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Management kutaner Lymphome

Management of cutaneous lymphomas

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Zusammenfassung

Hintergrund

Kutane Lymphome stellen sowohl für den Grundlagenforscher als auch für den Kliniker eine besondere Herausforderung dar, da ihre kausale Pathogenese noch weitgehend ungeklärt ist, was die Entwicklung kausal kurativer Therapieansätze erschwert.

Diagnose

Zur Diagnosestellung ist eine komplexe Kombination aus Klinik, Histologie, Immunhistologie und Molekularbiologie notwendig. Die exakte Diagnose ist bedeutsam für den Patienten und den behandelnden Arzt, da die verschiedenen Hautlymphome sehr unterschiedliche Prognosen und Verläufe haben, die bedeutsam für die Therapieauswahl sind.

Therapie

Da bislang keine kurativen Therapien existieren, ist im Verlauf einer Hautlymphomerkrankung selbst unter Therapie häufig ein Wiederaufflammen der Erkrankung zu verzeichnen. Dies macht Therapieumstellungen notwendig, sodass viele Patienten im Verlauf ihrer Erkrankung zahlreiche Therapien durchlaufen. Die etablierten Therapieformen bedürfen häufig aufgrund ihres Nebenwirkungsprofils engmaschiger Kontrollen sowie Erfahrung und speziellen Wissens im Umgang mit den entsprechenden Substanzen. Anhand konkreter und komplexerer Fälle werden in diesem Beitrag allgemeine und praxisrelevante Aspekte des mitunter schwierigen Managements kutaner Lymphome dargestellt.

Abstract

Background

Cutaneous lymphomas challenge both researchers and physicians for several reasons. First, their pathogenesis has not been completely elucidated, which complicates the development of new curative therapies.

Diagnosis

Second, the diagnosis depends on a complex combination of clinic, histology, immunohistochemistry and molecular biology. Determination of the correct diagnosis is important for the patient and clinician because the different types of cutaneous lymphomas have very different prognoses and clinical courses, knowledge of which is essential for making treatment decisions.

Therapy

Third, no curative therapies for cutaneous lymphomas are available, so that the disease often relapses even during therapy. Thereby frequent changes in therapy are necessary, so that many patients receive a variety of treatments during the course of their disease. Many of the established therapeutic agents have a broad spectrum of side effects, so that special knowledge and experience with each agent is required, as well as careful monitoring. On the basis of more complex patient cases, general aspects of the difficult management of cutaneous lymphomas are discussed in this article.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J.P. Nicolay erhielt Reisebeihilfen für wissenschaftliche Tagungen von der TEVA/Cephalon Pharma GmbH. C.-D. Klemke erhielt Reisebeihilfen für wissenschaftliche Tagungen und Honorare für wissenschaftliche Vorträge von TEVA/Cephalon Pharma GmbH und Therakos, Johnson & Johnson Medical GmbH. Er ist Mitglied im TEVA Cutaneous Lymphoma Advisory Board. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Dermatologie, Venerologie und Allergologie, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68135, Mannheim, Deutschland

    J.P. Nicolay &  C.-D. Klemke

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  1. J.P. Nicolay
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  2. C.-D. Klemke
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Correspondence to C.-D. Klemke.

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Nicolay, J., Klemke, CD. Management kutaner Lymphome. Hautarzt 65, 607–613 (2014). https://doi.org/10.1007/s00105-013-2736-5

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