Introduction:
Sézary syndrome (SS) is a rare, aggressive leukemic cutaneous T-cell lymphoma with historically poorer outcomes in Black patients.
Objective:
To evaluate racial and sex-based survival disparities in SS.
Methods:
75 SS cases at Moffitt Cancer Center (MCC, 2015–2025) and 403 cases from SEER22 (2000–2021) were analyzed.
Results:
In MCC (n=75; 56 White, 13 Black, 6 Other; median-age 73), Black patients were more often< 60 (38.5% vs.10.7%, p=0.041), had more stage-IVB disease (30.8% vs.8.9%, p=0.047), and higher LCT frequency (76.9% vs.30.4%, p=0.003), compared to White patients. Sex distribution was similar (p=0.83).
Median OS was not reached (follow-up 57mo); 1- and 3-year OS were 87.8% and 72.1%. Black patients had worse OS compared with White race (1-year 76.2% vs.89.1%; 3-year 35.5% vs.82.2%), with univariate HR 3.6 (p=0.007) and multivariate HR 3.1 (p=0.018); LCT also predicted worse outcomes (HR 2.1, p=0.047).
ECP remained the mainstay therapy (77% Black vs.86% White), with similar mogamulizumab use. Black patients more frequently received ECP+Pegasys, romidepsin, brentuximab, and combination chemotherapy.
In SEER22 (n=403; 311 White, 77 Black; median-age 68), compared to White patients, Black patients were younger (46.8% vs.25.4% < 60 years, p=0.0004); male proportions were similar (55.3% vs.53.2%, p=0.80). Median OS was 48 months; 12- and 36-month OS were 83.2% and 60.9%. At 36 months, OS was 63.9% for White and 51.5% for Black patients. Adjusted Cox model showed inferior survival in Black patients (HR 1.56, 95%CI 1.12–2.17; p=0.009).
Conclusions:
Racial and sex-based survival disparities persist in SS, with Black patients experiencing worse outcomes-evident in institutional data and confirmed in national cohorts.
