Lymphomes cutanés apparus sous biothérapies : étude rétrospective multicentrique du Groupe Français d’Etude des Lymphomes Cutanés, données de la Base Nationale de la Pharmacovigilance

Abstract : Background: controversies exist regarding the primary cutaneous lymphomas (PCL) risk under biologics, their prognosis and management. Most cases reported occurred under TNFα inhibitors. Our objective was to describe PCL occurring under biologics, type, behavior and management. Methods: retrospective, multicenter declarative (exhaustive data collection sheet) study among the 8364 patients registered from 2010 to 2017 into the French Cutaneous Lymphoma Study Group (GFELC). Additional analysis from the National Pharmacovigilance Database. Results: Forty-four cases were notified: 30 men and 14 women. Main biologic: anti-TNFα (n=40), unrelated to the PCL subtype. Cutaneous T cell lymphoma (CTCL) : 31 cases (70%) including 15 with past dermatological history. Mean onset: 32 months; 24 mycosis fungoides (MF), including 5 transformed-MF (T-MF) with aggressive behavior. For all T-MF but one, psoriasis was the disease justifying biologics. After CTCL diagnosis, biologic was discontinued in all except 3 patients (n=2 Crohn disease and n=1 rheumatoid arthritis) with limited MF, stage ≤ IIA, who achieved partial or complete remission with local specific treatment while continuing biologics. Cutaneous B cell lymphoma (CBCL) : 13 cases (30%) including 2 with past dermatological history. Mean onset: 69 months. Most were indolent forms with good prognosis (n=11; 85%). Biologics were discontinued in all but one, either initially or owing to relapse of CBCL Conclusion: as in non-exposed patients, MF are the most common, but not the unique subtype of PCL. Biologic’s aggravating role may be suspected in two situations: pre-existing MF misdiagnosed as psoriasis (aggressive behavior) and psoriasis-associated MF. However, PCL (MF or not MF) might occur outside of psoriasis, with a variable course. In limited MF, biologics may be continued with close follow-up if the underlying disease justifies it. Recurrence of CBCL when biologic was re-introduced or continued, may suggest an inducing role.
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Laure Dequidt. Lymphomes cutanés apparus sous biothérapies : étude rétrospective multicentrique du Groupe Français d’Etude des Lymphomes Cutanés, données de la Base Nationale de la Pharmacovigilance. Médecine humaine et pathologie. 2018. ⟨dumas-02066941⟩

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