Unrelated immunodeficiency states may impact outcomes and immune checkpoint molecule expression in patients with mycosis fungoides: A clinicopathologic case-control study Journal Article


Authors: Warren, S.; Kheterpal, M.; Myskowski, P. L.; Moskowitz, A.; Horwitz, S. M.; Pulitzer, M. P.
Article Title: Unrelated immunodeficiency states may impact outcomes and immune checkpoint molecule expression in patients with mycosis fungoides: A clinicopathologic case-control study
Abstract: Background: Immunodeficiency (ID) correlates with worse outcomes and decreased immune checkpoint molecule expression in melanoma. The impact of ID in mycosis fungoides (MF) is unknown. Objective: Our goal was to evaluate the impact of ID in MF. Methods: We conducted a case-control study of 17 patients with MF and ID versus age-, stage-, and race-matched controls as a subset of a comparative analysis of 23 patients with MF with ID (prior lymphoma, recent/current pregnancy, HIV, hypogammaglobulinemia, and prior chemotherapy) versus without ID. Programmed cell death 1 (PD1), programmed death ligand 1 (PDL1), forkhead box p3, and interleukin 17 immunohistochemistry was performed on 12 patients with ID and 10 controls. Results: Patients with ID had more treatment failure (14 of 23 vs 5 of 17 [P =.028]), more treatment failure within 3 years of diagnosis (12 of 23 vs 4 of 17 [P =.050]), more angiocentrism (6 of 12 vs 0 of 10 [P =.005]), larger cells (1.92 ± 0.51 out of 3 vs 1.30 ± 0.48 out of 3 [P =.009]), more cases with at least 10% PD1 positivity (9 of 11 vs 4 of 10 [P =.031]) and at least 10% PDL1 positivity (7 of 12 vs 2 of 10 [P =.042]), and a higher average percentage of PD1+ cells (43.27 ± 40.22 vs 11.2 ± 13.62 [P =.028]). No differences in survival, forkhead box p3 expression, interleukin 17 expression, histologic depth, ulceration, granulomatous changes, or syringotropism were seen. Limitations: This was a small single-center study with heterogeneous immunodeficiencies. Conclusion: ID correlated with worse outcomes and increased PD1 and PDL1 expression in MF. Patients with MF and ID may be candidates for immune checkpoint inhibitor therapy, pending further investigation. © 2017 American Academy of Dermatology, Inc.
Keywords: adult; treatment outcome; aged; aged, 80 and over; middle aged; young adult; case control study; case-control studies; antineoplastic agent; forkhead transcription factors; metabolism; pathology; immunology; pregnancy; interleukin 17; interleukin-17; immune deficiency; immunocompromised host; forkhead transcription factor; mycosis fungoides; immunologic deficiency syndromes; foxp3 protein, human; immunosuppression; programmed death 1 ligand 1; programmed death 1 receptor; complication; peripheral tolerance; very elderly; humans; human; male; female; pdcd1 protein, human; programmed cell death 1 receptor; cd274 protein, human; b7-h1 antigen; programmed cell death 1 protein
Journal Title: Journal of the American Academy of Dermatology
Volume: 78
Issue: 3
ISSN: 0190-9622
Publisher: Mosby Elsevier  
Date Published: 2018-03-01
Start Page: 530
End Page: 539
Language: English
DOI: 10.1016/j.jaad.2017.09.015
PUBMED: 29132694
PROVIDER: scopus
PMCID: PMC5815943
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. Melissa P Pulitzer
    132 Pulitzer
  2. Steven M Horwitz
    368 Horwitz
  3. Alison Moskowitz
    151 Moskowitz
  4. Patricia Myskowski
    139 Myskowski
  5. Shay Ivan Warren
    3 Warren