{
  "abstract": "Background and Importance Sézary syndrome (SS) is a leukaemic variant of cutaneous T-cell lymphoma. After failure of first- and second-line therapies, treatment options remain limited. Evidence supporting the use of mogamulizumab in combination with chemotherapy is scarce and outcomes are variable.Aim and Objectives The aim is to evaluate the clinical efficacy and tolerability of mogamulizumab, a humanised anti-CCR4 monoclonal antibody, combined with DA-EPOCH polychemotherapy in a 67-year-old female patient with refractory SS following failure of methotrexate and doxorubicin monotherapy.Material and Methods We reviewed the clinical course of a patient treated for her dermatology and haematology clinic at a secondary-level hospital. The patient was diagnosed with stage IVA2 SS, presenting with diffuse erythroderma, lymphadenopathy, and documented clonal T-cell population. Mogamulizumab was initiated as third-line therapy subsequent to disease progression. Due to a suboptimal clinical response, mogamulizumab was consequently combined off-label with DA-EPOCH chemotherapy. Clinical outcomes were assessed using PET/CT imaging, symptom evolution, pruritus control, and safety profileResults After two cycles of combined mogamulizumab and DA-EPOCH chemotherapy, the PET/CT scan demonstrated a partial metabolic response with a Deauville score of 3 and a measurable reduction in both nodal and cutaneous disease burden. Compared with the limited benefit observed with mogamulizumab monotherapy, the combination produced improved lesion regression and partial resolution of erythroderma. The patient also reported marked symptomatic relief, including reduced fatigue, improved functional status, and notably decreased pruritus. The latter was managed with the off-label use of aprepitant and low-dose naltrexone, both approved by the hospital pharmacy committee. No grade 3/4 toxicities were observed. The patient successfully completed the planned cycles without dose delays or hospital readmissions, and the response was sustained at the next scheduled follow-up.Conclusion and Relevance In this heavily pretreated patient, the off-label addition of DA-EPOCH chemotherapy to mogamulizumab provided enhanced clinical benefit compared with prior monotherapy regimens. Improvements were achieved in both metabolic and symptomatic parameters, including a significant reduction in pruritus and lymphadenopathy. These findings support further investigation of this combination as a therapeutic alternative in refractory SS, pending validation in larger clinical settings.References and/or Acknowledgements 1. Kim YH, Bagot M, Pinter-Brown L, et al. Mogamulizumab versus vorinostat in previously treated cutaneous T-cell lymphoma. Lancet Oncol. 2018;19(9):1192–1204.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Hospital Universitario Clínico San Cecilio, Farmacia Hospitalaria, Granada, Spain"
      ],
      "name": "C Guerrero Herrera"
    },
    {
      "affiliations": [
        "Hospital Universitario Clínico San Cecilio, Farmacia Hospitalaria, Granada, Spain"
      ],
      "name": "J Peréz Cruz"
    },
    {
      "affiliations": [
        "Hospital Universitario Clínico San Cecilio, Farmacia Hospitalaria, Granada, Spain"
      ],
      "name": "MR Robles Muñoz"
    },
    {
      "affiliations": [
        "Hospital Universitario Clínico San Cecilio, Farmacia Hospitalaria, Granada, Spain"
      ],
      "name": "C Arcos Álvarez"
    }
  ],
  "title": "5PSQ-057 Case report: combination therapy with mogamulizumab and DA-EPOCH chemotherapy in refractory sézary syndrome",
  "uid": "cc6c423f-e20d-5184-a48b-6e5350184ead"
}