Comorbidities in Mycosis Fungoides and Racial Differences in Co-Existent Lymphomatoid Papulosis: A Cross-Sectional Study of 580 Patients in an Urban Tertiary Care Center.

Subuhi Kaul,Pegah R Bakhshi,Varun Mahadevan,Ronald J Sweren,John-Douglas Matthew Hughes,Annie L Grossberg,Raveena Khanna,Kyle A Williams,Micah Belzberg,Shawn G Kwatra,Michael S Hong

doi:10.3390/medicines7010001

Abstract

Background: Mycosis fungoides (MF) is a cutaneous T-cell lymphoma. Previous reports have suggested MF is associated with inflammatory conditions such as psoriasis, increased cardiovascular risk factors as well as secondary neoplasms. Methods: A cross-sectional study of MF patients seen from 2013 to 2019 was performed. Comorbidities were selected based on the 2015 Medicare report highlighting the most common chronic medical illnesses in the United States. Lifetime comorbidity occurrence in patients with MF were compared with that in patients with atopic dermatitis, psoriasis and patients without MF. Additional analyses were performed with patients sub-stratified by race. Results: Compared to control groups, MF was strongly associated with lymphomatoid papulosis and Hodgkin’s disease, but not significantly associated with lung, breast or colon cancer. Interestingly, the association with lymphomatoid papulosis was observed in Caucasians (CI 1062-4338; p < 0.001) and not African Americans (p = 0.9). Patients with MF had a greater association with congestive heart failure, hypertension (HT) and hyperlipidemia (HLD) compared with the general population. However, they were significantly less likely to have HT and HLD when compared with psoriasis patients (HT CI: 0.6–0.9; p < 0.001, and HLD CI: 0.05–0.07; p < 0.001). MF patients were also significantly less likely to have concomitant vitamin D deficiency compared with atopic dermatitis (AD) and psoriasis (p < 0.001). Conclusions: Our results suggest that the association of MF with lymphomatoid papulosis varies by race. Compared to the general population, hypertension and hyperlipidemia were positively associated with MF, however, these were significantly less likely on comparison to psoriasis. Unlike previously described, vitamin D deficiency was found to be significantly less in patients with MF.

Highlights

Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma (CTCL), accounting for approximately half of all primary cutaneous lymphomas [1]
Our study found that MF in Caucasian patients is statistically significantly associated with lymphomatoid papulosis, a finding that was not seen in our African American cohort
There may be additional unknown confounding factors such as socioeconomic status or preexisting medical comorbidities in the mycosis fungoides group that could have affected the interpretation of our results. These results indicate that MF is strongly associated with Hodgkin’s disease, and that MF in Caucasians is associated with lymphomatoid papulosis

Summary

Introduction

Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma (CTCL), accounting for approximately half of all primary cutaneous lymphomas [1]. The incidence of CTCL was rising in the 1970s, (due to either a real increase in cases, improvement in diagnostic methods, or a combination of the two) it has since stabilized to 5.6 per million persons with MF in the United States [2,3,4]. Patients with MF are reported to be at an increased risk of developing secondary neoplasms, Hodgkin lymphoma and lymphomatoid papulosis [2]. Previous reports have suggested MF is associated with inflammatory conditions such as psoriasis, increased cardiovascular risk factors as well as secondary neoplasms. Results: Compared to control groups, MF was strongly associated with lymphomatoid papulosis and Hodgkin’s disease, but not significantly associated with lung, breast or colon cancer. Patients with MF had a greater association with congestive heart failure, hypertension (HT) and hyperlipidemia (HLD)

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Discussion

Conclusion