SAN FRANCISCO Mycosis fungoides is classically considered a disease of middle-aged white men, but onset prior to age 40 years is significantly more common in black women than in white men or women, according to the experience at M.D. Anderson Cancer Center.
Moreover, young black women with mycosis fungoides (MF) are particularly likely to have rapid progression with a poor prognosis, Patricia Sun reported at the annual meeting of the American Academy of Dermatology.
"We would like people to consider more aggressive therapy in African American women who present with MF before age 40including allogeneic transplantationearlier than you would think of it in other patients," said Ms. Sun of M.D. Anderson and the University of Texas, Houston.
MF is the most common form of cutaneous T-cell lymphoma, with an annual incidence of 6.4 cases per million population. The peak age at presentation is 6069 years. The ratio of men to women with MF is roughly 2:1. The disease is most often characterized by an indolent course, and in one large series, median survival was 10 years. MF is more common in whites than blacks.
However, when the cutaneous T-cell lymphoma team at M.D. Anderson recently noticed a small cluster of young black women who presented with MF of an aggressive nature, it enlisted Ms. Sun to lead a study aimed at learning whether these cases were simply a fluke or were representative of a consistent yet previously unrecognized trend.
Ms. Sun analyzed the prospectively collected data on 1,074 MF patients who presented to the cancer center during 19692007. She noted onset prior to age 40 years in 33% of black patients, 36% of Hispanics, and 13% of whites. Women presented with MF prior to age 40 significantly more often than did men. Indeed, 35% of the 40 black women with MF in the series presented before age 40, as did 48% of 40 affected Hispanic women and less than 15% of 550 white women.
Aggressive diseasedefined as rapid progression from stable, mild disease to stage IV in the span of less than a year at any time during the disease courseoccurred in nine women with early-onset MF. Eight of these women were black and one was white. Six of the eight black women with aggressive early-onset MF died of their disease; the two survivors underwent allogeneic transplantation.
Why the poorer outcome in black women with MF before the age of 40? "Our thought is vitamin D," Ms. Sun said. "I know everybody's talking about vitamin D now, but many of our African American patients are vitamin-D deficient."
One audience member cautioned that MF is notoriously difficult to diagnose, particularly in darker-skinned individuals, and there's probably a bias for the more severe cases to be referred to M.D. Anderson.