Recommendations for Managing Cutaneous Lymphoma During COVID-19

A new guideline provides strategies for managing patients with primary cutaneous lymphoma during the COVID-19 pandemic.

The European Organization for Research and Treatment of Cancer (EORTC) has published general practice guidelines for treating patients with primary cutaneous lymphomas during the coronavirus disease (COVID-19) pandemic in the Journal of the European Academy of Dermatology and Venereology.

According to the guideline authors, follow up with teledermatology is recommended for patients with indolent lymphomas or other lymphomas considered at low risk and treated with topical or systemic therapies. In addition, prescriptions should be administered by mail to avoid hospital visits. The decision to continue or initiate PUVA and narrowband UVB treatments should be made based on the hospital situation.

Patients with indolent lymphomas or low-risk lymphomas could be treated with topical potent steroids and/or chlormethine, which is available in some countries in Europe. Treatment with rituximab can be postponed for up to 2 months for patients with indolent disseminated B cell lymphoma who are indicated for the therapy.

In late-stage disease or cases of aggressive lymphomas, the guideline authors recommend continuation of regular medications, including infusions with CD30 and CD20 antibody therapies. Also, prophylactic interruption is not recommended for continuous therapies. Treatments may be halted and/or the frequency of infusions could be reduced if disease is in partial remission or stable, but this treatment should be discussed with patients and caregivers.

Discontinuation of methotrexate therapy, which has been linked to a theoretical increase in severe COVID-19 risk, should be discussed with patients with aggressive lymphomas who are concerned about their infection risk. Treatment with CCR4 antibody mogamulizumab may possibly increase the risk for severe COVID-19, and continuation should also be discussed with patients. Systemic treatment with bexarotene or IFN-2a should be continued during the pandemic.

In addition to these recommendations, the EORTC suggested that cases of advanced cutaneous T-cell lymphomas “should be carefully handled especially those with adverse prognostic factors such as older age and advanced or aggressive disease in addition to risk factors to COVID infections such as comorbidities and multiple previous immunosuppressive treatment.”

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Papadavid E, Scaribrick J, Ortiz Romero P, et al. Management of primary cutaneous lymphoma patients during COVID-19 pandemic: EORTC CLTF guidelines Maarten Vermeer [published online May 16, 2020]. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16593