This cohort study characterizes the clinical characteristics, course of hospitalization, and mortality outcomes of an inpatient cohort with cutaneous T-cell lymphoma.
Key Points
Question
What are trends in hospitalization features and mortality outcomes of inpatients with cutaneous T-cell lymphoma (CTCL) in the US?
Findings
In this cohort study of 79 patients, the majority of admitted patients with CTCL had mycosis fungoides, advanced disease, and infection during hospitalization. In-hospital mortality was associated with high body mass index, thromboembolic disease, and sepsis, and postdischarge mortality was associated with comorbid malignant neoplasms, wound care as a reason for dermatology consultation, and large cell transformation.
Meaning
This study improves characterization of inpatient populations with CTCL and identifies potential factors associated with outcomes that may better guide clinical management.
Abstract
Importance
Cutaneous T-cell lymphoma (CTCL) is a group of rare, complex cutaneous malignant neoplasms associated with significant disease burden on patients and the health care system. Currently, the population of patients with CTCL admitted to the hospital remains largely uncharacterized and poorly understood.
Objective
To characterize the clinical characteristics, course of hospitalization, and mortality outcomes of an inpatient CTCL cohort.
Design, Setting, and Participants
This multicenter retrospective cohort study reviewed medical records for adult patients (age ≥18 years) with a CTCL diagnosis per National Comprehensive Cancer Network guidelines admitted for inpatient hospitalization at 5 US academic medical centers with inpatient dermatology consult services and CTCL clinics between August 2016 and August 2020.
Main Outcomes and Measures
Patient demographics, clinical history and findings, hospitalization courses, and mortality outcomes.
Results
A total of 79 hospitalized patients with CTCL were identified, including 52 (70.3%) men and 22 (29.7%) women, with a median (IQR) age at hospitalization of 62.9 (27-92) years. The majority of admitted patients with CTCL were White (65 patients [82.3%]), had disease classified as mycosis fungoides (48 patients [61.5%]), and had advanced-stage disease (≥IIB, 70 patients [89.7%]). Most hospitalizations were complicated by infection (45 patients [57.0%]) and required intravenous antibiotic therapy (45 patients [57.0%]). In-hospital mortality occurred in 6 patients (7.6%) and was associated with higher body mass index (36.5 vs 25.3), history of thromboembolic disease (50.0% vs 12.3%), and diagnosis of sepsis on admission (66.7% vs 20.5%). At 1-year postdischarge, 36 patients (49.3%) patients had died, and mortality was associated with history of solid organ cancers (27.8% vs 10.8%), wound care as the reason for dermatology consultation (58.3% vs 24.3%), and presence of large cell transformation (58.3% vs 22.9%).
Conclusions and Relevance
The findings of this cohort study improve the understanding of hospitalized patients with CTCL and lend valuable insight into identifying factors associated with both in-hospital and long-term mortality outcomes. This refined understanding of the inpatient CTCL population provides a foundation for larger, more robust studies to identify causal risk factors associated with mortality, development of prognostic scoring systems to estimate the probability of hospital mortality. Overall, the findings may prompt physicians caring for patients with CTCL to implement preventive strategies to diminish hospitalization and improve clinical management across this unique disease spectrum.
Introduction
Primary cutaneous T-cell lymphomas (CTCLs) comprise a heterogeneous array of rare extranodal non-Hodgkin lymphomas characterized by malignant monoclonal T-cell proliferations within the skin. The most prevalent subtypes of CTCL include mycosis fungoides (MF) and Sezary syndrome (SS). Incidence of CTCL ranges from about 6 to 10 per million persons, with over half representing MF.1 Males and Black patients are more commonly affected, and incidence generally increases with age.2
Despite the rarity of CTCL, it is a substantial burden on patients and the health care system. Cutaneous lymphomas are associated with significantly higher costs per affected person when compared to other skin diseases.3 Patients with cutaneous lymphomas also have the highest 30-day all-cause readmission rate, 39.6%, of any skin disease.4 While patients with CTCL are admitted to the hospital for a variety of reasons, hospitalizations remain poorly characterized. This study sought to address this knowledge gap by characterizing the clinical features and course of hospitalization of patients with CTCL.
Methods
We performed a multicenter retrospective medical record review from 5 US academic medical centers with inpatient dermatology consults and cutaneous lymphoma clinics between August 2016 and August 2020. Each hospital is staffed with at least 1 dermatology hospitalist who evaluated the consultation. Data on demographics, clinical findings, hospitalization course, and outcomes were abstracted from the electronic medical record. Race and ethnicity information was obtained from self-reported information in the medical records. This information was collected to identify potential drivers of disparities. Inclusion criteria were patients 18 years or older with CTCL diagnosed by National Comprehensive Cancer Network guidelines admitted for inpatient hospitalization. Patients with other forms of non-Hodgkin lymphomas were excluded. Descriptive analyses were performed, and group comparisons were assessed via Mann-Whitney U test/Wilcoxon rank-sum test at P < .05. Mortality analyses were conducted via Cox proportional hazards regression and the Kaplan-Meier method to analyze time-to-event data. Statistical analyses were conducted using SPSS, version 26.0 (IBM). Institutional review board approval and data use agreements were granted from each participating institution. Patient informed consent was waived owing to the retrospective nature of the study and use of deidentified data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
Results
Patient Characteristics
Our multicenter cohort consisted of 79 patients with a median (IQR) age at hospitalization of 62.9 (27-92) years. The majority were male (70.3%), White (82.3%), and had a history of cardiovascular comorbidities (65.8%) (Table 1). Median (IQR) time from diagnosis to hospital admission was 3.2 (0-15.7) years. Based on World Health Organization–European Organization for Research and Treatment of Cancer classifications, most patients were diagnosed with MF (61.5%) or SS (28.2%), frequently with large cell transformation (40.3%). Most patients had early-stage disease (IA-IIA) (53.9%) at diagnosis and advanced stage (≥IIB) at hospitalization (89.7%). Notably, 24.1% of patients met criteria for sepsis on admission. During hospitalization, infections (57.0%) and need for intravenous antimicrobials (57.0%) were frequent. Dermatology services were most frequently consulted for symptom management (59.5%). Median (IQR) duration of hospitalization was 9 (1-60) days and length of survival from time of CTCL diagnosis was 44.5 (1-180) months (Table 1).
Table 1. Clinical Characteristics of Hospitalized Patients With CTCL.
| Characteristic | Total, No. (%) |
|---|---|
| No. | 79 |
| Age, median (IQR), y | 62.9 (27-92) |
| Age at diagnosis, median (IQR), y | 58.9 (25-88) |
| Sex | |
| Female | 22 (29.7) |
| Male | 52 (70.3) |
| Race | |
| Black | 14 (17.7) |
| White | 65 (82.3) |
| Ethnicity, Hispanic | 6 (7.6) |
| BMI, median (IQR) | 25.8 (19.9-53.5) |
| Smoking history | |
| Current | 9 (12.5) |
| Prior | 28 (38.9) |
| Never smoker | 35 (48.6) |
| Medical history | |
| Skin cancer history | 10 (12.7) |
| Hematologic cancer | 6 (7.9) |
| Solid organ cancer | 15 (19.0) |
| Cardiovascular | 52 (65.8) |
| Respiratory | 15 (19.0) |
| Diabetes | 17 (21.5) |
| Anxiety/depression | 26 (32.9) |
| DVT/PE | 12 (15.2) |
| Clinical course | |
| Admit reasona,b | |
| Cutaneous | 43 (54.4) |
| Systemic | 35 (44.3) |
| Other | 1 (1.3) |
| Sepsis on admit | 19 (24.1) |
| Dermatology consult | |
| New rash | 29 (36.7) |
| Symptom management | 47 (59.5) |
| Wound care | 35 (44.3) |
| Infection on final dermatologic diagnosis | 27 (34.2) |
| WHO-EORTC classification | |
| MF without LCT | 25 (32.1) |
| MF with LCT | 23 (29.5) |
| SS ± LCT | 22 (28.2) |
| PCGD-TCL | 8 (10.3) |
| LCT | 31 (40.3) |
| Initial diagnosis stage | |
| Early (IA-IIA) | 41 (53.9) |
| Advanced (>IIB) | 35 (46.1) |
| Hospital stage | |
| Early (IA-IIA) | 8 (10.3) |
| Advanced (>IIB) | 70 (89.7) |
| Change in stage | 35 (46.1) |
| Hospitalization infection | 45 (57.0) |
| MRSA | 12 (15.2) |
| IV antimicrobial treatment required | 45 (57.0) |
| ICU admission | 4 (5.1) |
| Diagnosis to admit, median (IQR), y | 3.2 (0-15.7) |
| Hospital stay, median (IQR), d | 9 (1-60) |
| Admission from clinic | 31 (39.2) |
| Initial visit | 5 (7.0) |
| ECOG, median (IQR) | 1 (0-4) |
| CCI scorec | |
| <5, Mild/moderate | 35 (45.5) |
| ≥5, Severe | 42 (54.5) |
| Treatments prior to admission | |
| Skin-directed only | 10 (12.8) |
| 1 Systemic ± skin | 9 (11.5) |
| 2 Systemics ± skin | 6 (7.7) |
| ≥3 Systemics | 15 (19.2) |
| Chemotherapy ± 1 or 2 | 38 (48.7) |
| Clinical outcomes | |
| Readmission | 27 (34.2) |
| Death during hospitalization | 6 (7.6) |
| Death at 1 y postdischarged | 36 (49.3) |
| Length of survival from diagnosis, median (IQR), moe | 44.5 (1-180) |
Abbreviations: BMI, body mass index, calculated as weight in kilograms divided by height in meters squared; CCI, Charlson Comorbidity Index; CTCL, cutaneous T-cell lymphoma; DVT/PE, deep vein thrombosis/pulmonary embolism; ECOG, Eastern Cooperative Oncology Group; GVHD, graft-vs-host disease; ICU, intensive care unit; IV, intravenous; LCT, large cell transformation; MF, mycosis fungoides; MRSA, methicillin-resistant Staphylococcus aureus; PCGD-TCL, primary cutaneous gamma-delta T-cell lymphoma; SS, Sezary syndrome; WHO-EORTC; World Health Organization–European Organization for Research and Treatment of Cancer.
Specific categorization of admission reason include: cutaneous = rash, cellulitis, pruritus, erythroderma, anasarca; systemic = sepsis, bacteremia, B symptoms, metabolic abnormalities, GVHD; other = cardiac, fracture.
Details on admission reason for patients with early stage CTCL were largely systemic: sepsis, hyperglycemia, GVHD, bony fracture, atrial fibrillation, angina.
Based on the total CCI score, comorbidity severity was characterized as mild/moderate or severe. Further subdivisions between mild/moderate were unable to be analyzed due to limited sample size.
Excludes patients who died during hospitalization.
Excludes patients alive at last follow-up.
Hospitalization Outcomes
At discharge, 6 patients (7.6%) had died. We observed higher in-hospital mortality by body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) (36.5 vs 25.3), history of deep vein thrombosis/pulmonary embolism (50.0% vs 12.3%), and sepsis on admission (66.7% vs 20.5%) (eTable 1 in Supplement 1). Thirteen patients experienced multiple admissions during the study period.
At 1-year postdischarge, 36 patients (49.3%) had died. Mortality was higher in White patients (88.9% vs 81.1%) and those with history of solid organ cancers (27.8% vs 10.8%). Death was also associated with cutaneous complaints on admission (77.8% vs 37.8%) and necessity for wound care dermatology consults (58.3% vs 24.3%). Patients with MF without large-cell transformation were found to have higher survival compared to other subtypes (48.6% vs 14.3%). Conversely, large cell transformation was more prevalent among those who died (58.3% vs 22.9%) (Table 2; eTable 2 in Supplement 1).
Table 2. One-Year Postdischarge Outcomes of Hospitalized Patients With CTCL.
| Characteristics | No. (%) | P value | HR (95% CI) | P value | ||
|---|---|---|---|---|---|---|
| Total (n = 73) | Alive at 1 y postdischarge (n = 37) | Death at 1 y postdischarge (n = 36) | ||||
| Age, median (IQR), y | 63.2 (27-92) | 58.6 (27-84) | 67.8 (44-92) | .06 | 0.98 (0.95-1.02) | .35 |
| Age at diagnosis, median (IQR), y | 59.2 (25-88) | 54.3 (25-84) | 63.7 (40-88) | .09 | 1.01 (0.98-1.04) | .57 |
| Sex | ||||||
| Female | 21 (30.9) | 13 (37.1) | 8 (24.2) | .19 | 1.82 (0.78-4.25) | .17 |
| Male | 47 (69.1) | 22 (62.9) | 25 (75.8) | 1 [Reference] | NA | |
| Race | ||||||
| Black | 11 (15.1) | 7 (18.9) | 4 (11.1) | .29 | 1 [Reference] | NA |
| White | 62 (84.9) | 30 (81.1) | 32 (88.9) | .03 | 3.24 (1.13-9.30) | .03 |
| Ethnicity, Hispanic | 6 (8.2) | 6 (16.2) | 0 | .01 | NA | NA |
| BMI, median (IQR) | 25.3 (19.9-37.5) | 25.5 (20.9-37.5) | 25 (19.9-33) | .53 | 0.96 (0.89-1.04) | .31 |
| Medical history | ||||||
| Skin cancer history | 10 (13.7) | 6 (16.2) | 4 (11.1) | .39 | 0.93 (0.32-2.66) | .89 |
| Hematologic cancer | 6 (8.2) | 3 (8.1) | 3 (8.3) | .65 | 0.31 (0.07-1.31) | .11 |
| Solid organ cancer | 14 (20.0) | 4 (10.8) | 10 (27.8) | .04 | 2.40 (1.10-5.22) | .03 |
| Cardiovascular | 49 (67.1) | 25 (67.6) | 24 (66.7) | .57 | 1.20 (0.58-2.49) | .62 |
| Respiratory | 14 (19.2) | 8 (21.6) | 6 (16.7) | .41 | 2.16 (0.87-5.34) | .10 |
| Diabetes | 16 (21.9) | 7 (18.9) | 9 (25.0) | .36 | 1.02 (0.47-2.18) | .97 |
| Anxiety/depression | 25 (34.2) | 15 (40.5) | 10 (27.8) | .18 | 1.15 (0.54-2.43) | .71 |
| DVT/PE | 9 (12.3) | 6 (16.2) | 3 (8.3) | .25 | 0.46 (0.14-1.52) | .20 |
| Clinical course | ||||||
| Admit reasona,b | ||||||
| Cutaneous | 42 (57.5) | 14 (37.8) | 28 (77.8) | .001 | 1.12 (0.49-2.49) | .81 |
| Systemic | 30 (41.1) | 22 (59.5) | 8 (22.2) | .001 | 0.90 (0.40-2.04) | .81 |
| Other | 1 (1.4) | 1 (2.7) | 0 | .51 | NA | NA |
| Dermatology consult | ||||||
| New rash | 29 (39.7) | 16 (43.2) | 13 (36.1) | .35 | 1.02 (0.51-2.04) | .96 |
| Symptom management | 41 (56.2) | 23 (62.2) | 19 (52.8) | .37 | 0.81 (0.42-1.57) | .53 |
| Wound care | 30 (41.1) | 9 (24.3) | 21 (58.3) | .003 | 1.37 (0.69-2.70) | .37 |
| Large cell transformation | 29 (40.8) | 8 (22.9) | 21 (58.3) | .002 | 1.02 (0.52-2.03) | .94 |
| Hospitalization infection | 40 (54.8) | 25 (67.6) | 15 (41.7) | .02 | 0.78 (0.40-1.53) | .47 |
| Diagnosis to admit, median (IQR), y | 3.75 (0-15.7) | 3.77 (0-15.7) | 3.73 (0-14.3) | .94 | 0.37 (0.25-0.54) | <.001 |
Abbreviations: BMI, body mass index, calculated as weight in kilograms divided by height in meters squared; CTCL, cutaneous T-cell lymphoma; DVT/PE, deep vein thrombosis/pulmonary embolism; GVHD, graft-vs-host disease; HR, hazard ratio; NA, not applicable.
Specific categorization of admission reason include the following: cutaneous = rash, cellulitis, pruritus, erythroderma, anasarca; systemic = sepsis, bacteremia, B symptoms, metabolic abnormalities, GVHD; other = cardiac, fracture.
Details on admission reason for patients with early-stage CTCL were largely systemic: sepsis, hyperglycemia, GVHD, bony fracture, atrial fibrillation, angina.
Poorer overall survival was observed among White patients (hazard ratio [HR], 3.24 [95% CI, 1.13-9.30]) and those with history of solid organ cancer (HR, 2.40 [95% CI, 1.10-5.22]). Conversely, increased time from diagnosis to admission (HR, 0.37 [95% CI, 0.25-0.54]) and direct admission from clinic (HR, 0.478 [95% CI, 0.23-0.97]) were associated with better overall survival (eFigure in Supplement 1).
Reasons for Admission
Most admissions were due to cutaneous concerns (54.4%), such as cellulitis, rash, and erythroderma, followed by systemic complaints (44.3%), such as bacteremia, sepsis, and tumor lysis syndrome (Table 1 and Table 3).
Table 3. Summary of Reasons for Admission.
| Category | Reason |
|---|---|
| Cutaneous | Cellulitis Pruritus Erythroderma Anasarca Abscess Unspecified rash |
| Systemic | Bacteremia Sepsis B symptoms Metabolic abnormalities (eg, metabolic acidosis, hyperglycemia) Tumor lysis syndrome |
| Other | Bone fracture Cardiac symptoms Respiratory symptoms |
| Treatment-related | Hematopoietic stem cell transplantation Chimeric antigen receptor (CAR) T-cell therapy |
Discussion
This multicenter cohort study improves the current understanding and characterization of hospitalized patients with CTCL. At 1-year postdischarge, 53.2% of patients had died. While most patients were classified as having MF, about half of those had evidence of large cell transformation, and 89.7% had advanced-stage disease, suggesting that large cell transformation and/or advanced stage are risks for hospitalization and subsequent mortality. Reported data of survival in patients with advanced-stage CTCL describe median survival of 3.4 to 4.7 years for stage III disease and 1.4 to 3.8 years for stage IV disease.5,6 Compared to the aforementioned data, our findings suggest hospitalization is associated with even poorer survival in patients with CTCL, including those with advanced-stage CTCL.
Patients with CTCL have a higher susceptibility to infections.7 Over half of admitted patients with CTCL in our cohort were found to have an infection, and all but 1 required intravenous antimicrobials. Infection was significantly associated with higher mortality within 1 year after discharge, and sepsis on admission was significantly associated with increased hospital mortality. While it is known that sepsis in hospitalized patients with cancer is associated with worsened survival,8 this study supports the association of sepsis with worse in-hospital survival for patients with CTCL. Wound care as the reason for dermatology consultation was also found to be significantly associated with mortality within 1 year after discharge, suggesting that chronic/infected wounds are also a poor prognostic indicator. Altogether, these observations suggest a need to focus on infection prevention and aggressive management of active infection and wounds in hospitalized patients with CTCL.
The findings of this study newly associate thromboembolic disease with worsened in-hospital survival in patients with CTCL during hospital admission. Increased risk of venous thromboembolic (VTE) disease has been previously associated with CTCL.9 Pooled data from hospitalizations of patients with various cancers estimate incidence of VTE around 8.4%,10 and the rate of VTE in patients included in our study was 15.8%. Thromboembolic disease has a well-known association with worsened survival in patients with cancer11,12 as well as worsened survival of hospitalized patients,10 but the association of VTE with worsened survival specifically in hospitalized patients with CTCL is a new observation.
High BMI (>30) has been associated with increased incidence of CTCL.13 Meta-analyses have not identified high BMI as a risk factor for worsened survival in the general population of patients with cancer,14 and in some cancers, high BMI has been identified as protective.14 Our finding of high BMI as a risk factor for worse in-hospital survival of patients with CTCL is novel.
Limitations
Study limitations include its small sample size, retrospective nature, and inclusion of patients with access to tertiary cancer centers with inpatient dermatology services. In addition, time-to-event data from diagnosis to advanced-stage disease were not available, and thus timing of disease progression with associated risk of hospitalization was unable to be analyzed. Larger prospective studies are needed to establish a causal relationship for the risk factors identified in this study.
Conclusions
Cutaneous T-cell lymphoma is a complex disease with a high burden on patients and the health care system alike. Our findings lend further support that hospitalized patients with CTCL are susceptible to high rates of infections, readmissions, and ultimately poor outcomes. Future directions include using these identified variables to formulate a scoring system to estimate readmission rate, mortality risk, and/or prognosis and, ultimately, improve prognosis and decrease mortality both within the hospital as well as after discharge.
eTable 1. Discharge outcomes of hospitalized patients with CTCL
eTable 2. Additional one-year post-discharge outcomes of hospitalized patients with CTCL
eFigure. Kaplan-Meier survival curves by clinical characteristics
Data Sharing Statement
References
- 1.Malachowski SJ, Moy A, Messina J, et al. Mapping cutaneous T-cell lymphoma in the state of Florida: a retrospective exploratory spatial analysis of incidence patterns. J Am Acad Dermatol. 2022;86(1):186-188. doi: 10.1016/j.jaad.2021.01.041 [DOI] [PubMed] [Google Scholar]
- 2.Imam MH, Shenoy PJ, Flowers CR, Phillips A, Lechowicz MJ. Incidence and survival patterns of cutaneous T-cell lymphomas in the United States. Leuk Lymphoma. 2013;54(4):752-759. doi: 10.3109/10428194.2012.729831 [DOI] [PubMed] [Google Scholar]
- 3.Lim HW, Collins SAB, Resneck JS Jr, et al. A risk adjustment approach to estimating the burden of skin disease in the United States. J Am Acad Dermatol. 2018;78(1):129-140. doi: 10.1016/j.jaad.2017.08.060 [DOI] [PubMed] [Google Scholar]
- 4.Arnold JD, Crockett RM, Kirkorian AY. Hospital readmissions among patients with skin disease: a retrospective cohort study. J Am Acad Dermatol. 2018;79(4):696-701. doi: 10.1016/j.jaad.2018.03.042 [DOI] [PubMed] [Google Scholar]
- 5.Agar NS, Wedgeworth E, Crichton S, et al. Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal. J Clin Oncol. 2010;28(31):4730-4739. doi: 10.1200/JCO.2009.27.7665 [DOI] [PubMed] [Google Scholar]
- 6.Kim YH, Liu HL, Mraz-Gernhard S, Varghese A, Hoppe RT. Long-term outcome of 525 patients with mycosis fungoides and Sezary syndrome: clinical prognostic factors and risk for disease progression. Arch Dermatol. 2003;139(7):857-866. doi: 10.1001/archderm.139.7.857 [DOI] [PubMed] [Google Scholar]
- 7.Axelrod PI, Lorber B, Vonderheid EC. Infections complicating mycosis fungoides and Sézary syndrome. JAMA. 1992;267(10):1354-1358. doi: 10.1001/jama.1992.03480100060031 [DOI] [PubMed] [Google Scholar]
- 8.Allen PB, Switchenko J, Ayers A, Kim E, Lechowicz MJ. Risk of bacteremia in patients with cutaneous T-cell lymphoma (CTCL). Leuk Lymphoma. 2020;61(11):2652-2658. doi: 10.1080/10428194.2020.1779259 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Lindahl LM, Schmidt M, Farkas DK, Sørensen HT, Iversen L. Risk of venous thromboembolism in patients with mycosis fungoides and parapsoriasis: a Danish nationwide population-based cohort study. J Am Acad Dermatol. 2018;78(6):1077-1083.e4. doi: 10.1016/j.jaad.2017.11.043 [DOI] [PubMed] [Google Scholar]
- 10.Lyman GH, Culakova E, Poniewierski MS, Kuderer NM. Morbidity, mortality and costs associated with venous thromboembolism in hospitalized patients with cancer. Thromb Res. 2018;164(suppl 1):S112-S118. doi: 10.1016/j.thromres.2018.01.028 [DOI] [PubMed] [Google Scholar]
- 11.Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846-1850. doi: 10.1056/NEJM200012213432504 [DOI] [PubMed] [Google Scholar]
- 12.Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166(4):458-464. doi: 10.1001/archinte.166.4.458 [DOI] [PubMed] [Google Scholar]
- 13.Aschebrook-Kilfoy B, Cocco P, La Vecchia C, et al. Medical history, lifestyle, family history, and occupational risk factors for mycosis fungoides and Sézary syndrome: the InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014;2014(48):98-105. doi: 10.1093/jncimonographs/lgu008 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Greenlee H, Unger JM, LeBlanc M, Ramsey S, Hershman DL. Association between body mass index and cancer survival in a pooled analysis of 22 clinical trials. Cancer Epidemiol Biomarkers Prev. 2017;26(1):21-29. doi: 10.1158/1055-9965.EPI-15-1336 [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eTable 1. Discharge outcomes of hospitalized patients with CTCL
eTable 2. Additional one-year post-discharge outcomes of hospitalized patients with CTCL
eFigure. Kaplan-Meier survival curves by clinical characteristics
Data Sharing Statement