title: Aggressive cutaneous T-cell lymphomas after TNFalpha blockade.
abstract: Pharmacologic blockade of TNFalpha has been a highly effective approach to treating several immunologically mediated diseases, including rheumatoid arthritis, Crohn's disease, and psoriatic arthritis. 1,2,3 Both etanercept, the recombinant extracellular domain of the tumor necrosis factor receptor 2 (TNFR2), and infliximab, a humanized murine antibody, bind TNFalpha and block its interaction with cell surface receptors. Recently, it has become clear that blockade of TNFalpha action is profoundly immunosuppressive, and may result in reactivation of tuberculosis and histoplasmosis, as well as the emergence of B-cell lymphomas. 4,5,6 In this report, we describe two cases of cutaneous and systemic T-cell lymphoma that progressed rapidly in the setting of TNFalpha blockade. Both cases were characterized by rapid onset, a fulminant clinical course with extensive cutaneous and systemic involvement, and death within months of diagnosis.
authors.affiliation: Department of Dermatology at Harvard Medical School, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Adams
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Zwicker
authors.forename: Clara
authors.initials: C
authors.lastname: Curiel
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Kadin
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Falchuk
authors.forename: Reed
authors.initials: R
authors.lastname: Drews
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Kupper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003424:Crohn Disease / Q000175:diagnosis; D003520:Cyclophosphamide / Q000008:administration & dosage; D003586:Cytomegalovirus Infections; D003937:Diagnosis, Differential; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D005756:Gastritis / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D016399:Lymphoma, T-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use*; D011241:Prednisone / Q000008:administration & dosage; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014409:Tumor Necrosis Factor-alpha; D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate