Challenges in utilizing ALK expression to distinguish primary cutaneous from systemic anaplastic large cell lymphoma

Gleason,Laura; Afifi,Ladan; Banner,Lauren; Talasila,Sahithi; Joffe,Daniel; Bhatti,Safiyyah; Alpdogan,Onder; Porcu,Pierluigi; Nikbakht,Neda

doi:10.3892/mco.2024.2733

Challenges in utilizing ALK expression to distinguish primary cutaneous from systemic anaplastic large cell lymphoma

Authors:
- Laura Gleason
- Ladan Afifi
- Lauren Banner
- Sahithi Talasila
- Daniel Joffe
- Safiyyah Bhatti
- Onder Alpdogan
- Pierluigi Porcu
- Neda Nikbakht
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Affiliations: Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA, Department of Dermatology, University of California Los Angeles, Los Angeles, CA 90067, USA, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA
Published online on: March 19, 2024 https://doi.org/10.3892/mco.2024.2733
Article Number: 35

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Abstract

Anaplastic large cell lymphoma (ALCL) is a CD30+ peripheral T‑cell lymphoma with a clinical spectrum including cutaneous and systemic presentations. While primary cutaneous ALCL (pcALCL) has a favorable prognosis, systemic ALCL (sALCL) has poorer survival outcomes. Expression of anaplastic lymphoma kinase (ALK) by malignant cells has been suggested to distinguish sALCL from pcALCL. However, there have been documented cases of ALK‑positive ALCL confined to the skin. The present study reviewed characteristics of published cutaneous ALK‑positive ALCL cases to distinguish between these two entities. In 23 identified adults with ALK‑positive pcALCL, 26% developed systemic involvement and 74% had skin‑limited disease. In 14 pediatric patients, 36% had both cutaneous and systemic involvement and 64% had cutaneous disease only. This analysis revealed that pcALCL and sALCL could not reliably be distinguished by ALK expression or nuclear vs. cytoplasmic localization. Localized treatment with frequent monitoring may be sufficient in ALK‑positive pcALCL until there is evidence of progression. Physicians should be aware of the overall spectrum of ALCL, including cutaneous limited disease, systemic disease, disease with NPM‑ALK translocation, disease with ALK positivity and disease with skin recurrence.

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