On March 15, 2012 in San Diego, CA the United States Cutaneous Lymphoma Consortium (USCLC) held its Annual Workshop entitled: CD30+ Lymphoproliferative Disorders (LPD): Controversies and Progress. The recent approval of a novel antibody-drug conjugate that targets CD30, brentuximab vedotin (ADCETRIS, Seattle Genetics), and the recent joint publication of a new set of international clinical practice guidelines for CD30+ LPD by the European Organisation for Research and Treatment of Cancer (EORTC), the International Society for Cutaneous Lymphomas (ISCL) and the USCLC (Werner et al., Blood 2011) ensured high participation and a very robust, informative discussion.
The Workshop, held the Thursday before the start of the 70th Annual Meeting of the American Academy of Dermatology (AAD), brought together more than 20 leading American and European cutaneous lymphoma speakers from all medical specialties and garnered attendance from more than 150 USCLC members and other participants.
Cutaneous CD30+ Lymphoproliferative Disorders comprise a clinically diverse family of T-cell lymphoproliferative disorders of the skin, characterized by the presence of large atypical T-cells expressing strongly and uniformly a marker called CD30. The clinical spectrum ranges from lymphomatoid papulosis (LyP), a premalignant or very early form of CTCL that manifests with self-resolving, small papular lesions, to anaplastic large cell lymphoma (ALCL), a true lymphoma that presents with larger, dome-shaped nodular lesions, that, unlike LyP, do not typically resolve spontaneously and may ulcerate. While the cause(s) of LyP and ALCL remain unknown, much has recently been discovered about the biology of CD30+ LPD and the molecular markers that are helpful in making a faster and more accurate diagnosis.
The Workshop opened with Dr. Elise Olsen, President of the USCLC, whose introductory remarks were followed by a series of presentations by Drs. Walter Kempf (University of Zurich), Marshall E. Kadin (Boston University), Angelica Selim (Duke University), and Jakki Junkins-Hopkins (Johns Hopkins), on the pathological classification of CD30+ LPD and the best diagnostic approach to these disorders. This was followed by the Zakheim Lecture, which was delivered by Dr. Marshall E. Kadin, Professor of Dermatology at Boston University, and Staff Physician at the Roger Williams Medical Center in Providence, RI. Dr. Kadin, a pioneer of the study of CD30+ LPD, provided an overview of the history of these disorders followed by a discussion on the most important developments in biology and clinical management along with advances made during the past few years. The need for prospective, collaborative studies and clinical trials was strongly emphasized.
Dr. Andrew Feldman, from the Mayo Clinic, presented an updated study of the genetics of CD30+ LPD with an emphasis of the role of the IRF4 and ALK-1 genes, and the translocations affecting them, in distinguishing various subsets of ALCL. The next session, chaired by Dr. Michael Girardi (Yale) and Dr. Pierluigi Porcu (Ohio State University), addressed the clinical problem of patients presenting with more than one type of CD30+ LPD and offered a hypothesis (Girardi) about their development and biological relatedness.
The following session, chaired by Dr. Madeleine Duvic (MD Anderson Cancer Center), Dr. Lauren Pinter Brown (UCLA), and Dr. Uma Sundram (Stanford), offered an overview and discussion of the important clinical problem of transformed mycosis fungoides (MF), which often shows expression of CD30, although less uniformly and intensely than CD30+ LPD. The diagnostic distinction between ALCL and transformed MF is not always easy, especially in patients who have simultaneously MF and CD30+ LPD.
The afternoon sessions focused on clinical aspects and treatment. Dr. Larisa Geskin (University of Pittsburgh) and Dr. Christiane Querfeld (Memorial Sloan Kettering) offered a superb discussion on the management of LyP and ALCL, respectively, while Dr. Lauren Pinter Brown (UCLA) provided an update on a rare, but emerging, new type of ALCL associated with breast implants.
Finally, Dr. Barbara Pro (Fox Chase Cancer Center) offered an in-depth discussion of the most recent data about the efficacy and safety of the new anti-CD30 drug brentuximab vedotin.
The Workshop closed with Dr. Pierluigi Porcu (Ohio State University), Secretary-Treasurer of the USCLC, who led an open discussion with the audience on the topic of collaborative research, pilot studies, and young investigator mentoring within the USCLC.