10.5826/dpc.1304a227
text/xml
2160-9381
3220
en
Nicola Pimpinelli
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Abscopal Effect After Localized Radiotherapy in a Patient With Sezary Syndrome Under Treatment with Mogamulizumab
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-10-31
2023-02-06
2023-10-31
2024-01-15
e2023227
Dermatol Pract Concept
Nicola Pimpinelli
2023/10/31
10.5826/dpc.1304a227
e2023227
Department of Health Sciences, Section of Dermatology, University of Florence, P. Palagi Hospital, Florence, Italy
2160-9381
en
e2023227
Kim YH, Bagot M, Pinter-Brown L, et al. Mogamulizumab versus vorinostat in previously treated cutaneous T-cell lymphoma (MAVORIC): an international, open-label, randomised, controlled phase 3 trial. Lancet Oncol 2018;19:1192–204.
Abscopal Effect After Localized Radiotherapy in a Patient With Sezary Syndrome Under Treatment with Mogamulizumab
https://dpcj.org/index.php/dpc/article/download/3220/2403
         Abscopal Effect After Localized Radiotherapy
           in a Patient With Sezary Syndrome Under
                Treatment with Mogamulizumab
              Vieri Grandi1, Isabella Ciardetti1, Andrea Gemignani1, Eleonora Gherardi1,
                                 Tommaso Grassi2, Nicola Pimpinelli1


1 Department of Health Sciences, Section of Dermatology, University of Florence, P. Palagi Hospital, Florence, Italy
2 Public Health, Hygiene and Preventive Medicine Unit, P. Palagi Hospital, Florence, Italy



Citation: Grandi V, Ciardetti I, Gemignani A, Gherardi E, Grassi T, Pimpinelli N. Abscopal Effect After Localized Radiotherapy in a Patient
with Sezary Syndrome Under Treatment with Mogamulizumab. Dermatol Pract Concept. 2023;13(4):e2023227. DOI: https://doi
.org/10.5826/dpc.1304a227
Accepted: April 5, 2023; Published: October 2023
Copyright: ©2023 Grandi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Grandi Vieri, Department of Health Sciences, Section of Dermatology, University of Florence, P. Palagi Hospital,
Viale Michelangelo 41, 50141, Florence, Italy. Email: Vieri.grandi@unifi.it




Case Presentation                                                         Teaching Point
A 50-year-old lady with Sezary Syndrome (stage IVA1), di-                 The abscopal effect refers to an uncommon activation of the
agnosed 2 years before, had been treated previously with                  immune system secondary to radiotherapy that may lead to
extracorporeal photophoresis + Interferon-alfa, metho-                    clinical responses in areas far from the irradiation site [1].
trexate, and gemcitabine. After 12 months, we introduced                  Mogamulizumab is a defucosylated, humanized IgG1
mogamulizumab i.v. After 6 cycles, she achieved a partial                 kappa immunoglobulin selective against CC Receptor type
response in the skin, with only a large thick plaque residual             4 (CCR4). It binds directly to CCR4 expressed on tumor
on the back (modified Severity Assessment Tool, mSWAT                     cells, yet it is also known to exert indirect immune-­mediated
= 8), and a complete response in the blood. After two                     antitumor effects via inhibition of CCR4 on Tregs [2]. Rapid
months, her disease progressed with bulky nodal involve-                  lysis of tumor cells induced by radiotherapy, alongside the
ment in the right cervical basin (IVA2), treated with pallia-             positive immune activation induced by mogamulizumab,
tive surgery. Subsequently, she developed a rapidly growing               might explain the impressive response obtained in a large,
tender mass on the occiput. We decided to treat it with elec-             refractory skin plaque in our patient. We believe that mog-
tron radiotherapy (15 Gy in 5 fractions), obtaining rapid                 amulizumab combined with radiotherapy is an interesting
local control. After a few weeks from the scalp irradiation,              approach in patients with cutaneous T-cell lymphoma, yet
the large plaque on the back disappeared, leaving a hyper-                further studies are needed in order to better explain the re-
pigmented area.                                                           ported abscopal effect.



Image Letter | Dermatol Pract Concept. 2023;13(4):e2023227                                                                               1
Figure 1. Clinical photos of a 50-year-old lady affected by Sezary Syndrome with mogamulizumab-refractory skin lesions. A) Rapidly grow-
ing, painful tumor mass on the scalp. B) Same lesion, 45 days after electron-beam radiotherapy (15 Gy in 5 fractions). C) Large infiltrated,
pruritic plaque on the back. D) Asymptomatic, post-­inflammatory hyper- and hypopigmented macules as result of the complete spontaneous
resolution of the lesion




References                                                               2. Kim YH, Bagot M, Pinter-Brown L, et al. Mogamulizumab ver-
                                                                            sus vorinostat in previously treated cutaneous T-cell lymphoma
 1. Yilmaz MT, Elmali A, Yazici G. Abscopal Effect, From Myth               (MAVORIC): an international, open-label, randomised, con-
    to Reality: From Radiation Oncologists’ Perspective. Cureus             trolled phase 3 trial. Lancet Oncol 2018;19:1192–204.Image
    2019;11:e3860.                                                          Letter




2                                                                              Image Letter | Dermatol Pract Concept. 2023;13(4):e2023227
