Background

Cutaneous lymphoma diagnosed after anti–tumor necrosis factor-α therapy (anti–TNF-α) has been reported in the literature, yet a clear link between both events remains elusive.

Objective

To review our experience with cutaneous lymphoma diagnosed during or after the use of anti–TNF-α therapies.

Methods

This is a multicenter retrospective study and a literature review.

Results

A total of 22 cases, including 20 cutaneous T-cell lymphomas (CTCLs) and 2 cutaneous B-cell lymphomas, were identified. In the CTCL group, 75% of the patients received an anti–TNF-α agent for a presumed inflammatory skin condition. Mycosis fungoides and Sézary syndrome were the most common subtypes of CTCL diagnosed. Advanced disease (stage IIB to IVA) was commonly seen at time of diagnosis and required aggressive therapy, including stem cell transplant in 3 patients; 2 patients in whom cutaneous B-cell lymphomas was diagnosed had an indolent course. A total of 31 cases were gathered from a literature search.

Limitations

This is a retrospective study.

Conclusions

Our findings suggest that the disease of most of the identified patients was misdiagnosed as psoriasis or eczema; therefore, a comprehensive morphologic and molecular review of skin biopsy specimens and peripheral blood samples should be considered before initiation of anti–TNF-α therapy in patients with poorly defined dermatitis or atypical presentations of psoriasis.

中文翻译：

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抗肿瘤坏死因子-α治疗后未确诊的皮肤淋巴瘤的进展

背景

已有文献报道抗肿瘤坏死因子-α疗法（抗-TNF-α）后诊断为皮肤淋巴瘤，但这两个事件之间的明确联系仍然难以捉摸。

客观的

回顾我们在使用抗-TNF-α治疗期间或之后诊断出的皮肤淋巴瘤的经验。

方法

这是一项多中心回顾性研究和文献综述。

结果

总共鉴定出22例病例，包括20例皮肤T细胞淋巴瘤（CTCL）和2例皮肤B细胞淋巴瘤。在CTCL组中，有75％的患者因推测的炎症性皮肤病而接受了抗TNF-α药物治疗。蕈样真菌病和塞扎里氏综合症是确诊的CTCL最常见的亚型。晚期疾病（IIB至IVA期）在诊断时很常见，需要积极治疗，其中3例患者进行了干细胞移植。2名被诊断为皮肤B细胞淋巴瘤的患者病程缓慢。通过文献检索共收集到31例病例。

局限性

这是一项回顾性研究。

结论

我们的发现表明，大多数已鉴定患者的疾病被误诊为牛皮癣或湿疹。因此，对于定义不明确的皮炎或非典型牛皮癣患者，在开始抗TNF-α治疗之前，应考虑对皮肤活检标本和外周血标本进行全面的形态学和分子检查。