Acta Dermato-Venereologica 99-9CompleteContent | Page 9

774 CLINICAL REPORT Therapeutic Efficacy of Etretinate on Cutaneous-type Adult T-cell Leukemia-Lymphoma Kentaro YONEKURA 1 , Koichiro TAKEDA 2 , Nobuyo KAWAKAMI 1 , Tamotsu KANZAKI 1 , Takuro KANEKURA 2 and Atae UTSUNOMIYA 3 Departments of 1 Dermatology and 3 Hematology, Imamura General Hospital, and 2 Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima Japan Cutaneous-type adult T-cell leukemia-lymphoma is treated with antiviral or skin-directed therapy. Medications that are used to treat skin lesions of cu- taneous T-cell lymphomas are also used for the cuta- neous-type adult T-cell leukemia-lymphoma. Etreti- nate, a synthetic retinoid, has been used for treating cutaneous T-cell lymphomas; however, its clinical ef- fectiveness for the treatment of cutaneous-type adult T-cell leukemia-lymphoma has not been fully studied. We conducted a retrospective assessment of the ef- ficacy and safety of etretinate in 9 patients with cuta- neous-type adult T-cell leukemia-lymphoma. Complete and partial responses to etretinate were observed in 1 and 7 patients, respectively. Among the responders, remission was maintained for more than 6 years in 2 patients. These results suggest that etretinate is a pro- mising treatment option for cutaneous-type adult T- cell leukemia-lymphoma. Key words: adult T-cell leukemia-lymphoma; etretinate; reti- noid; cutaneous type. Accepted Apr 16, 2019; E-published Apr 16, 2019 Acta Derm Venereol 2019; 99: 774–776. Corr: Kentaro Yonekura, MD, PhD, Department of Dermatology, Imamura General Hospital, 11-23 Kamoikeshinmachi, Kagoshima 890-0064, Ja- pan. E-mail: [email protected] E tretinate, a synthetic retinoid analogue, is widely used for the treatment of cutaneous T-cell lym­ phomas (CTCLs) as a monotherapy or in combination with other therapies, such as ultraviolet radiation (1, 2). Cutaneous-type adult T-cell leukemia-lymphoma (cATL) is a peculiar subgroup of smoldering-type ATL in which the skin is predominantly affected (3). Patients with cATL are primarily treated with skin-directed therapy, similar to those with CTCLs (2). In Europe and the USA, SIGNIFICANCE Cutaneous-type adult T-cell leukemia-lymphoma is a pe- culiar subgroup of smoldering adult T-cell leukemia-lymp- homa associated with cutaneous lesions. Patients with the cutaneous-type adult T-cell leukemia-lymphoma are pri- marily treated with skin-directed therapy, similar to those with cutaneous T-cell lymphomas. However, once they be- come resistant to this treatment, the subsequent treatment options are limited. In this original article, we report the results of our retrospective study: etretinate, a synthetic retinoid analogue, which is widely used for the treatment of cutaneous T-cell lymphomas, is highly effective in treating cutaneous-type adult T-cell leukemia-lymphoma. a combination therapy with interferon (IFN) alpha and azidothymidine (AZT) is available. However, in Japan, it is not yet approved and clinical trials are still underway (4, 5). A few reports have demonstrated the beneficial effects of etretinate in ATL and its off-label use in clini­ cal settings (2, 6, 7). However, its efficacy in ATL has not been systematically evaluated. We demonstrate the clinical efficacy of etretinate in the treatment of cATL in our retrospective study. METHODS This study was approved by the human research ethics committee of our hospital and prior written informed consent was obtained from all participants. A total of 9 patients, 8 men and 1 woman, with a median age of 73 years (range 51–80 years), were enrolled into the study. They were treated with etretinate from April 2009 to July 2010. We followed-up these patients until August 2016 in our hospital (Table I). Their diagnosis, treatments, laboratory findings and therapeutic results were obtained from their clinical records. Considering that adequate consensus about the definite diagnostic criteria of cATL has not been obtained, in this study, we diagnosed Table I. Patients characteristics Case Age Sex Type of eruption Previous treatment 1 2 3 4 5 6 7 8 9 Median 51 54 57 68 73 75 78 79 80 73 M F M M M M M M M – Plaque, nodule Erythema, papule Nodule Nodule Erythema, papule Nodule Erythema, papule Papules Erythema Narrow band ultraviolet None Narrow band ultraviolet Narrow band ultraviolet Psoralen ultraviolet A None Narrow band ultraviolet Narrow band ultraviolet None – doi: 10.2340/00015555-3196 Acta Derm Venereol 2019; 99: 774–776 Combined treatment B B B B B None None Narrow Narrow PUVA None Narrow Narrow None – band ultraviolet B band ultraviolet B, local electolon beam band ultraviolet B band ultraviolet B This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.