You Made the Call
more appropriate modality of therapy,
but the FDA label is for relapsed/refrac-
tory disease, not frontline treatment. The
best choice of therapy will depend in part
on the extent of peripheral blood involve-
ment. If the patient has a high burden of
disease in the blood (i.e., >10,000 Sézary
cells/uL), I would debulk him with low-dose
alemtuzumab (10-15 mg subcutaneous
three times a week) until the Sézary cells
have cleared, and then I would follow up
with extracorporeal photopheresis (ECP),
interferon, and bexarotene. If the patient
has a low burden of disease in the blood,
I would start him on ECP, interferon, and
bexarotene. If the patient does not achieve
a complete response with this approach, or
relapses, I would switch him to romidepsin.
If you are thinking this lymphoma
is a transformation from a former
cutaneous T-cell lymphoma, another
alternative would be the administration
of pralatrexate.
Pierluigi Porcu, MD
Sidney Kimmel Cancer Center at Jefferson
Philadelphia, PA
We asked, and you answered!
Here are a few responses from this
month’s “You Make the Call.”
For the full description of the clinical
dilemma, and to see how the expert
responded, turn to page 37.
Clinical Dilemma:
A 65-year-old man presenting with
an exfoliating rash, hypopigmented
areas, and full-blown lymphade-
nopathy was found to have peripheral
T-cell lymphoma NOS. The LN biopsy
seems to be effaced with large cells.
Further stains are pending. I was
planning to treat the patient with ro-
midepsin, but I couldn’t find any lit-
erature to use this for transformed or
high-grade lymphoma. Should I give
him CHOP/CHOEP-based therapy?
I would give this gentleman CHOEP
chemotherapy if he is fit to tolerate
it. German data say in the >60 age
group CHOP might be safer, but I
would assess patient fitness and
decide based on that.
Paolo Gallipoli, PhD
University of Cambridge
Cambridge, United Kingdom
MARKEY
CANCER
CENTER
In a region where cancer is at its worst, it takes bold action to make a
difference. That’s why the University of Kentucky Markey Cancer Center
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Treat him with EPOCH.
Steven Kalter, MD
San Antonio, TX
This patient has transformed mycosis
fungoides or Sézary syndrome (i.e.,
CTCL), as opposed to PTCL-NOS. The
two are easy to confuse histopatho-
logically, although they can be distin-
guished mostly on clinical grounds, and
because he has a two year history of