Acta Dermato-Venereologica 99-9CompleteContent | Page 9
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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
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Journal Compilation © 2019 Acta Dermato-Venereologica.