title: Systemic therapy for cutaneous T-cell lymphoma: who, when, what, and why?
abstract: CTCL are rare neoplasms. Optimal care requires integrated use of diagnostic and treatment modalities spanning multiple specialties. Current instruments for patient risk stratification and disease measurement across all anatomical compartments are suboptimal. A common treatment dichotomy between early (Dermatology) and advanced stage (Hematology-Oncology) has hindered accrual of long term outcome data. Thus, important facts about natural history, such as frequency and determinants of stage progression, and the impact of specific treatment modalities on these endpoints, are not known. Areas covered: One of the most important decisions in the management of CTCL is when to start systemic therapy and what agents to use. This review provides background information to understand why systemic therapy is needed and what goals are currently achievable. Expert commentary: Risk-adapted approaches, based on better knowledge of host and tumor biology, and more accurate disease measurement tools are needed to optimize the use of specific systemic therapies.
authors.affiliation: a Department of Medicine, Dermatology Service , Memorial Sloan Kettering Cancer Center , New York , NY , USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Virmani
authors.affiliation: b Department of Internal Medicine, Division of Hematology , The Ohio State University , Columbus , OH , USA.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Hwang
authors.affiliation: c Department of Internal Medicine, Division of Dermatology , The Ohio State University , Columbus , OH , USA.
authors.forename: Justin G
authors.initials: JG
authors.lastname: Hastings
authors.affiliation: d Department of Hematology , University of Colorado , Aurora , CO , USA.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Haverkos
authors.affiliation: e Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA.|f Department of Veterinary Biosciences , Ohio State University , Columbus , OH , USA.
authors.forename: Becca
authors.initials: B
authors.lastname: Kohnken
authors.affiliation: g Department of Pathology , University of Virginia , Charlottesville , VA , USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Gru
authors.affiliation: c Department of Internal Medicine, Division of Dermatology , The Ohio State University , Columbus , OH , USA.|e Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA.
authors.forename: Anjali
authors.initials: A
authors.lastname: Mishra
authors.affiliation: c Department of Internal Medicine, Division of Dermatology , The Ohio State University , Columbus , OH , USA.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Fabbro
authors.affiliation: h Department of Medicine, Lymphoma Service , Memorial Sloan Kettering Cancer Center , New York , NY , USA.
authors.forename: Steve M
authors.initials: SM
authors.lastname: Horwitz
authors.affiliation: b Department of Internal Medicine, Division of Hematology , The Ohio State University , Columbus , OH , USA.|e Comprehensive Cancer Center , The Ohio State University , Columbus , OH , USA.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Porcu
mesh_terms: D035843:Biomedical Research; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D009367:Neoplasm Staging; D018570:Risk Assessment; D059039:Standard of Care; D016896:Treatment Outcome
keywords: CTCL; Sezary syndrome; mycosis fungoides; outcomes; staging; systemic therapy