries.