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Mogamulizumab: a new tool for management of cutaneous T-cell lymphoma

Authors Ollila TA, Sahin I, Olszewski AJ

Received 27 November 2018

Accepted for publication 18 January 2019

Published 7 February 2019 Volume 2019:12 Pages 1085—1094


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Takuya Aoki

Thomas A Ollila,1,2 Ilyas Sahin,1,2 Adam J Olszewski1,2

1Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; 2Department of Medicine, Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA

Abstract: Cutaneous T-cell lymphoma (CTCL) poses unique treatment challenges, given its range of presentations and numerous systemic therapy options. These options often lack comparative evidence or are characterized by low response rates and short remission duration in relapsed/refractory disease. The approval of mogamulizumab, a humanized, glycoengineered IgG1κ monoclonal antibody targeting the chemokine receptor type 4 (CCR4) chemokine receptor, brings a novel tool into the spectrum of treatment options for advanced CTCL and adult T-cell leukemia/lymphoma (ATLL). CCR4 is expressed in almost all cases of ATLL, and in a majority of CTCLs, particularly when blood involvement is present. In a Phase III randomized trial, mogamulizumab was associated with 28% overall response rate among patients with relapsed CTCL, median progression-free survival of 7.7 months, and median duration of remission of 14.1 months. Responses are more frequent among patients with Sézary syndrome and within the blood compartment. Common adverse effects include rash and infusion reactions, which are usually low grade. Sentinel reports indicate that exposure to mogamulizumab may result in severe or refractory graft vs host disease after allogeneic bone marrow transplantation, highlighting the need for vigilance and expert management. Further research may establish incremental efficacy of combining mogamulizumab with cytotoxic or immunomodulatory agents in CTCL, ATLL, and possibly other lymphomas and even solid tumors.

Keywords: cutaneous T-cell lymphoma, mogamulizumab, CCR4, adult T-cell leukemia, lymphoma, Sezary syndrome, mycosis fungoides

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