Clinical Staging and Prognostic Factors in Folliculotropic Mycosis Fungoides.
Large case series suggest that patients with folliculotropic mycosis fungoides (FMF) have a worse prognosis than patients with classic mycosis fungoides (MF). However, recent studies described a subgroup of patients with FMF with a more favorable prognosis. Distinction between indolent and aggressive FMF may have important therapeutic consequences but is hampered by the inability of the current tumor-node-metastasis-blood (TNMB) staging system to classify patients with FMF in a clinically meaningful way.



To differentiate between indolent and aggressive FMF using clinicopathological criteria and to define prognostic factors in patients with FMF.



In this prospective cohort study, we followed 203 patients with FMF, included in the Dutch Cutaneous Lymphoma Registry between October 1985 and May 2014 at a tertiary referral center hosting the Dutch Cutaneous Lymphoma Registry. Overall, 220 patients with FMF had been registered, but 17 patients with incomplete follow-up data or a history of classic MF were excluded.



Main outcomes included clinical and histological characteristics, disease progression, and survival. Prognostic factors were investigated using Cox proportional hazard regression analysis. Distinction between early plaque-stage FMF and advanced plaque-stage FMF was made by a blinded review of skin biopsy specimens from patients presenting with plaques.



In a cohort of 147 men and 56 women (median [range] age, 59 [15-93] years), patients with histologically early plaque-stage FMF had a very similar overall survival (OS) rate to patients with only patches and/or follicular papules (10-year OS, 71% vs 80%), while the survival rate of patients with histologically advanced plaque-stage FMF was almost identical to that of patients presenting with tumors (10-year OS, 25% vs 27%). Subsequently, 3 clinical subgroups with significantly different survival data were distinguished: early skin-limited FMF (group A; n = 84; 5-year and 10-year OS, 92% and 72%); advanced skin-limited FMF (group B; n = 102; 5-year and 10-year OS, 55% and 28%); and FMF presenting with extracutaneous disease (group C; n = 17; 5-year and 10-year OS, 23% and 2%). Age at diagnosis, large cell transformation and secondary bacterial infection were independent risk factors for disease progression and/or poor survival.



The results of this study provide useful criteria to differentiate between indolent and aggressive FMF and confirm the existence of a subgroup of FMF with a favorable prognosis.
Department of Dermatology, Leiden University Medical Center, the Netherlands.
Suzanne
S
van Santen
Department of Dermatology, Leiden University Medical Center, the Netherlands.
Rachel E J
RE
Roach
Department of Dermatology, Leiden University Medical Center, the Netherlands.
Remco
R
van Doorn
Department of Dermatology, University Medical Center of Groningen, the Netherlands.
Barbara
B
Horváth
Department of Dermatology, University Medical Center of Groningen, the Netherlands.
Marjolein S
MS
Bruijn
Department of Dermatology, University Medical Center Utrecht, the Netherlands.
Cornelus J G
CJ
Sanders
Department of Dermatology, University Medical Center Utrecht, the Netherlands.
Jacco C
JC
de Pooter
Department of Dermatology, Radboud University Medical Center, Nijmegen, the Netherlands.
Michelle M
MM
van Rossum
Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.
Ellen R M
ER
de Haas
Department of Dermatology, Maastricht University Medical Center, the Netherlands.
Joep C J M
JC
Veraart
Department of Dermatology, Academic Medical Center and Vrije University Medical Center, Amsterdam, the Netherlands.
Marcel W
MW
Bekkenk
Department of Dermatology, Leiden University Medical Center, the Netherlands.
Maarten H
MH
Vermeer
Department of Dermatology, Leiden University Medical Center, the Netherlands.
Rein
R
Willemze
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications; D018450:Disease Progression; D005260:Female; D018859:Hair Follicle / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000150:complications / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012535:Scalp; D012878:Skin Neoplasms / Q000150:complications / Q000473:pathology*; D015996:Survival Rate; D055815:Young Adult