Histopathologic Features of Dupilumab-Associated Cutaneous T-cell Lymphoma Identified

Mayo Clinic researchers described the evolution of atypical lymphoid infiltrates in a handful of patients with atopic dermatitis treated with dupilumab in a small retrospective cohort study published online ahead of print in The American Journal of Dermatopathology.

“Observations highlighting the ‘unmasking’ of cutaneous T-cell lymphoma after treatment with dupilumab for atopic dermatitis have been recently reported,” explained first author Olayemi Sokumbi, MD, of Mayo Clinic Jacksonville, and coauthors. “However, there remains a paucity of literature describing the evolution of clinical and histopathological features that characterizes this phenomenon.”

The seven patients in the study ranged in age from 27 to 74. They had atopic dermatitis an average 5.7 years, and were on dupilumab an average 9.8 months, before being diagnosed with mycosis fungoides.

Researchers reported three notable histopathologic features across the patients’ predupilumab and postdupilumab biopsies. All seven of the patients had a progressive increase in the densities of the atypical lymphoid infiltrates. Additionally, six of the seven patients had atypical epidermotropic lymphocytes present, and six patients had papillary dermal fibrosis.

“These cases highlight the transformation of lymphoid infiltrates after dupilumab treatment for atopic dermatitis,” researchers wrote, “and emphasize the importance of clinical and histopathologic evaluation before and during treatment with dupilumab for treatment-refractory presumed atopic dermatitis.”

Reference:
Sokumbi O, Shamim H, Davis M, Wetter D, Newman C, Comfere N. Evolution of Dupilumab-Associated Cutaneous Atypical Lymphoid Infiltrates [published online ahead of print, 2021 Jun 15]. Am J Dermatopathol. 2021;10.1097/DAD.0000000000001875. doi:10.1097/DAD.0000000000001875