DEAR EDITOR, Incidence rates of cutaneous T-cell lymphomas (CTCL) and mycosis fungoides (MF) are higher among African American (AA) than white individuals in the United States of America.1 Population-based registries2 and single center retrospective studies3 have shown that AAs present with earlier onset and more advanced disease in comparison to white patients.3 Searching our institution’s cancer registry between 1992–2017 showed that the proportion of patients self-identified as black or AA was 13% of all patients with MF diagnostic codes. Our experience with 88 AA patients with newly diagnosed early-stage MF are in support of the previously reported demographic and clinical MF characteristics in the AA population.1–3 Median age at diagnosis was 47 years (interquartile range, 35–58 years) and female to male ratio was 1.4:1. 23.9% of AA patients presented with clinical stage IA, 67.0% - IB, and 9.1% - IIA. Hypopigmented lesions were noted in 59.1% of the patients and 35.2% presented solely with hypopigmented MF. Detailed immunohistochemistry results at the time of diagnosis were available in 61 cases, showing a CD8+ phenotype in 37.7% and a CD4+ phenotype in 62.3%.
AA race has been shown to be independently associated with shorter overall and disease-specific survival.2 However, our understanding of the relationship between race and prognosis in MF is limited to small retrospective single-center cohorts and to population-based registries that lack diagnosis confirmation and are prone to misdiagnosis/miscoding.
The PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) study is a large international cohort of patients with confirmed early-stage MF who are being followed with the aim of developing a prognostic index that may identify patients at risk of disease progression. A recent report by Scarisbrick et al. described the clinical characteristics of 348 early-stage MF patients enrolled in 29 centers and 15 countries.4 The analyzed patients’ demographics included age and sex while race and ethnicity were not reported.
Racial disparity in MF is poorly understood and further studies are needed to delineate the role of race in MF. Large international prospective studies such as PROCLIPI have the potential to determine the prognostic implications of race and ethnicity in this complex disease.
Acknowledgments
Funding sources: This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA008748.
References
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