CAUSES OF DEATH IN CUTANEOUS T-CELL LYMPHOMA PATIENTS

Background: The advancing evolution towards a Th2 immune environment confers a progressive immunosuppression in patients with longstanding cutaneous T-cell lymphoma (CTCL). The conjunction of the disease-related immunosuppression as well as the immunosuppressive character of some CTCL treatments increase the risk of infectious and neoplastic diseases, sometimes with fatal outcomes. Objectives: To prospectively study the causes of death in a cohort of CTCL patients, in a tertiary university skin cancer center. Methods: All CTCL patients who died between 2008 to 2020 were included. The cause of the death was classified as directly or indirectly related or unrelated to CTCL. Results: Over the study period 31 (13F/18M) patients with CTCL died (mean age: 75.2 years, mean delay between diagnosis and death: 3.2 years (min: 1, max: 12 years), 58.1% of death causes were classified as indirect (infection), 12.9% directly related (blastic transformation), 22.5% unrelated and 6.5% of unknown cause. 51.6% of MF patients who died had early-stage disease (IA-IIA) or were on remission. 45.2% of dead patients had advanced-stage MF (IIB-IVB). Mean CRP level is increased in patients who died from infection whereas LDH level increased in patients with blastosis. A tertiary center is expected to manage of a higher proportion of CTCL patients with advanced-stage disease. Conclusions: As infection represented more than 50% of the causes of death in CTCL patients, particular attention should be given to preventive measures such as anti-infective vaccination. Regular surveillance of CRP and LDH levels could be helpful for follow-up of MF patients, respectively with regards to infection and blastosis.