MFF Forum, edition 2

ISCL Meets in Paris
by Seth Stevens, M.D., Assistant Professor of Dermatology and Oncology at Cas Western Reserve University, Chief of Dermatology at the Cleveland VA Medical Center, and Director of the Cutaneous Lympoma Program of the Ireland Cancer Center/University Hospitals of Cleveland

The International Society of Cutaneous Lymphomas (ISCL) held a joint meeting in Paris this June with the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Task Force and the Japan Cutaneous Lymphoma Group to discuss "Staging and Prognostic Factors in Cutaneous Lymphoma."

The scientific program included presentations on classification, staging, treatment strategies and prognostic factors. There was sharing of information and roundtable discussions on "The Next Step Forward."

Chaired by Dr. Gunter Burg (University Hospital of Zurich), the session on classification compared the several different classification systems in use, and described several new or rare entities that have been noted in both the Western world and the Eastern world. The importance of efforts to clarify the classification of lymphomas is to work toward the use of a common language in describing an individual patient's disease in order to best advise other patients on their prognosis and to choose the best therapies for any given individual.

Along with the classification of cutaneous lymphomas, there was a presentation on the consensus definition of early mycosis fungoides (MF). This effort has gone on for many years and the presentation of a means to define MF that integrates the clinical appearance and behavior, routine pathology and specialized tests (such as T-cell receptor gene analysis and immunohistochemistry) in order to facilitate more uniform criteria for making the diagnosis. The importance of this work is probably readily apparent to our readers, given the frequently frustrating delays in reaching a diagnosis of MF and the accompanying uncertainty as to whether a patient does or does not have a lymphoma. The approach of the issuance of such a consensus report is exciting because previous attempts have not been successful. We must congratulate the dedication and the hard work of the ISCL in this regard.

The second session, Chaired by Dr. Youn Kim (Stanford University Hospital) addressed staging. Again, the point of these discussions is to lead to a better understanding of the likely outcomes of patients at the time of diagnosis and to tailor treatment appropriately. In particular, two new staging systems were presented in which patch lesions are viewed as distinct from plaque lesions and the other, which recognizes that the currently used staging system does not take into account the extent of blood involvement with lymphoma. While staging patients' disease can guide clinical decisions, these discussions recognize that new techniques for diagnosis and new data regarding clinical lesions' behavior can be exploited to improve the current staging system, which is a quarter of a century old.

The third session focused on prognostic factors other than staging. Whereas, staging information provides information regarding prognosis, stages of cutaneous lymphomas broadly group patients. Therefore patients are frequently given information that describes the average patient with that stage of disease. This information is critical, however, each individual patient wants to know whether he or she is likely to fare better or worse than the average patient. Towards that goal, more subtle features of the pathologic appearance, genetics, and blood test results have been investigated as to whether they may influence patient outcome.

The final session of the day was chaired by Dr. Seth Stevens (University Hospitals of Cleveland) and focused on standardizing the response to therapy. This session discussed ways to quantify the amount of cutaneous lymphoma, and particularly MF, and how to measure changes in the routine care of patients and during clinical trials. As with some of the other sessions, the main goal of this session was to work toward a uniform means to describe the behavior of patients' disease. This is important in order to compare outcomes of clinical trials on a head-to-head basis. Also, it is likely that short of complete response, some degree of partial response to therapy may have prognostic importance.

Similar meetings bring the world's leading investigators to share information and compare what they have learned in their research. Collaborations such as these have the potential to lead to new and more effective therapies.

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