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. 2023 Dec 27;16(1):141.
doi: 10.3390/cancers16010141.

Mogamulizumab Combined with Extracorporeal Photopheresis as a Novel Therapy in Erythrodermic Cutaneous T-cell Lymphoma

Nadia Ninosu  1 , Susanne Melchers  1   2   3 , Max Kappenstein  4 , Nina Booken  5 , Inga Hansen  5 , Maël Blanchard  6 , Emmanuella Guenova  6 , Chalid Assaf  7   8 , Sergij Goerdt  1 , Jan P Nicolay  1   2   3
Affiliations

Mogamulizumab Combined with Extracorporeal Photopheresis as a Novel Therapy in Erythrodermic Cutaneous T-cell Lymphoma

Nadia Ninosu et al. Cancers (Basel). .

Abstract

Background: Primary cutaneous T-cell lymphomas (CTCLs) are rare lymphoproliferative malignancies characterized by significant morbidity and mortality in advanced disease stages. As curative approaches apart from allogeneic stem cell transplantation are lacking, establishing new treatment options, especially combination therapies, is crucial.

Methods: This retrospective study included 11 patients with SS or MF receiving therapy with mogamulizumab in combination with ECP from four European expert centers. The response rates in the skin and blood as well as treatment use and adverse events (AE) were described.

Results: 8/11 patients (73%) showed an overall response (OR) in the skin. The mean mSWAT decreased from 98.2 ± 40.8 to 34.6 ± 23.8. The overall response rate (ORR) in the blood was 64% with two complete responses. During combination therapy, the mean number of Sézary cells decreased from 3365.3 × 106/L before treatment to 1268.6 × 106/L. The mean minimum known period without progress was 7.2 months in the skin and 7.6 months in the blood. The most common AEs were mogamulizumab-associated rash (MAR) (45.5%), anemia (27.3%), lymphocytopenia (27.8%), and infusion related reaction (16.7%). No AE led to treatment discontinuation.

Conclusions: Our study presents the combination of mogamulizumab and ECP as an effective therapy in the blood and skin in CTCL with good tolerability, similar to mogamulizumab monotherapy.

Keywords: CTCL; Sézary syndrome; extracorporeal photopheresis; mogamulizumab; mycosis fungoides.

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Conflict of interest statement

J.P.N. received travel and congress participation funding from TEVA and Novartis as well as consulting fees from TEVA, Almirall, Biogen, Novartis, Kyowa Kirin, Innate Pharma, Takeda and Actelion, UCB Pharma, and Recordati. S.M. received honoraria and travel funding from Kyowa Kirin. C.A. has performed consultancies for Takeda, Kyowa, Helsinn, Recordati, 4SC. Max Kappenstein works as consultant for the global management consultancy Bain & Company. N.N., I.H., M.B., and S.G. have no conflicts of interests to declare.

Figures

Figure 1
Figure 1
Efficacy of the combination of mogamulizumab and ECP. (A) Representative pictures of patients 10 and 5 before treatment and after 9 months and 1 month of combination treatment. (B) Representative time curves of the Sézary cell count and CD4/CD8 ratio of patient 10 and 9. Depicted are the values since the first presentation in our hospital. The treatment period is shown in months.
Figure 2
Figure 2
Efficacy in skin and blood. (A) Waterfall plot of best response in the skin, depicted by a reduction in mSWAT, in 10 of 11 patients (in 1 patient, the respective data were not available); (B) mean mSWAT values of 10 erythrodermic CTCL patients before and after combination therapy with mogamulizumab and ECP (in 1 patient, the respective data were not available). Differences were considered significant at p < 0.05 and are depicted by asterisks, with * for 0.01 < p ≤ 0.05. (C) Waterfall plot of blood response in Sézary patients reflected by reduction in Sézary cells in %. (D) Mean quantitative absolute Sézary cell values of 10 Sézary patients before and after combination therapy with mogamulizumab and ECP.
Figure 3
Figure 3
Adverse events under mogamulizumab and ECP combination therapy. (A) AE sorted by CTCAE grade. Depicted is the percentage of AE of each grade from total AE. (B) Percentage of patients who suffered from AE of each CTCAE grade. (C) Most frequent AE under mogamulizumab and ECP therapy sorted by frequency and depicted as the percentage of patients who suffered them including CTCAE grade.
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