Immune checkpoint inhibitors (ICIs) have been associated with paradoxical phenomena such as tumor pseudoprogression and hyperprogressive disease. This systematic literature review summarizes available reports of cutaneous T-cell lymphomas (CTCL) developing (de novo) or accelerating (pre-existing) during ICI therapy.
A systematic search of PubMed, Embase, and Web of Science was conducted according to PRISMA guidelines. Eligible publications included clinical trials, case series, and case reports. Extracted data included patient characteristics, CTCL subtype, ICI regimen, timing, clinical presentation, histopathology, outcomes, and proposed mechanisms.
Across 11 eligible studies, 11 patients were identified. Seven patients developed new onset CTCL, while four experienced rapid progression of pre-existing disease during treatment with immunotherapy. Most ICIs were prescribed for treatment of metastatic melanoma or renal cell carcinoma. One clinical trial enrolled patients with CTCL. The interval between ICI initiation and CTCL onset/acceleration ranged from 12 days to 18 months. Clinical presentations included erythroderma, panniculitis-like nodules, and indurated plaques. Outcomes varied: some patients deteriorated rapidly and died within months, whereas others achieved remission following ICI discontinuation and additional treatment.
These reports highlight a rare but clinically relevant possible association between ICI therapy and new onset or rapid progression of pre-existing CTCL. Clinicians should maintain vigilance for atypical cutaneous eruptions or sudden disease acceleration in patients receiving ICIs. This issue is particularly important as ICI monotherapy and combination regimens are actively being explored in clinical trials as novel therapies for CTCL. Larger studies are required to clarify risk factors, clinical management, and underlying mechanisms.
