eMedicine Specialties > Dermatology > Lymphoma and Related Processes

Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma: Treatment & Medication

Author: Chung-Che Chang, MD, PhD, Medical Director and Program Director of Hematopathology, Associate Professor of Pathology, Department of Hematopathology, Methodist Hospital, Weil Medical College, Cornell University, Houston
Coauthor(s): Scott M Acker, MD, Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: Feb 27, 2007

Treatment

Medical Care

  • Radiation therapy is the preferred treatment of solitary or localized skin disease.
  • Generalized skin lesions may respond to methotrexate.
  • Multiagent chemotherapy, such as F-MACHOP regimen (see detailed information in the reference by Fanin cited in the Bibliography), should be considered only in patients with systemic disease. The issue of how to treat patients with local nodal disease is somewhat more controversial, and some may consider multiagent chemotherapy in these patients (see detailed information in the reference by Bekkenk cited in the Bibliography).
  • Recently, anti-CD30 monoclonal antibody has been used experimentally for patients in whom multichemotherapy failed.

Surgical Care

Simple excision may be considered for solitary or localized skin lesions.

Consultations

  • Consult a hematologist/oncologist for chemotherapy evaluation.
  • Consult a radiation oncologist for therapy.

Diet

No limitation on diet is necessary.

Activity

No limitation on activity is necessary.

Medication

The goals are to reduce morbidity and to prevent complications.

Chemotherapeutic agents

Methotrexate is the choice of single-agent chemotherapy, if necessary.


Methotrexate (Rheumatrex, Folex PFS)

Antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction in malignant cells. Satisfactory response seen in 3-6 wk following administration. Adjust dose gradually to attain satisfactory response.

Adult

25 mg/wk PO/IM for 3-6 wks

Pediatric

Not established

Salicylates, NSAIDs, dipyridamole, probenecid, retinoids, ethanol, triamterene, pyrimethamine, sulfonamides, TCN, chloramphenicol, penicillin or other broad-spectrum antibiotics, trimethoprim, dapsone, theophylline, phenytoin, phenothiazines, barbiturates and nitrofurantoin (impair folic acid absorption), ascorbic acid, phenylbutazone, cyclosporin, and aminoglycosides

Absolute: Pregnancy or desire to get pregnant; active peptic ulcer; alcoholism; primary/secondary immunodeficiency; blood dyscrasias; active hepatitis; cirrhosis; chronic renal failure; active infections
Relative: History of excessive ethanol intake or substance abuse; increased LFT results; recent hepatitis; diabetes; obesity; family history of heritable liver disease; unreliable patient; CrCl <50 mL/min; male contemplating conception (must have 3 mo off)

Pregnancy

D - Unsafe in pregnancy

Precautions

Potential toxicity primarily involves liver and bone marrow; monitor CBC counts qwk, and liver and renal function q1-3mo during therapy (monitor more frequently during initial dosing, dose adjustments, or when risk of elevated MTX levels, eg, dehydration); has toxic effects on hematologic, renal, GI, pulmonary, and neurologic systems; discontinue if significant decrease in blood counts occurs; aspirin, NSAIDs, or low-dose steroids may be administered concomitantly with MTX (possibility of increased toxicity with NSAIDs, including salicylates, has not been tested)

More on Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma

Overview: Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma
Differential Diagnoses & Workup: Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma
Treatment & Medication: Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma
Follow-up: Cutaneous CD30+ (Ki-1) Anaplastic Large-Cell Lymphoma
References
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References

  1. Bekkenk MW, Geelen FA, van Voorst Vader PC, Heule F, Geerts ML, van Vloten WA, et al. Primary and secondary cutaneous CD30(+) lymphoproliferative disorders: a report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment. Blood. Jun 15 2000;95(12):3653-61. [Medline].

  2. Bonzheim I, Geissinger E, Roth S, Zettl A, Marx A, Rosenwald A, et al. Anaplastic large cell lymphomas lack the expression of T-cell receptor molecules or molecules of proximal T-cell receptor signaling. Blood. Nov 15 2004;104(10):3358-60. [Medline].

  3. de Bruin PC, Beljaards RC, van Heerde P, Van Der Valk P, Noorduyn LA, Van Krieken JH, et al. Differences in clinical behaviour and immunophenotype between primary cutaneous and primary nodal anaplastic large cell lymphoma of T-cell or null cell phenotype. Histopathology. Aug 1993;23(2):127-35. [Medline].

  4. Duncan LM. Cutaneous lymphoma. Understanding the new classification schemes. Dermatol Clin. Jul 1999;17(3):569-92. [Medline].

  5. Fanin R, Sperotto A, Silvestri F, Cerno M, Geromin A, Stocchi R, et al. The therapy of primary adult systemic CD30-positive anaplastic large cell lymphoma: results of 40 cases treated in a single center. Leuk Lymphoma. Sep 1999;35(1-2):159-69. [Medline].

  6. Kempf W, Dummer R, Burg G. Approach to lymphoproliferative infiltrates of the skin. The difficult lesions. Am J Clin Pathol. Jan 1999;111(1 Suppl 1):S84-93. [Medline].

  7. Kinney MC, Kadin ME. The pathologic and clinical spectrum of anaplastic large cell lymphoma and correlation with ALK gene dysregulation. Am J Clin Pathol. Jan 1999;111(1 Suppl 1):S56-67. [Medline].

  8. Kummer JA, Vermeer MH, Dukers D, Meijer CJ, Willemze R. Most primary cutaneous CD30-positive lymphoproliferative disorders have a CD4-positive cytotoxic T-cell phenotype. J Invest Dermatol. Nov 1997;109(5):636-40. [Medline].

  9. LeBoit PE. Lymphomatoid papulosis and cutaneous CD30+ lymphoma. Am J Dermatopathol. Jun 1996;18(3):221-35. [Medline].

  10. Mori M, Manuelli C, Pimpinelli N, Mavilia C, Maggi E, Santucci M, et al. CD30-CD30 ligand interaction in primary cutaneous CD30(+) T-cell lymphomas: A clue to the pathophysiology of clinical regression. Blood. Nov 1 1999;94(9):3077-83. [Medline].

  11. Paulli M, Berti E, Boveri E, Kindl S, Bonoldi E, Gambini C, et al. Cutaneous CD30+ lymphoproliferative disorders: expression of bcl-2 and proteins of the tumor necrosis factor receptor superfamily. Hum Pathol. Nov 1998;29(11):1223-30. [Medline].

  12. Paulli M, Berti E, Rosso R, Boveri E, Kindl S, Klersy C, et al. CD30/Ki-1-positive lymphoproliferative disorders of the skin--clinicopathologic correlation and statistical analysis of 86 cases: a multicentric study from the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Project Group. J Clin Oncol. Jun 1995;13(6):1343-54. [Medline].

  13. Shehan JM, Kalaaji AN, Markovic SN, Ahmed I. Management of multifocal primary cutaneous CD30 anaplastic large cell lymphoma. J Am Acad Dermatol. Jul 2004;51(1):103-10. [Medline].

  14. Tomaszewski MM, Lupton GP, Krishnan J, May DL. A comparison of clinical, morphological and immunohistochemical features of lymphomatoid papulosis and primary cutaneous CD30(Ki-1)-positive anaplastic large cell lymphoma. J Cutan Pathol. Aug 1995;22(4):310-8. [Medline].

  15. Vergier B, Beylot-Barry M, Pulford K, Michel P, Bosq J, de Muret A, et al. Statistical evaluation of diagnostic and prognostic features of CD30+ cutaneous lymphoproliferative disorders: a clinicopathologic study of 65 cases. Am J Surg Pathol. Oct 1998;22(10):1192-202. [Medline].

  16. Vonderheid EC, Sajjadian A, Kadin ME. Methotrexate is effective therapy for lymphomatoid papulosis and other primary cutaneous CD30-positive lymphoproliferative disorders. J Am Acad Dermatol. Mar 1996;34(3):470-81. [Medline].

  17. Willemze R, Beljaards RC. Spectrum of primary cutaneous CD30 (Ki-1)-positive lymphoproliferative disorders. A proposal for classification and guidelines for management and treatment. J Am Acad Dermatol. Jun 1993;28(6):973-80. [Medline].

  18. Willemze R, Kerl H, Sterry W, Berti E, Cerroni L, Chimenti S, et al. EORTC classification for primary cutaneous lymphomas: a proposal from the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer. Blood. Jul 1 1997;90(1):354-71. [Medline].

  19. Yamaguchi T, Ohshima K, Karube K, Kawano R, Nakayama J, Suzumiya J, et al. Expression of chemokines and chemokine receptors in cutaneous CD30+ lymphoproliferative disorders. Br J Dermatol. May 2006;154(5):904-9. [Medline].

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Further Reading

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Keywords

CD30+ ALCL, regressing atypical histiocytosis, RAH, CD30+ cutaneous large T-cell lymphoma, pseudo-Hodgkin disease, pseudo-Hodgkin's disease, non-Hodgkin lymphoma, NHL, pseudo-Hodgkin lymphoma

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Contributor Information and Disclosures

Author

Chung-Che Chang, MD, PhD, Medical Director and Program Director of Hematopathology, Associate Professor of Pathology, Department of Hematopathology, Methodist Hospital, Weil Medical College, Cornell University, Houston
Chung-Che Chang, MD, PhD is a member of the following medical societies: American Medical Association, American Society of Clinical Pathologists, College of American Pathologists, and International Academy of Pathology
Disclosure: Nothing to disclose.

Coauthor(s)

Scott M Acker, MD, Associate Professor, Director of Dermatopathology, Departments of Dermatology and Pathology, University of Alabama at Birmingham
Scott M Acker, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Clinical Pathologists, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Günter Burg, MD, Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine, Switzerland
Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: none None None

Managing Editor

Daniel S Loo, MD, Associate Professor, Residency Program Director, Department of Dermatology, Boston University School of Medicine
Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other

 
 
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