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Journal of the American Academy of Dermatology
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 4 février 2020
Doi : 10.1016/j.jaad.2019.08.073
accepted : 30 August 2019
Outcomes and prognostic factors in African American and black patients with mycosis fungoides/Sézary syndrome: Retrospective analysis of 157 patients from a referral cancer center
 

Shamir Geller, MD a, b, , Emily Lebowitz, MD c, Melissa P. Pulitzer, MD c, d, Steven M. Horwitz, MD e, Alison J. Moskowitz, MD e, Steve Dusza, DrPH a, Patricia L. Myskowski, MD a, c
a Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 
b Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel 
c Weill Cornell Medical College, New York, New York 
d Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 
e Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center, New York, New York 

Reprint requests: Shamir Geller, MD, Dermatology Service, Memorial Sloan Kettering Cancer Center, 16 East 60th St, New York, NY 10022.Dermatology ServiceMemorial Sloan Kettering Cancer Center16 East 60th StNew YorkNY10022
Abstract
Background

The prevalence of mycosis fungoides/Sézary syndrome (MF/SS) is higher in the black population than in the white population in the United States and worse outcomes have been observed in black patients.

Objective

To describe the outcomes and to identify prognostic factors in African American and black patients with MF/SS.

Methods

Clinical features and follow-up data were analyzed in 157 self-identified African American or black patients seen during 1994-2018.

Results

We included 122 patients with early stage MF and 35 patients with advanced-stage disease (median follow-up of 25 months). Overall, >80% of the patients who died from disease or progressed had erythema or hyperpigmentation without hypopigmentation. Patients with hypopigmentation, either as the sole manifestation or in combination with other lesions, had better overall survival (P  = .002) and progression-free survival (P  = .014). Clinical stage, TNMB classification, plaque disease, and elevated serum lactate dehydrogenase were also significantly associated with outcomes. Demographic and socioeconomic parameters were not associated with prognosis.

Limitations

A retrospective study at a single cancer center.

Conclusion

MF/SS manifestations and outcomes in African American and black patients are heterogeneous. Demographic and socioeconomic factors do not seem to have a prognostic role, while clinical characteristics might help in the stratification of risk of progression and shorter survival, allowing for individually tailored therapeutic interventions.

The full text of this article is available in PDF format.

Key words : African American, cutaneous lymphoma, hyperpigmented MF, hypopigmented MF, MF, racial disparity, skin of color, survival analysis

Abbreviations used : CI, DSS, HR, LDH, MF/SS, MSKCC, OR, OS, PFS



 Funding sources: Supported in part through the National Institutes of Health National Cancer Institute Cancer Center support grant P30 CA008748.
 Conflicts of interest: Dr Horwitz has received research funding, grant support, honoraria and consulting fees from ADCT Therapeutics, Aileron, Forty-Seven Infinity/Verastem Kyowa-Hakka-Kirin, Millennium/Takeda, and Seattle Genetics; research and grant support from Celgene and Trillium; and honoraria and consulting fees from Affimed, Angimmune, Beigene, Corvus, Innate Pharma, Kura, Merck, Miragen, Mundipharma, Portola, and Syros Pharmaceutical. Dr Moskowitz received honoraria from Seattle Genetics; served as a consultant or in an advisory role for Seattle Genetics, Kyowa Hakko Kirin Pharma, Miragen Therapeutics, Takeda Pharmaceuticals, ADC Therapeutics, Cell Medica, Bristol-Myers Squibb, and Erytech PharmaResearch; and received funding through her institution from Incyte, Seattle Genetics, Merck, and Bristol-Myers Squibb. Dr Geller, Dr Lebowitz, Dr Pulitzer, Dr Dusza, and Dr Myskowski have no conflict of interest to declare.
 Previously presented at the European Organisation for Research and Treatment of Cancer (EORTC-CLTF) meeting in Athens, Greece, on September 26th, 2019.



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