Identifying and addressing unmet clinical needs in primary cutaneous B-cell lymphoma: A consensus-based paper from an ad-hoc international panel.

CBCL DIAGNOSIS CBCL PROGNOSIS CBCL TREATMENT clinical needs primary cutaneous B-cell lymphoma

Journal

Hematological oncology
ISSN: 1099-1069
Titre abrégé: Hematol Oncol
Pays: England
ID NLM: 8307268

Informations de publication

Date de publication:
30 Aug 2023
Historique:
revised: 08 08 2023
received: 03 06 2023
accepted: 08 08 2023
medline: 31 8 2023
pubmed: 31 8 2023
entrez: 31 8 2023
Statut: aheadofprint

Résumé

Primary cutaneous B-cell lymphomas (PCBCLs) are lymphoproliferative disorders that appear on the skin without evidence of extracutaneous manifestations at the time of diagnosis. There is a lack of evidence-based guidelines for their clinical management due to the availability of very few large scale studies and controlled clinical trials. Here we present and discuss a series of major unmet clinical needs (UCNs) in the management of PCBCLs by a panel of 16 experts involved in research and clinical practice of PCBCL. The Panel produced recommendations on the appropriateness of the clinical decisions concerning the identified clinical needs and proposed research for improving the knowledge needed to solve them. Recommendations and proposals were achieved by multiple-step formalized procedures to reach a consensus after a comprehensive analysis of the scientific literature. Recommendations and proposals lay in the domain of classification uncertainties of PCBCL, optimization of diagnosis, optimization of prognosis, optimization of staging and critical issues on therapeutic strategies with particular focus on new treatments. These recommendations are intended for use not only by experts but above all by dermatologists and hematologists with limited experience in the field of PCBCLs as well as general practitioners.

Identifiants

pubmed: 37649350
doi: 10.1002/hon.3215
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023 John Wiley & Sons Ltd.

Références

Willemze R. Primary cutaneous B-cell lymphoma: classification and treatment. Curr Opin Oncol. 2006;18(5):425-431. https://doi.org/10.1097/01.cco.0000239879.31463.42
Olsen EA, Whittaker S, Willemze R, et al. Primary cutaneous lymphoma: recommendations for clinical trial design and staging update from the ISCL, USCLC, and EORTC. Blood. 2022;140(5):419-437. https://doi.org/10.1182/blood.2021012057
Willemze R, Cerroni L, Kempf W, et al. The 2018 update of the WHO-EORTC classification for primary cutaneous lymphomas. Blood. 2019;133(16):1703-1714. https://doi.org/10.1182/blood-2018-11-881268
Swerdlow SH, Campo E, Harris NL, et al. eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. IARC; 2017.
Campo E, Jaffe ES, Cook JR, et al. The international consensus classification of mature lymphoid neoplasms: a report from the clinical advisory committee. Blood. 2022;140(11):1229-1253. https://doi.org/10.1182/blood.2022015851
Gianini A, Valenzuela F, Vial AL, et al. Miliary and agminated papules: report of an atypical presentation of primary cutaneous follicle center lymphoma. Int J Dermatol. 2020;59(11):e409-e411.
Dumont M, Battistella M, Ram-Wolff C, Bagot M, de Masson A. Diagnosis and treatment of primary cutaneous B-cell lymphomas: state of the art and perspectives. Cancers (Basel). 2020;12(6):1497-1515. https://doi.org/10.3390/cancers12061497
Delbecq AL Van de Ven Ah Gustafson DH. Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes. Scott, Foresman and Co; 1975.
Zhang Y, LeWitt TM, Louissaint A, Jr, Guitart J, Zhou XA, Choi J. Disease-defining molecular features of primary cutaneous B-cell lymphomas: implications for classification and treatment. J Invest Dermatol. 2023;143(2):189-196. https://doi.org/10.1016/j.jid.2022.07.027
Pham-Ledard A, Prochazkova-Carlotti M, Andrique L, et al. Multiple genetic alterations in primary cutaneous large B-cell lymphoma, leg type support a common lymphomagenesis with activated B-cell-like diffuse large B-cell lymphoma. Mod Pathol. 2014;27(3):402-411. https://doi.org/10.1038/modpathol.2013.156
Schrader AMR, de Groen RAL, Willemze R, et al. Cell-of-origin classification using the Hans and Lymph2Cx algorithms in primary cutaneous large B-cell lymphomas. Virchows Arch. 2022;480(3):667-675. https://doi.org/10.1007/s00428-021-03265-5
Pham-Ledard A, Beylot-Barry M, Barbe C, et al. High frequency and clinical prognostic value of MYD88 L265P mutation in primary cutaneous diffuse large B-cell lymphoma, leg-type. JAMA Dermatology. 2014;150(11):1173-1179. https://doi.org/10.1001/jamadermatol.2014.821
Mareschal S, Pham-Ledard A, Viailly PJ, et al. Identification of somatic mutations in primary cutaneous diffuse large B-cell lymphoma, leg type by massive parallel sequencing. J Invest Dermatol. 2017;137(9):1984-1994. https://doi.org/10.1016/j.jid.2017.04.010
Wright GW, Huang DW, Phelan JD, et al. A probabilistic classification tool for genetic subtypes of diffuse large B cell lymphoma with therapeutic implications. Cancer Cell. 2020;37(4):551-568. https://doi.org/10.1016/j.ccell.2020.03.015
Lucioni M, Berti E, Arcaini L, et al. Primary cutaneous B-cell lymphoma other than marginal zone: clinicopathologic analysis of 161 cases: comparison with current classification and definition of prognostic markers. Cancer Med. 2016;5(10):2740-2755. https://doi.org/10.1002/cam4.865
Swerdlow SH. Cutaneous marginal zone lymphomas. Semin Diagn Pathol. 2017;34(1):76-84. https://doi.org/10.1053/j.semdp.2016.11.007
Gibson SE, Swerdlow SH. How I diagnose primary cutaneous marginal zone lymphoma. Am J Clin Pathol. 2020;154(4):428-449. https://doi.org/10.1093/ajcp/aqaa116
Brenner I, Roth S, Puppe B, Wobser M, Rosenwald A, Geissinger E. Primary cutaneous marginal zone lymphomas with plasmacytic differentiation show frequent IgG4 expression. Mod Pathol. 2013;26(12):1568-1576. https://doi.org/10.1038/modpathol.2013.106
Carlsen ED, Swerdlow SH, Cook JR, Gibson SE. Class-switched primary cutaneous marginal zone lymphomas are frequently IgG4-positive and have features distinct from IgM-positive cases. Am J Surg Pathol. 2019;43(10):1403-1412. https://doi.org/10.1097/pas.0000000000001363
Carlsen ED, Bhavsar S, Cook JR, Swerdlow SH. IRTA1 positivity helps identify a MALT-lymphoma-like subset of primary cutaneous marginal zone lymphomas, largely but not exclusively defined by IgM expression. J Cutan Pathol. 2021;49(1):55-60. https://doi.org/10.1111/cup.14111
Edinger JT, Kant JA, Swerdlow SH. Cutaneous marginal zone lymphomas have distinctive features and include 2 subsets. Am J Surg Pathol. 2010;34(12):1830-1841. https://doi.org/10.1097/pas.0b013e3181f72835
van Maldegem F, van Dijk R, Wormhoudt TA, et al. The majority of cutaneous marginal zone B-cell lymphomas expresses class-switched immunoglobulins and develops in a T-helper type 2 inflammatory environment. Blood. 2008;112(8):3355-3361. https://doi.org/10.1182/blood-2008-01-132415
Maurus K, Appenzeller S, Roth S, et al. Panel sequencing shows recurrent genetic FAS alterations in primary cutaneous marginal zone lymphoma. J Invest Dermatol. 2018;138(7):1573-1581. https://doi.org/10.1016/j.jid.2018.02.015
Fernandez-Flores A. Is there a narrow connection between the two subsets of cutaneous MALT lymphomas and the dynamics of the follicle? Am J Dermatopathol. 2013;35(2):283-284. https://doi.org/10.1097/dad.0b013e31825aa352
Guitart J. Rethinking primary cutaneous marginal zone lymphoma: shifting the focus to the cause of the infiltrate. J Cutan Pathol. 2015;42(9):600-603. https://doi.org/10.1111/cup.12509
Guitart J, Deonizio J, Bloom T, et al. High incidence of gastrointestinal tract disorders and autoimmunity in primary cutaneous marginal zone B-cell lymphomas. JAMA Dermatology. 2014;150(4):412-418. https://doi.org/10.1001/jamadermatol.2013.9223
Nihal M, Mikkola D, Horvath N, et al. Cutaneous lymphoid hyperplasia: a lymphoproliferative continuum with lymphomatous potential. Hum Pathol. 2003;34(6):617-622. https://doi.org/10.1016/s0046-8177(03)00075-3
Guitart J, Gerami P. Is there a cutaneous variant of marginal zone hyperplasia? Am J Dermatopathol. 2008;30(5):494-496. https://doi.org/10.1097/dad.0b013e31817d1391
Belaud-Rotureau MA, Marietta V, Vergier B, et al. Inactivation of p16INK4a/CDKN2A gene may be a diagnostic feature of large B cell lymphoma leg type among cutaneous B cell lymphomas. Virchows Arch. 2008;452(6):607-620. https://doi.org/10.1007/s00428-008-0593-x
Dijkman R, Tensen CP, Jordanova ES, et al. Array-based comparative genomic hybridization analysis reveals recurrent chromosomal alterations and prognostic parameters in primary cutaneous large B-cell lymphoma. J Clin Oncol. 2006;24(2):296-305. https://doi.org/10.1200/jco.2005.02.0842
Kaune KM, Neumann C, Hallermann C, Haller F, Schon MP, Middel P. Simultaneous aberrations of single CDKN2A network components and a high Rb phosphorylation status can differentiate subgroups of primary cutaneous B-cell lymphomas. Exp Dermatol. 2011;20(4):331-335. https://doi.org/10.1111/j.1600-0625.2010.01226.x
Barasch NJK, Liu YC, Ho J, et al. The molecular landscape and other distinctive features of primary cutaneous follicle center lymphoma. Hum Pathol. 2020;106:93-105. https://doi.org/10.1016/j.humpath.2020.09.014
Zhou XA, Yang J, Ringbloom KG, et al. Genomic landscape of cutaneous follicular lymphomas reveals 2 subgroups with clinically predictive molecular features. Blood Advances. 2021;5(3):649-661. https://doi.org/10.1182/bloodadvances.2020002469
Koning MT, Quinten E, Zoutman WH, et al. Acquired N-linked glycosylation motifs in B-cell receptors of primary cutaneous B-cell lymphoma and the normal B-cell repertoire. J Invest Dermatol. 2019;139(10):2195-2203. https://doi.org/10.1016/j.jid.2019.04.005
Cerroni L, Arzberger E, Pütz B, et al. Primary cutaneous follicle center cell lymphoma with follicular growth pattern. Blood. 2000;95(12):3922-3928. https://doi.org/10.1182/blood.v95.12.3922.012k08_3922_3928
Cerroni L, El-Shabrawi-Caelen L, Fink-Puches R, LeBoit PE, Kerl H. Cutaneous spindle-cell B-cell lymphoma. Am J Dermatopathol. 2000;22(4):299-304. https://doi.org/10.1097/00000372-200008000-00001
Hallermann C, Kaune KM, Gesk S, et al. Molecular cytogenetic analysis of chromosomal breakpoints in the IGH, MYC, BCL6, and MALT1 gene loci in primary cutaneous B-cell lymphomas. J Invest Dermatol. 2004;123(1):213-219. https://doi.org/10.1016/s0344-0338(04)80760-x
Dalle S, Thomas L, Balme B, Dumontet C, Thieblemont C. Primary cutaneous marginal zone lymphoma. Crit Rev Oncol Hematol. 2010;74(3):156-162. https://doi.org/10.1016/j.critrevonc.2009.09.003
Cho-Vega JH, Vega F, Rassidakis G, Medeiros LJ. Primary cutaneous marginal zone B-cell lymphoma. Am J Clin Pathol. 2006;125(Suppl l):S38-S49. https://doi.org/10.1309/cvfybqnmx1pknaa7
Kogame T, Takegami T, Sakai TR, et al. Immunohistochemical analysis of class-switched subtype of primary cutaneous marginal zone lymphoma in terms of inducible skin-associated lymphoid tissue. J Eur Acad Dermatol Venereol. 2019;33(11):e401-e403. https://doi.org/10.1111/jdv.15703
Sun JR, Nong L, Liu XQ, Tu P, Wang Y. Frequent immunoglobulin G4 expression in a common variant of primary cutaneous marginal zone B-cell lymphoma. Australas J Dermatol. 2018;59(2):141-145. https://doi.org/10.1111/ajd.12699
Li C, Inagaki H, Kuo TT, Hu S, Okabe M, Eimoto T. Primary cutaneous marginal zone B-cell lymphoma: a molecular and clinicopathologic study of 24 asian cases. Am J Surg Pathol. 2003;27(8):1061-1069. https://doi.org/10.1097/00000478-200308000-00003
Grange F, Bekkenk MW, Wechsler J, et al. Prognostic factors in primary cutaneous large B-cell lymphomas: a European multicenter study. J Clin Oncol. 2001;19(16):3602-3610. https://doi.org/10.1200/jco.2001.19.16.3602
Senff NJ, Hoefnagel JJ, Jansen PM, et al. Reclassification of 300 primary cutaneous B-Cell lymphomas according to the new WHO-EORTC classification for cutaneous lymphomas: comparison with previous classifications and identification of prognostic markers. J Clin Oncol. 2007;25(12):1581-1587. https://doi.org/10.1200/jco.2006.09.6396
Pham-Ledard A, Cowppli-Bony A, Doussau A, et al. Diagnostic and prognostic value of BCL2 rearrangement in 53 patients with follicular lymphoma presenting as primary skin lesions. Am J Clin Pathol. 2015;143(3):362-373. https://doi.org/10.1309/ajcp4subr4npsptn
Guinard E, Alenezi F, Lamant L, et al. Staging of primary cutaneous follicle centre B-cell lymphoma: bone marrow biopsy, CD10, BCL2 and t(14;18) are not relevant prognostic factors. Eur J Dermatol. 2019. Online ahead of print. https://doi.org/10.1684/ejd.2018.3489
Servitje O, Climent F, Colomo L, et al. Primary cutaneous vs secondary cutaneous follicular lymphomas: a comparative study focused on BCL2, CD10, t(14;18) expression. J Cutan Pathol. 2019;46(3):182-189. https://doi.org/10.1111/cup.13399
Pileri A, Agostinelli C, Bertuzzi C, et al. BCL-2 expression in primary cutaneous follile center B-cell lymphoma and its prognostic role. Front Oncol. 2020;10:662.
Willemze R, Jaffe ES, Burg G, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005;105(10):3768-3785. https://doi.org/10.1182/blood-2004-09-3502
Kim YH, Willemze R, Pimpinelli N, et al. TNM classification system for primary cutaneous lymphomas other than mycosis fungoides and sezary syndrome: a proposal of the international society for cutaneous lymphomas (ISCL) and the cutaneous lymphoma Task Force of the European organization of research and treatment of cancer (EORTC). Blood. 2007;110(2):479-484. https://doi.org/10.1182/blood-2006-10-054601
Zinzani PL, Quaglino P, Pimpinelli N, et al. Prognostic factors in primary cutaneous B-cell lymphoma: the Italian study group for cutaneous lymphomas. J Clin Oncol. 2006;24(9):1376-1382. https://doi.org/10.1200/jco.2005.03.6285
Servitje O, Muniesa C, Benavente Y, et al. Primary cutaneous marginal zone lymphoma: response to treatment and disease-free survival in a series of 137 patients. J Am Acad Dermatol. 2013;69(3):357-365. https://doi.org/10.1016/j.jaad.2013.04.047
Senff NJ, Willemze R. The applicability and prognostic value of the new TNM classification system for primary cutaneous lymphomas other than mycosis fungoides and Sézary syndrome: results on a large cohort of primary cutaneous B-cell lymphomas and comparison with the system used by the Dutch Cutaneous Lymphoma Group. Br J Dermatol. 2007;157(6):1205-1211. https://doi.org/10.1111/j.1365-2133.2007.08239.x
Mian M, Marcheselli L, Luminari S, et al. CLIPI: a new prognostic index for indolent cutaneous B cell lymphoma proposed by the International Extranodal Lymphoma Study Group (IELSG 11). Ann Hematol. 2011;90(4):401-408. https://doi.org/10.1007/s00277-010-1083-1
Mehta-Shah N, Horwitz SM, Ansell S, et al. NCCN guidelines insights: primary cutaneous lymphomas, version 2.2020. Natl Compr Canc Netw. 2020;18(5):522-536. https://doi.org/10.6004/jnccn.2020.0022
Willemze R, Hodak E, Zinzani PL, Specht L, Ladetto M. ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:iv30-iv40. https://doi.org/10.1093/annonc/mdy133
Senff NJ, Noordijk EM, Kim YH, et al. European organization for research and treatment of cancer and international society for cutaneous lymphoma consensus recommendations for the management of cutaneous B-cell lymphomas. Blood. 2008;112(5):1600-1609. https://doi.org/10.1182/blood-2008-04-152850
Vachhani P, Neppalli VT, Cancino CJ, et al. Radiological imaging and bone marrow biopsy in staging of cutaneous B-cell lymphoma. Br J Haematol. 2019;184(4):674-676. https://doi.org/10.1111/bjh.15154
Kheterpal MK, Dai J, Geller S, et al. Role of imaging in low grade cutaneous B-cell lymphoma presenting in the skin. J Am Acad Dermatol. 2019;81(4):970-976. https://doi.org/10.1016/j.jaad.2019.01.037
Adams HJ, Kwee TC, de Keizer B, Fijnheer R, de Klerk JMH, Nievelstein RAJ. FDG PET/CT for the detection of bone marrow involvement in diffuse large B-cell lymphoma: systematic review and meta-analysis. Eur J Nucl Med Mol Imag. 2014;41(3):565-574. https://doi.org/10.1007/s00259-013-2623-4
Senff NJ, Kluin-Nelemans HC, Willemze R. Results of bone marrow examination in 275 patients with histological features that suggest an indolent type of cutaneous B-cell lymphoma. Br J Haematol. 2008;142(1):52-56. https://doi.org/10.1111/j.1365-2141.2008.07159.x
Magro CM, Kalomeris T, Roberts A. Primary cutaneous blastic marginal zone lymphoma: a comprehensive clinical, light microscopic, phenotypic and cytogenetic appraisal. Ann Diagn Pathol. 2022;63:152101. https://doi.org/10.1016/j.anndiagpath.2022.152101
Ricard F, Cheson B, Barrington S, et al. Application of the Lugano classification for initial evaluation, staging, and response assessment of Hodgkin and non-hodgkin lymphoma: the PRoLoG consensus initiative. (Part 1- clinical). J Nucl Med. 2023;64(2):239-243. https://doi.org/10.2967/jnumed.122.264106
Nicolay JP, Wobser M. Cutaneous B-cell lymphomas - pathogenesis, diagnostic workup, and therapy. J Dtsch Dermatol Ges. 2016;14(12):1207-1224. https://doi.org/10.1111/ddg.13164
La Selva R, Alberti Violetti S, Delfino C, et al. A literature revision in primary cutaneous B-cell lymphoma. Indian J Dermatol. 2017;62(2):146-157. https://doi.org/10.4103/ijd.ijd_74_17
Wilcox RA. Cutaneous B-cell lymphomas: 2019 update on diagnosis, risk stratification, and management. Am J Hematol. 2018;93(11):1427-1430. https://doi.org/10.1002/ajh.25224
Gilson D, Whittaker SJ, Child FJ, et al. British association of dermatologists and UK Cutaneous Lymphoma group guidelines for the management of primary cutaneous lymphomas. Br J Dermatol. 2019;180(3):496-526. https://doi.org/10.1111/bjd.17240
Lang CCV, Ramelyte E, Dummer R. Innovative therapeutic approaches in primary cutaneous B cell lymphoma. Front Oncol. 2020;10:1163. https://doi.org/10.3389/fonc.2020.01163
Specht L, Dabaja B, Illidge T, Wilson LD, Hoppe RT. Modern radiation therapy for primary cutaneous lymphomas: field and dose guidelines from the international lymphoma radiation oncology group. Int J Radiat Oncol Biol Phys. 2015;92(1):32-39. https://doi.org/10.1016/j.ijrobp.2015.01.008
Perry A, Vincent BJ, Parker SR. Intralesional corticosteroid therapy for primary cutaneous B-cell lymphoma. Br J Dermatol. 2010;163(1):223-225. https://doi.org/10.1111/j.1365-2133.2010.09798.x
Cozzio A, Kempf W, Schmid-Meyer R, et al. Intra-lesional low-dose interferon alpha2a therapy for primary cutaneous marginal zone B-cell lymphoma. Leuk Lymphoma. 2006;47(5):865-869. https://doi.org/10.1080/10428190500399698
Mori M, Campolmi P, Mavilia L, Rossi R, Cappugi P, Pimpinelli N. Topical photodynamic therapy for primary cutaneous B-cell lymphoma: a pilot study. J Am Acad Dermatol. 2006;54(3):524-526. https://doi.org/10.1016/j.jaad.2005.10.016
Farkas A, Kemeny L, French LE, Dummer R. New and experimental skin-directed therapies for cutaneous lymphomas. Skin Pharmacol Physiol. 2009;22(6):322-334. https://doi.org/10.1159/000241302
Morton CA, Szeimies RM, Sidoroff A, Braathen L. European guidelines for topical photodynamic therapy part 2: emerging indications-field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol. 2013;27(6):672-679. https://doi.org/10.1111/jdv.12026
Fabbri A, Cencini E, Alterini R, et al. Rituximab plus liposomal pegylated doxorubicin in the treatment of primary cutaneous B-cell lymphomas. Eur J Haematol. 2014;93(2):129-136. https://doi.org/10.1111/ejh.12315
Kim YH. Multidisciplinary care in the management of patients with cutaneous lymphoma: a perspective. Clin Lymphoma, Myeloma & Leukemia. 2010;10((Suppl 2)):S106-S108. https://doi.org/10.3816/clml.2010.s.021
Tyler KH, Haverkos BM, Hastings G, et al. The role of an integrated multidisciplinary clinic in the management of patients with cutaneous lymphoma. Front Oncol. 2015;5:136. https://doi.org/10.3389/fonc.2015.00136
Fox LC, Yannakou CK, Ryland G, et al. Molecular mechanisms of disease progression in primary cutaneous diffuse large B-cell lymphoma, leg type during ibrutinib therapy. Int J Mol Sci. 2018;19(6):1758. https://doi.org/10.3390/ijms19061758
Zhou XA, Louissaint A, Wenzel A, et al. Genomic analyses identify recurrent alterations in immune evasion genes in diffuse large B cell lymphoma, leg type. J Invest Dermatol. 2018;138(11):2365-2376. https://doi.org/10.1016/j.jid.2018.04.038
Gupta E, Accurso J, Sluzevich J, Menke DM, Tun HW. Excellent outcome of immunomodulation or bruton’s tyrosine kinase inhibition in highly refractory primary cutaneous diffuse large B-Cell Lymphoma, Leg type. Rare Tumors. 2015;7(4):164-166. https://doi.org/10.4081/rt.2015.6067
Di Raimondo C, Abdulla FR, Zain J, Querfeld C, Rosen ST. Rituximab, lenalidomide and pembrolizumab in refractory primary cutaneous diffuse large B-cell lymphoma, leg type. Br J Haematol. 2019;187(3):e79-e82. https://doi.org/10.1111/bjh.16211
Walter HS, Trethewey CS, Ahearne MJ, et al. Successful treatment of primary cutaneous diffuse large B-cell lymphoma leg type with single-agent venetoclax. JCO Precis Oncol. 2019;3:1-5. https://doi.org/10.1200/po.19.00002
Tadiotto Cicogna G, Ferranti M, Lazzarotto A, Alaibac M. Biological approaches to aggressive cutaneous B-cell lymphomas. Front Oncol. 2019;9:1238. https://doi.org/10.3389/fonc.2019.01238

Auteurs

Pietro Quaglino (P)

Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy.

Nicola Pimpinelli (N)

Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy.

Pier Luigi Zinzani (PL)

IRCCS Azienda Ospedaliero-Universitaria di Bologna. Istituto di Ematologia "Seràgnoli", Bologna, Italy.
Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale. Università di Bologna, Bologna, Italy.
Istituto di Ematologia "Seràgnoli", Azienda Ospedaliero-Universitaria di Bologna - IRCCS, Bologna, Italy.

Marco Paulli (M)

Pathology Section, Department of Molecular Medicine, University of Pavia and Fondazione I.R.C.C.S. Policlinico "S.Matteo", Pavia, Italy.

Stefano Pileri (S)

IEO - European Institute of Oncology IRCCS (Milan) & Bologna University School of Medicine, Milano, Italy.

Emilio Berti (E)

Dermatology Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy.

Lorenzo Cerroni (L)

Department of Dermatology, Research Unit Dermatopathology, Medical University of Graz, Graz, Austria.

Joan Guitart (J)

Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Youn H Kim (YH)

Department of Dermatology, Stanford University School of Medicine, Palo Alto, California, USA.

Serena Rupoli (S)

Clinica di Ematologia, Ospedali Riuniti di Ancona, Ancona, Italy.

Marco Santucci (M)

Pathology Unit, Careggi University Hospital, Florence, Italy.
Department of Health Sciences, Section of Pathological Anatomy, University of Florence, Florence, Italy.

Gabriele Simontacchi (G)

Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

Maarten Vermeer (M)

Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.

Richard Hoppe (R)

Department of Radiation Oncology, Stanford University, Stanford, California, USA.

Barbara Pro (B)

Northwestern University, Chicago, Illinois, USA.

Steven H Swerdlow (SH)

University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Giovanni Barosi (G)

Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.

Classifications MeSH