Mogamulizumab- induced granulomatous eruption of the scalp: a distinct entity associated with clinical response?
Poster
Mogamulizumab is an anti-CC chemokine receptor 4 (CCR4) monoclonal antibody, recently approved for the treatment for cutaneous T cell lymphomas (CTCL): mycosis fungoïdes (MF) and Sézary syndrome (SS). Mogamulizumab has been associated with a variety of cutaneous adverse events. Here we report 6 cases of patients presenting similar eruptions on the scalp, diagnosed as mogamulizumab induced skin side effect.
Among 25 patients treated with Mogamulizumab for CTCL in two referral centers, we observed 6 patients presenting with similar skin plaques on the scalp and alopecia. The patients were aged from 57 to 71 years, 3 were treated for erythrodermic MF with B1 stage and 3 had SS, all received a median number of 3 previous systemic therapies, range :[1-4]. In these 6 patients, we observed the development of thick, erythematous, infiltrated and scaly patches, with alopecia in 5 out 6 cases, limited to the scalp and peri-auricular area, without pruritus. These manifestations started after 5 to 48 months (median: 6 months) of mogamulizumab treatment. Cutaneous lymphoma location was the main hypothesis in all cases, but skin biopsies showed polymorphous inflammatory infiltrate composed of granulomatous infiltrate with some giant cells, eosinophils, lymphocytes especially with periadnexal location, polyclonal in 4 / 4 available cases. Different therapies were proposed: clobetasol, doxycycline, and intralesional corticoids, and hydroxychloroquine for one patient, resulting in moderate or no improvement. All these patients achieved a complete response in skin, blood and nodes at the time of the side effect occurrence. At last evaluation, all these patients but one (relapsed after mogamulizumab discontinuation) were in complete response either with mogamulizumab continuation or not.
Cutaneous side effects are frequent as shown in MAVORIC study and other recent reports. Granulomatous skin lesions under mogamulizumab have been described, these eruptions may mimic MF with erythematous, well limited erythematous plaques on the trunk or limbs. However, cases of scalp damage with scarring alopecia, mimicking folliculotropic MF have not been described so far. This mogamulizumab-induced granulomatous eruption has distinctive clinical and histological features and seems to be associated with long-term clinical response. However, skin biopsies have to be performed in order to rule out disease progression.
Among 25 patients treated with Mogamulizumab for CTCL in two referral centers, we observed 6 patients presenting with similar skin plaques on the scalp and alopecia. The patients were aged from 57 to 71 years, 3 were treated for erythrodermic MF with B1 stage and 3 had SS, all received a median number of 3 previous systemic therapies, range :[1-4]. In these 6 patients, we observed the development of thick, erythematous, infiltrated and scaly patches, with alopecia in 5 out 6 cases, limited to the scalp and peri-auricular area, without pruritus. These manifestations started after 5 to 48 months (median: 6 months) of mogamulizumab treatment. Cutaneous lymphoma location was the main hypothesis in all cases, but skin biopsies showed polymorphous inflammatory infiltrate composed of granulomatous infiltrate with some giant cells, eosinophils, lymphocytes especially with periadnexal location, polyclonal in 4 / 4 available cases. Different therapies were proposed: clobetasol, doxycycline, and intralesional corticoids, and hydroxychloroquine for one patient, resulting in moderate or no improvement. All these patients achieved a complete response in skin, blood and nodes at the time of the side effect occurrence. At last evaluation, all these patients but one (relapsed after mogamulizumab discontinuation) were in complete response either with mogamulizumab continuation or not.
Cutaneous side effects are frequent as shown in MAVORIC study and other recent reports. Granulomatous skin lesions under mogamulizumab have been described, these eruptions may mimic MF with erythematous, well limited erythematous plaques on the trunk or limbs. However, cases of scalp damage with scarring alopecia, mimicking folliculotropic MF have not been described so far. This mogamulizumab-induced granulomatous eruption has distinctive clinical and histological features and seems to be associated with long-term clinical response. However, skin biopsies have to be performed in order to rule out disease progression.