NCCN Guidelines Version 3.2012 Mycosis Fungoides/Sezary ...

TNMB g
Skin
Node
Visceral
T1
T2
T3
T4
N0
N1
N2
N3
NX
M0
M1
NCCN Guidelines Version 3.2012
Mycosis Fungoides/Sezary Syndrome
TNMB Classification and Staging of Mycosis Fungoides and Sezary Syndromeh Limited patches, ipapules and/or plaquesjcovering < 10 % of the skin surface
Patches, ipapules and/or plaquesjcovering � 10 % of the skin surface
One or more tumors k ( � 1 cm in diameter)
Confluence of erythema � 80 % body surface area
No clinically abnormal peripheral lymph nodes; biopsy not requiredl Clinically abnormal peripheral lymph nodes; histopathology Dutch Gr 1 or NCI LN 0-2
Clinically abnormal peripheral lymph nodes; histopathology Dutch Gr 2 or NCI LN 3
Clinically abnormal peripheral lymph nodes; histopathology Dutch Gr 3-4 or NCI LN 4
Clinically abnormal peripheral lymph nodes; no histologic confirmation
No visceral organ involvement
Visceral involvement (must have pathology confirmationm and organ involved should be specified)
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
Version 3.2012, 07/09/12 © National Comprehensive Cancer Network, Inc. 2012, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN .
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NHL Table of Contents
Discussion
Blood B0 Absence of significant blood involvement: � 5 % of peripheral blood lymphocytes are atypical (Sezary) cellsn
B1 Low blood tumor burden: > 5 % of peripheral blood lymphocytes are atypical (Sezary) cells but does not meet
the criteria of B2
B2 High blood tumor burden: � 1000/mcL Sezary cellsm
gOlsen
E, Vonderheid E, Pimpinelli N, et al. Blood 2007;110:1713-1722.
of large cell transformation has occurred. Phenotyping for CD30 is encouraged.
hSezary
syndrome (B2) is defined as a clonal rearrangement of the TCR in the lAbnormal
peripheral lymph node(s) = any palpable peripheral node that on physical
blood (clones should be relevant to clone in the skin) and either 1000/mcL or
increased CD4 or CD3 cells with CD4/CD8 of 10 or more or increase in CD4 cells
with an abnormal phenotype (40% CD4/CD7 or 30% CD4/CD26).
examination is firm, irregular, clustered, fixed or � 1.5 cm in diameter. Node groups
examined on physical examination = cervical, supraclavicular, epitrochlear, axillary
and inguinal. Central nodes, which are not generally amenable to pathologic
iPatch
= Any size skin lesion without significant elevation or induration.
Presence/absence of hypo- or hyperpigmentation, scale, crusting and/or
assessment, are not currently considered in the nodal classification unless used to
establish N3 histopathologically.
poikiloderma should be noted.
mSpleen
and liver may be diagnosed by imaging criteria.
jPlaque
= Any size skin lesion that is elevated or indurated. Presence or absence
of scale, crusting and/or poikiloderma should be noted. Histological features such
nSezary
cells are defined as lymphocytes with hyperconvoluted cerebriform nuclei. If
Sezary cells are not able to be used to determine tumor burden for B2, then one of
as folliculotropism or large cell transformation ( � 25 % large cells), CD30+ the following modified ISCL criteria along with a positive clonal rearrangement of
or CD30- and clinical features such as ulceration are important to document. the TCR may be used instead. (1) expanded CD4+ or CD3+ cells with CD4/CD8
kTumor
= at least one > 1 cm diameter solid or nodular lesion with evidence of
depth and/or vertical growth. Note total number of lesions, total volume of lesions,
largest size lesion, and region of body involved. Also note if histological evidence
ratio �
10, (2) expanded CD4+ cells with abnormal immunophenotype including
loss of CD7 or CD26.
MFSS-2