Mogamulizumab in combination improves clinical outcomes in relapsed and refractory Sézary syndrome

Jordan Pilkington ^* Delice Kayishunge Sophia Ly Cesar Gentille Henry Wong ^*

• University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States

Sezary Syndrome (SS) is an aggressive variant of cutaneous T-cell lymphoma that presents with generalized erythroderma, lymphadenopathy, peripheral blood involvement, and severe pruritus. Unfortunately, disease can relapse or progress and generally has a poor prognosis. Mogamulizumab is a targeted monoclonal antibody that has been shown to be effective in relapsed disease with particular benefit in the blood compartment and has received FDA approval for CTCL. Data regarding the combination of mogamulizumab with other systemic CTCL treatments has been limited. Here, we present clinical outcomes in a real-world setting where SS patients were treated with a mogamulizumab-based multiagent approach.We conducted a retrospective chart review of patients in a Cutaneous Lymphoma Clinic and identified 10 patients that met ISCL/EORTC diagnostic criteria for SS and were treated with mogamulizumab. These patients received at least four prior therapies, including systemics and topicals. All patients received mogamulizumab in addition to other systemic therapies. Responses were commonly observed in the blood after the first cycle. Global response, determined by assessment in four compartments including the skin, blood, viscera, and lymph nodes, identified four patients that achieved complete remission, three with partial response, two that maintained a stable disease, and one patient that experienced disease progression. The therapies most frequently used in combination were bexarotene and interferon. The median duration of response in our patient population was 23.5 months.In this case series, a multiagent approach combining mogamulizumab with traditional CTCL systemic agents was well tolerated and effective to treat relapsed or refractory SS and lead to a period of extended clinical improvement.