Treatment Of Primary Cutaneous Bcell Lymphoma

The classification of primary cutaneous B-cell lymphoma (PCBCL) remains controversial with separate and distinct terminology promoted by the Working Formulation, the Revised European-American Lymphoma (REAL) classification, the World Health Organization (WHO) and the European Organization for Research and Treatment of Cancer (EORTC).2-4 Most long-term follow-up data are based on studies according to the EORTC (Table 59.1). The varied classification schemes make it difficult to interpret the literature concerning treatment.

PCBCLs are characterized by a favorable prognosis with a tendency to remain localized to a limited area of the skin and a low risk of extracutaneous spread. Compared to cutaneous T-cell lymphoma (CTCL), experience with treatment of PCBCL is more limited and focuses on follicle center cell lymphoma (FCCL). The optimum treatment for marginal zone lymphoma (MZL)/immunocytoma (IC), large B-cell lymphoma of the leg (LBCL of the leg), and the provisional entities remains controversial. Traditional treatment approaches, including surgical excision, local radiation, and/or chemotherapy, are most commonly used, but relapses occur frequently. Antibiotics may be used as a first-line treatment of Borrelia burgdor-feri-associated primary cutaneous B-cell lymphoma.56 Biologic therapies, such as interferon alpha and ritux-imab, a chimeric monoclonal antibody directed against

CD20 cell surface marker, have been incorporated into treatment strategies.7 8 In select patients with relapsing and refractory disease, autologous or allogeneic transplantation is appropriate.

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