Management of cutaneous B-cell lymphoma: Recommendations of the French cutaneous lymphoma study group

Aims. - To provide recommendations for the treatment of cutaneous B-cell lymphomas (CBCL). Methods. - Literature review and expert opinions from the French Cutaneous Lymphoma Study Group. Results. - Diagnosis of marginal zone BCL (MZ BCL), centrofollicular BCL (CF BCL) or cutaneous large B-cell lymphoma, leg type (CLBCL, LT) is based on combination of clinical signs and histopathological features, together with B-cell clonality analyses whenever possible. Staging relies on straightforward laboratory examinations and imaging, completed in selected cases with bone marrow biopsy. Treatment may be topical, including excision, curative radiotherapy (30 Gray) or adjunctive/low dose (4 Gray) radiotherapy, topical corticosteroids, interferon or intralesional rituximab; or systemic, using chemotherapy and/or intravenous rituximab. For indolent forms of the disease (MZ CBCL and CF CBCL), curative (30 Gray) may be given as first-line treatment in patients with localized lesions or few scattered skin lesions. For more numerous slow-growing lesions with a low tumour burden, simple monitoring with adjunctive ad hoc local treatment of individual lesions is acceptable. For multiple growing lesions, systemic rituximab or chlorambucil may be proposed. Polychemotherapy should only be used for progressive forms unresponsive to previous therapies. CLBCL LT forms are more aggressive and occur in older subjects. These lymphomas are best treated with age-adapted combinations of polychemotherapies and rituximab. Conclusion. - Appropriate clinical trials are still needed to strengthen the levels of evidence of current recommendations. (C) 2010 Elsevier Masson SAS. All rights reserved.