Cutaneous Lymphoma

Overview

City of Hope has one of the nation's most distinguished skin lymphoma programs. We pride ourselves on having one of the few multidisciplinary clinics in the country that treats the full spectrum of disease, whether you are newly-diagnosed, have cancer that has returned or have failed other therapies. We offer all traditional — and many novel — therapies to control, and when possible, cure these diseases, including skin-directed and infusional therapies, immunotherapies, biologic therapies, clinical trials and stem cell transplants — all managed by the same team of professionals, who are part of your care team at all levels of your medical care.

Request a consultation

City of Hope’s skin lymphoma care team uses the latest technology and innovation to treat cancer while providing compassionate care. Call 800-826-HOPE or request an appointment online. Visit Making Your First Appointment for more information.

Multidisciplinary care

City of Hope is one of only a few dozen centers in the country that treat cutaneous lymphomas using a comprehensive approach — by a multidisciplinary team whose sole focus is treating this type of cancer.

Your care includes regular interaction and input from a team of experts that includes dermatologists, medical oncologists and radiation oncologists — along with dermatopathologists, nurses, social workers and supportive care — with all interaction occurring in the same clinic space.

This team brings together deep experience and diverse perspectives, shaped by seeing and treating skin lymphomas every day, to arrive at the ideal treatment for every patient.

Strengths of our cutaneous lymphoma program include:

  • An approach that places the patient in the center — putting your needs and care at the center of all interactions with our multidisciplinary team.
  • Access to the latest treatments and research designed to better understand the disease and define new treatments.
  • Pathologic diagnostics to characterize skin lymphoma subtypes, using state of the art genetic and molecular testing. This includes molecularly profiling tumor types to reveal specific abnormalities unique to each patient, allowing for tailored therapeutic approaches and personalized medicine.
  • Promising new therapies as part of our clinical trials program — including an upcoming CAR-T cell therapy trial — that provide additional treatment options.
  • A pioneering stem cell and bone marrow transplant program that is one of the largest in the United States. Our transplant outcomes are consistently highly-ranked by the Center for International Blood and Marrow Transplant Research. And innovative approaches to treating advanced cutaneous lymphoma allow for bridging therapies to successful transplant outcomes.
  • A psychosocial support program available to patients during clinic visits to screen for and support important issues that impact mental and emotional wellbeing.
  • Survivorship clinics that provide support and monitoring to patients throughout the course of the disease and post-transplant.

City of Hope is internationally recognized for its research and breakthrough treatments, has been named one of America’s top cancer hospitals by U.S. News & World Report for over a decade running and is a National Cancer Institute-designated comprehensive cancer center.

NEWS & BREAKTHROUGHS

What is cutaneous lymphoma?

Cutaneous lymphoma (also called lymphoma of the skin) is a rare type of non-Hodgkin lymphoma that affects the skin. There are approximately 72,580 cases of NHL diagnosed each year, only 5 percent of which are skin lymphomas, according to the American Cancer Society.

Cutaneous lymphomas result in rashes, and sometimes tumors, which can be mistaken for other skin conditions. In a small number of people the disease may migrate to the lymph nodes or internal organs, causing serious complications. Skin lymphomas are rarer and behave very differently than systemic lymphomas, and usually require different treatments.

There are several subtypes of skin lymphoma that are based on the type of cell in which the disease starts, including:

  • T-cell lymphoma
  • B-cell lymphoma
  • NK-cell lymphoma

Among skin lymphomas, T-cell lymphomas are the most commonly diagnosed.

How lymphoma develops

Lymphoma develops when lymphocytes — infection-fighting white blood cells in the immune system — become abnormal and grow and divide uncontrollably into tumors. Lymphocytes are the main part of the immune system and circulate throughout the body responding to bacteria and viruses.

With lymphoma, abnormal white blood cells grow in number (also causing the lymph nodes to swell) not because of an infection, but because of a defect inside the cells. Instead of fighting disease, these cells, which have no real purpose in the body, grow and take up space.

Symptoms of cutaneous lymphoma

The physical symptoms of cutaneous lymphoma vary from patient to patient. They include:

  • Larger papules or lumps: Pimple-like lesions
  • Patches: Flat, scaly lesions
  • Plaques: Thicker, raised lesions
  • Tumors: Raised lumps
  • Erythroderma: A red rash that can cover most of the skin on the body

Other symptoms, such as weight loss, fever, profuse sweating and severe itching may also appear with skin lymphoma. Symptoms of other medical conditions may mirror those of cutaneous lymphoma. If you are treated for those conditions, or if your symptoms last for several weeks despite medical treatment, you may need further consultation to rule out cutaneous lymphoma.

What increases risk of cutaneous lymphoma?

The exact causes of cutaneous lymphoma are not known, although some risk factors are associated with developing the disease, including being older than 50 and being male. And cutaneous lymphoma is more often diagnosed in African Americans than other groups. While risk factors may be useful in identifying high-risk individuals, they do not determine whether a person develops a disease.

So far, large studies have not linked the environment, chemicals, or infections to developing cutaneous lymphoma.

Cutaneous T cell lymphomas

There are two main types of lymphocytes: B lymphocytes (B cells) and T lymphocytes (T cells). Lymphomas are classified according to which cell type they are with skin lymphomas divided into either B or T cell lymphomas. Cutaneous T-cell lymphomas make up 75 to 80 percent of cutaneous lymphomas. Most CTCLs are indolent (slow growing) and not life threatening. The two most common CTCLs are:

  • Mycosis Fungoides: Mycosis fungoides (MF) makes up about half of all cutaneous lymphoma cases. It tends to show up as flat, scaly, red lesions called patches; thicker, raised lesions called plaques; and raised lumps called tumors. In the early stages, MF can be easily confused with other skin problems, such as eczema, psoriasis, or dermatitis, making it difficult to diagnose.
  • Sezary Syndrome: With this condition, patients develop a red rash that covers almost the entire body (called erythroderma). Unlike other types of CTCLs, which affect only the skin, Sezary syndrome affects both the skin and the blood. Lymphoma cells called Sezary cells are found in the skin and the blood, and lymph nodes are often enlarged. Sezary syndrome tends to grow and spread faster than mycosis fungoides. It is also more difficult to treat.
Other types of CTCL include:
  • Lymphoproliferative Disorders: This group includes Primary Cutaneous CD30-Positive disease and its two main subtypes, lymphomatoid papulosis (LyP) and primary cutaneous anaplastic large cell lymphoma (C-ALCL); along with Lymphomatoid Papulosis and Primary Cutaneous Anaplastic Large Cell Lymphoma.
  • Subcutaneous Panniculitis-Like T Cell Lymphoma
  • Primary Cutaneous Peripheral T Cell Lymphoma, Unspecified
  • Primary Cutaneous Aggressive Epidermotropic CD8+ Cytotoxic T Cell Lymphoma
  • Primary Cutaneous Gamma/Delta T-Cell Lymphoma
  • Primary Cutaneous CD4+ Small/Medium Sized Pleomorphic T Cell Lymphoma

Cutaneous B cell lymphomas

Cutaneous B cell lymphomas (CBCLs) are much rarer than cutaneous T-cell lymphomas and make up about 20 to 25 percent of cutaneous lymphomas. More common systemic B cell lymphomas, such as Hodgkin’s disease, can spread to the skin and mimic a CBCL. The three main types of CBCL are:
  • Primary Cutaneous Marginal Zone B Cell Lymphoma
  • Primary Cutaneous Follicle-Center Lymphoma
  • Primary Cutaneous Diffuse Large B Cell Lymphoma, Leg Type
More detailed information about skin lymphoma may be found at the American Cancer Society and Leukemia and Lymphoma Society websites.

What continues to inspire me each and every day is being able to put all of these pieces together, almost like a puzzle, to pinpoint the proper diagnosis and determine the right treatment regimen." Christiane Querfeld, M.D., director, Cutaneous Lymphoma Program

Cutaneous lymphomas include a large group of cancers with overlapping features — and since every patient’s disease looks different, getting an accurate diagnosis can be the most challenging part of treatment. The difference between skin lymphomas is subtle and may be difficult to distinguish some from other skin problems. For these reasons treatment at City of Hope begins with leading-edge diagnostics, performed by dermatopathologists who are versed about the entire spectrum of this disease.

How cutaneous lymphoma is diagnosed

Skin lymphoma diagnosis begins with a complete physical examination, which includes a comprehensive skin exam. To arrive at the most accurate diagnosis and staging — and ultimately the best treatment — we perform tests that include:

  • Blood testing to measure levels of substances in the blood, such as white blood cells and cells specific to certain skin lymphomas, such as Sezary cells.
  • Skin biopsy, which involves removing a small sliver of tissue and examining it under a microscope.
  • PET-CT scans

We perform several tests on the tissue to arrive at the most accurate diagnosis. Other diagnostic tests that may be performed include:

  • Molecular testing: Determining whether a growth is benign or cancerous is a subtle process, requiring a trained eye and deep experience. As part of the diagnostic process, our specially trained dermatopathologist performs wide-ranging, leading-edge molecular testing for the most accurate diagnosis, including FISH analysis (fluorescent in situ hybridization)
  • Bone marrow aspiration and biopsy, taking a small sample of marrow cells from inside the bone and looking at them under a microscope
  • Lymph node biopsy, involving removing a small sample of the lymph node using a thin, hollow needle or removing the entire node


 

CTCL patients have the unique challenge of having their disease on the “outside” of their body, affecting their appearance, their life and even their relationships... and they have to continue to function in spite of it. Some of the most rewarding transplant outcomes for me have been with CTCL patients who have gone on to live normal lives." Jasmine Zain, M.D., director, T Cell Lymphoma Program

Diagnosis, treatment and cure rates for lymphoma are improving every year, and research at City of Hope has helped to fuel those trends and improve outcomes among our patients.

Leading-edge clinical trials, collaborations with a large network of institutions and our designation as a lymphoma Specialized Program of Research Excellence provide our patients with exciting new treatment options. And City of Hope’s unique ability to produce and manufacture the agents being developed by our investigators means treatments get to our patients faster.

Experts in cutaneous lymphoma

Cutaneous lymphomas are rare diseases — most physicians see very few cases in their lifetime. City of Hope is one of the only cancer centers in the country with skin lymphoma experts, who saw and treated over {INSERT NUMBER} in 2016 alone. They have helped develop treatment guidelines and are pioneering modern therapies for:

  • Cutaneous T cell lymphoma
  • Follicle center lymphoma
  • Marginal zone B cell lymphoma
  • Diffuse large B cell lymphomas of the leg and other areas

These are some of the most difficult lymphomas to diagnose since they resemble other common skin conditions like eczema, psoriasis and ringworm. Our team includes dermatopathologists able to discern subtle differences between skin lymphoma subtypes, and are responsible for developing groundbreaking skin-directed and light therapies used to treat them once they are diagnosed.

Treatments for cutaneous lymphoma

Treatment for skin lymphomas depends on how widespread the disease is. If lymphoma is confined to the skin, a variety of skin-directed treatments may be used, including phototherapy, topical nitrogen mustard (a topical chemotherapy) and radiation therapy — some of which may be combined with systemic medications that can attack the lymphoma from the inside to complement the effect. Some of these treatments include:

  • Light therapy: Light therapy — a mainstay of treatment for cutaneous lymphoma — uses ultraviolet light to kill malignant (cancerous) cells in the skin, along with other cells that may be contributing to the growth of skin lymphoma cells. These cells are sensitive to light therapy and eventually die off.
  • Radiation: Radiation therapy uses high-energy radiation to kill cancer cells and shrink tumors. It is an effective treatment for skin lymphoma and often is paired with other treatments. City of Hope offers advanced radiation treatments that are highly targeted to cancer cells while protecting the surrounding normal tissue. The most common form of radiation therapy for skin lymphoma is electron beam radiation.
  • Topical treatments: Drugs that are applied directly to the skin are called topical treatments. These range from topical corticosteroids and retinoids, to topical chemotherapy and immune therapy drugs.
  • Systemic therapies: These include medications, that can be given orally, subcutaneously or intravenously, to attack lymphoma cells from within the body. Most cases are treated using biologic agents, immune modifiers such as interferon, agents that work to repair genetic abnormalities in cancer cells, immune modifiers and a whole slate of targeted agents being tested as part of our clinical trials program.
  • Extracorporeal photopheresis: A procedure that involves extracting blood from the patient and exposing it to light, in order to induce death in malignant cells.
  • Stem cell transplantation: For patients with recurrent or particularly aggressive disease, transplantation may be a treatment option. City of Hope uses innovative approaches for stem cell and bone marrow transplantation to treat advanced skin lymphomas. We offer reduced intensity stem cell transplants and have approaches to minimize toxicity. Our center performs transplants using stem cells from various sources, including siblings and other family members, cord blood and unrelated donors, depending on availability and the match with the patient.
  • Clinical trials: We are at the forefront of developing new therapies for the treatment of cancer — and skin lymphomas are no exception. City of Hope was involved in pivotal trials for newer agents such as pralatrexate and brentuximab vedotin and our researchers continue to explore new molecular pathways for the treatment of cutaneous lymphomas.

City of Hope provides every patient with comprehensive care — each with an experienced team, including dermatologists, oncologists and dermatopathologists, that convenes regularly to drive decisions about their care.

City of Hope’s renowned physicians and researchers use the latest in technology and innovation to treat cutaneous lymphoma, coupled with an enduring belief in providing unparalleled compassionate care.

Dermatology

Christiane Querfeld, M.D., Ph.D.

Clinical Specialties

  • Dermatology
  • Dermatopathology

Hematology/Oncology

Steven T. Rosen, M.D.

Clinical Specialties

  • Hematology/Oncology
Jasmine M. Zain, M.D.

Clinical Specialties

  • Hematology/Oncology

Radiation Oncology

Savita Dandapani, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

Research

Clinical trials – research studies that involve volunteer patients – are a crucial component to developing new, more effective treatments that save lives. Many of today’s standard therapies are based on the results of previous trials, some of which were initiated at City of Hope.

Cutaneous lymphoma research at City of Hope is focused on developing and discovering new treatments to improve prognosis and outcomes for our patients. Clinical investigations we are leading include efforts to better understand the tumor microenvironment — the interaction between tumor and other cells that foster cancer growth — and finding new targets and developing new therapies aimed at finding a cure. We are testing dozens of new therapies and combinations for lymphoma patients developed and manufactured in City of Hope’s own on-campus labs. Our current open trials include:
 
IRB 15157: A Prospective, Observational, US-Based Study Assessing Outcomes, Adverse Events, Treatment Patterns, and Quality of Life in Patients Diagnosed with Mycosis Fungoides Cutaneous T-Cell Lymphoma and Treated with Valchlor®.
 
PHASE I

IRB 16273: A Dose Escalation Trial of Intratumoral Injections of TTI-621 in Subjects with Relapsed and Refractory Percutaneously-Accessible Solid Tumors and Mycosis Fungoides.

IRB 15270: A Dose-Ranging Study to Investigate the Safety, Tolerability, and Pharmacokinetics of MRG-106 Following Local Intratumoral and Subcutaneous Injection in Patients with Cutaneous T-Cell Lymphoma (CTCL), Mycosis Fungoides (MF) Sub-Type.
 
IRB 15165: A Study Evaluating Safety, Tolerability, and Pharmakinetics of Escalating Doses or AGS67E Given as Monotherapy in Subjects with Refractory or Relapsed Lymphoid Malignancies.

IRB 14349: A Study of Yttrium-90 Labeled Anti-CD25 Monoclonal Antibody Plus Standard BEAM Conditioning for Autologous Hematopoietic Cell Transplantation in Patients with Mature T-Cell Non-Hodgkin Lymphoma: the aTAC-BEAM Regimen.
 
PHASE I / IIA
 
IRB 16221: Durvalumab With or Without Lenalidomide in Treating Patients With Relapsed or Refractory Cutaneous or Peripheral T Cell Lymphoma

IRB 16257: An Open-Label Study to Determine the Safety and Tolerability of ALRN-6924 in Patients with Advanced Solid Tumors of Lymphomas Expressing Wild-Type p53 Protein.
 
PHASE I / IB

IRB 15428: A Dose Escalation Study to Evaluate Safety and Efficacy of RP6530, a Dual P13K Delta/Gamma Inhibitor, in Patients with Relapsed or Refractory T-cell Lymphoma.
 
PHASE II

IRB 16042: A Trial of Intravenous Fenretinide (N-(4-hydroxyphenyl) Retinamide, 4-HPR) Emulsion for Patients with Relapsed/Refractory Peripheral T-cell Lymphomas (PTCL).

IRB 14321: A Single-Arm, Open-Label, Multicenter, Study of Folotyn® (Pralatrexate Injection) in Combination with Oral Leucovorin to Prevent or Reduce Mucositis in Patients with Relapsed or Refractory (R/R) Peripheral T-Cell Lymphoma (PTCL).

IRB 14290: A Study of Romidepsin Plus Lenalidomide for Patients with Previously Untreated PTCL
 
 
PHASE III

IRB 15122: A Multicenter, Randomized, Double-Blind, Placebo Controlled Study to Determine the Efficacy of Topical SGX301 (Synthetic Hypericin) and Fluorescent Bulb-Light Irradiation for the Treatment of Cutaneous T-Cell Lymphoma.
        
IRB 14338: A Randomized, Double-Blind, Placebo-Controlled Study of Brentuximab Vedotin and CHP (A+CHP) Versus CHOP in the Frontline Treatment of Patients with CD30-Positive Mature T-cell Lymphomas.
 
For more information on a specific clinical trial, please call 626-218-1133. For a full listing of clinical trials, visit clinicaltrials.coh.org.
 

Fellowship

Living with cutaneous lymphoma

When you come to City of Hope, you have access to a strong network of support services and staff to help you and your family along your cancer journey. That support is an integral part of your care and includes everything from financial counseling to talk therapy to meditation to being paired up with a patient navigator.

We can help with all of the following concerns, and more:

  • Managing pruritus
  • Managing pain
  • Wound care
  • Your emotional, social and spiritual well-being
  • Poor appetite and trouble eating/drinking
  • Adjusting to new diet and lifestyle habits
  • Palliative care
  • Staying healthy and active
  • Healthy cooking and eating
  • Healing arts
  • Caregiver skills
  • Dealing with family, school and work stress
  • Navigating the health care system

Learn more about these resources by visiting our Living with Cancer or Supportive Care Medicine sites.

Join a community of people who understand what you’re going through

The Leukemia & Lymphoma Society’s community is an online community of people living with or supporting someone with blood cancer. Get connected and share your voice to drive change.

Support the cutaneous lymphoma program

We deliver exquisite care at the leading-edge of lymphoma cancer treatment. It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts over 100 years ago. Their efforts - and those of our supporters today - have built the foundation for the care we provide and the research we conduct.

For more information about supporting the skin lymphoma program, please contact:

Julie Hara
Direct: 626-218-0869
[email protected]

Amy M. Cook, Ph.D.
Direct: 626-218-6228
Email: [email protected]

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