Abstract
Mycosis fungoides (MF) and Sézary syndrome are primary cutaneous T-cell lymphomas with widely varying courses of disease and prognosis. Here, we report the case of a patient with MF with blood involvement who experienced many lines of skin-directed and systemic therapies throughout their disease course. The male patient presented with scaly, itchy, and painful patches on his trunk and upper extremities in 2012 and was diagnosed with MF, which progressed to erythroderma with blood involvement. Various skin-directed therapies were prescribed; however, in 2014, progression of skin lesions ensued. The patient achieved a partial response with methotrexate but discontinued after ~12 months due to elevated transaminases. Following treatment with bexarotene then gemcitabine, CHOP chemotherapy was initiated in December 2019, but, after a period of partial skin response, the patient relapsed with progression of skin lesions. Mogamulizumab was initiated in May 2020 (1 mg/kg intravenously on days 1, 8, 15, and 22 of the first 28-day cycle, then on days 1 and 15 of subsequent cycles) with a good initial response in skin and blood. Disease progression in the skin occurred in December 2020; mogamulizumab was continued, and the patient achieved remission with the addition of etoposide and prednisone in August 2021. Onset of progression occurred in July 2022, which did not respond to repeat combination treatment. In October 2022, the patient was diagnosed with large cell CD30(+) transformation, and the therapeutic approach was changed to extracorporeal photopheresis, brentuximab vedotin, and topical steroids. The patient died in February 2023 due to sepsis. Our experience adds to the limited evidence that mogamulizumab may be continued in combination with etoposide following disease progression in patients with MF with blood involvement; however, more research is needed on the efficacy and safety of this approach.