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      Relief of intractable pruritus with romidepsin in patients with cutaneous T cell lymphoma: A series of four cases

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          Abstract

          Cutaneous T‐cell lymphomas (CTCL) are a relatively rare and heterogeneous group of non‐Hodgkin lymphomas that typically present in the skin. The majority of patients with CTCL experience pruritus, which can interfere with daily activities, significantly impact quality of life, and is typically uncontrolled by standard anti‐itch therapies. Several lymphoma treatments have reported anti‐pruritic effects including romidepsin, a potent class 1 selective histone deacetylase inhibitor approved for the treatment of patients with CTCL who have had at least one prior systemic therapy. Here, we describe the cases of four patients with debilitating and refractory pruritus that were resolved with romidepsin. Resolution of pruritus was observed in both clinical responders and nonresponders, and dose modification was used successfully to manage adverse events and for maintenance treatment. The potential for pruritus relief with romidepsin should be considered when treating patients with CTCL.

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          Most cited references9

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          Mechanism of action of lenalidomide in hematological malignancies

          Immunomodulatory drugs lenalidomide and pomalidomide are synthetic compounds derived by modifying the chemical structure of thalidomide to improve its potency and reduce its side effects. Lenalidomide is a 4-amino-glutamyl analogue of thalidomide that lacks the neurologic side effects of sedation and neuropathy and has emerged as a drug with activity against various hematological and solid malignancies. It is approved by FDA for clinical use in myelodysplastic syndromes with deletion of chromosome 5q and multiple myeloma. Lenalidomide has been shown to be an immunomodulator, affecting both cellular and humoral limbs of the immune system. It has also been shown to have anti-angiogenic properties. Newer studies demonstrate its effects on signal transduction that can partly explain its selective efficacy in subsets of MDS. Even though the exact molecular targets of lenalidomide are not well known, its activity across a spectrum of neoplastic conditions highlights the possibility of multiple target sites of action.
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            IL-31 Is Produced by the Malignant T-Cell Population in Cutaneous T-Cell Lymphoma and Correlates with CTCL Pruritus

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              Cutaneous T-cell Lymphoma and Pruritus: The Expression of IL-31 and its Receptors in the Skin.

              Approximately 88% of cutaneous T-cell lymphoma (CTCL) patients are affected by pruritus that responds poorly to current antipruritic therapies. Interleukin (IL)-31, a Th2 cytokine, has been found to be increased in the serum of CTCL patients and to correlate with itch severity. This study investigated the role of IL-31 and its receptors (IL-31 receptor-alpha [IL-31RA] and OSMRβ) in the skin of CTCL patients with mild versus moderate/severe pruritus. Expression levels of IL-31, IL-31RA, and OSMRβ in the skin were measured using immunohistochemistry and correlated to pruritus severity and disease stage. In CTCL patients with moderate/severe pruritus, IL-31 was significantly elevated in the epidermis and dermal infiltrate, while IL-31RA and OSMRβ were significantly elevated only in the epidermis. Furthermore, epidermal IL-31 levels correlated to itch severity. These results show that IL-31 may play a role in CTCL pruritus by exerting indirect effects on sensory nerves through epidermal neoplastic T cells and keratinocytes to transmit itch.
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                Author and article information

                Contributors
                bpoligone@roclymphoma.com
                Journal
                Dermatol Ther
                Dermatol Ther
                10.1111/(ISSN)1529-8019
                DTH
                Dermatologic Therapy
                John Wiley & Sons, Inc. (Hoboken, USA )
                1396-0296
                1529-8019
                04 January 2019
                Mar-Apr 2019
                : 32
                : 2 ( doiID: 10.1111/dth.v32.2 )
                : e12804
                Affiliations
                [ 1 ] Rochester Skin Lymphoma Center Fairport New York
                [ 2 ] City of Hope Comprehensive Cancer Center, Cutaneous Lymphoma Program Toni Stephenson Lymphoma Center Duarte, California
                Author notes
                [*] [* ] Correspondence

                Brian Poligone, Rochester Skin Lymphoma Center, 6800 Pittsford‐Palmyra Road Suite 150, Fairport, New York 14450.

                Email: bpoligone@ 123456roclymphoma.com

                Author information
                https://orcid.org/0000-0002-4822-0534
                Article
                DTH12804
                10.1111/dth.12804
                6590428
                30549384
                9579654c-3d66-4cc5-b835-6bf382109a32
                © 2018 The Authors. Dermatologic Therapy published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 07 August 2017
                : 20 July 2018
                : 28 November 2018
                Page count
                Figures: 2, Tables: 0, Pages: 4, Words: 2182
                Funding
                Funded by: Leukemia Lymphoma Society (LLS), Stop Cancer Foundation and Celgene
                Categories
                Therapeutic Hotline: Short Paper
                Therapeutic Hotline: Short Papers
                Custom metadata
                2.0
                dth12804
                March/April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:24.06.2019

                cutaneous t‐cell lymphoma,lenalidomide,pruritus,romidepsin

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