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Romidepsin Controls Chronic Lymphocytic Leukemia in a Patient with Mycosis Fungoides
David M Lemchak1, Oleg E Akilov2
1University of Pittsburgh Medical Center Altoona , PA, USA.
Abstract:
Romidepsin belongs to a class of medications called histone deacetylase inhibitors and is currently approved for treatment of cutaneous and peripheral T-cell lymphomas. Romidepsin was previously investigated for the treatment of chronic lymphocytic leukemia (CLL), and demonstrated potential benefit, but interest in its use declined following phase I clinical trials that showed poor tolerance of a significant side effect profile. We presented a patient with a history of stage II CLL, referred to dermatology for treatment of new-onset of mycosis fungoides (MF), who was treated with romidepsin over seven months. The patient achieved a partial response with 50% decrease in body surface area occupied by MF, thinning of remaining plaques, and near complete response in his CLL. His absolute lymphocyte count remained within the normal range for four months following discontinuation of romidepsin. Side effects were well-tolerated and did not limit therapy. Current literature on romidepsin is reviewed and compared to existing treatments for CLL.
Insights
Romidepsin, a histone deacetylase inhibitor, showed a partial response in mycosis fungoides and near complete response in chronic lymphocytic leukemia (CLL) in one patient. Side effects were well-tolerated, suggesting potential for re-evaluation in CLL treatment.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Romidepsin is a histone deacetylase inhibitor approved for T-cell lymphomas.
- Previous investigations in chronic lymphocytic leukemia (CLL) were limited by poor tolerance.
- Mycosis fungoides (MF) is a type of T-cell lymphoma often affecting the skin.
Observation:
- A patient with stage II CLL and new-onset MF was treated with romidepsin.
- Treatment duration was seven months.
- The patient presented with significant skin involvement from MF.
Findings:
- Partial response in MF with a 50% decrease in body surface area affected.
- Thinning of remaining MF plaques observed.
- Near complete response in CLL with normalized absolute lymphocyte count post-treatment.
- Romidepsin was well-tolerated, with side effects not limiting therapy.
Implications:
- Romidepsin demonstrates potential efficacy and improved tolerability in a CLL patient with concomitant MF.
- This case suggests re-evaluating romidepsin for CLL, potentially in combination therapies or specific patient populations.
- Further research into romidepsin's role in managing T-cell malignancies, including CLL and MF, is warranted.
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