Researchers Report Case of Patient With Mogamulizumab-Induced Vitiligo

Researchers recently reported a case of mogamulizumab-induced vitiligo in an elderly male with mycosis fungoides, a type of cutaneous T-cell lymphoma (CTCL). The report and their findings were published in the Journal of the European Academy of Dermatology and Venereology.¹

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Background

A 2019 review published in the Journal of the Advanced Practitioner in Oncology outlined mogamulizumab-kpkc's novelty in CTCL, having been approved by the US Food and Drug Administration in 2018.²

Mogamulizumab targets the CCR4 receptor on T lymphocytes, specifically regulatory T cells, which are implicated in the pathogenesis of cutaneous T-cell malignancies. By depleting these cells, mogamulizumab may disrupt immune tolerance and trigger autoimmune responses against melanocytes.²

Reported adverse events predominantly relate to skin, with skin disorders, autoimmune diseases, and drug eruptions, having been reported in the literature.³

Case Report

An 83-year-old African American male with stage IV-A2 mycosis fungoides and leukemic involvement experienced disease progression despite initial management with topical corticosteroids. As his condition progressed, clinicians introduced mogamulizumab as a treatment.

Six months after initiating mogamulizumab therapy, the patient developed generalized depigmented macules and patches, consistent with non-segmental vitiligo. Despite the appearance of vitiligo, the patient did not seek treatment, as the condition did not significantly impact his quality of life.

Case Alignment

The case aligns with prior reports of mogamulizumab-induced vitiligo. For instance, Algarni et al. and Serrano et al. documented similar cases with vitiligo onset ranging from 4 to 8 months post-treatment among patients with Sézary syndrome.⁴

Additionally, vitiligo has been observed in patients with mycosis fungoides/CTCL, often localized to affected skin areas. Research by Herrmann et al. indicates that vitiligo in these contexts may be related to malignant T-cell clones, supporting the notion that malignancy-associated T-cell dysregulation contributes to melanocyte destruction.⁵

Clinicians should be aware of the potential of vitiligo or pigmentary changes following mogamulizumab therapy, especially in patients undergoing treatment for cutaneous T-cell malignancies. Diagnosing mogamulizumab-induced vitiligo involves a clinical evaluation and, if necessary, histopathological examination to distinguish it from other causes of depigmentation.

Conclusions

"Although mogamulizumab-induced vitiligo is a clinical diagnosis, a biopsy may be performed to distinguish it from CTCL-associated vitiligo and other disorders of depigmentation," according to authors of the case study, Obeng-Nyarko et al.

Authors recommended additional research be conducted to better understand vitiligo induced by mogamulizumab, as there is presently limited research into its pathophysiology.

References

1. Obeng-Nyarko CN, Robinson CG, Axelson AR. A case of mogamulizumab-induced vitiligo in a patient with mycosis fungoides. J Eur Acad Dermatol Venereol. August 19, 2024. https://doi.org/10.1002/jvc2.523
2. Watson S, Marx JB. Mogamulizumab-kpkc: A novel therapy for the treatment of cutaneous T-cell lymphoma. J Adv Pract Oncol. 2019;10(8):883-888. doi:10.6004/jadpro.2019.10.8.10
3. Fernández-Guarino M, Ortiz P, Gallardo F, Llamas-Velasco M. Clinical and real-world effectiveness of mogamulizumab: a narrative review. Int J Mol Sci. 2024;25(4):2203. February 12, 2024. doi:10.3390/ijms25042203
4. Algarni AS, Ram-Wolff C, Bagot M, De Masson A. Mogamulizumab-induced vitiligo in patients with Sézary syndrome: three cases. Eur J Dermatol. 2021; 31(2): 213–216. https://doi.org/10.1684/ejd.2021.4002
5. Herrmann JL, Syklawer E, Tarrillion M, Duvic M, Hughey LC. Concomitant mycosis fungoides and vitiligo: how mycosis fungoides may contribute to melanocyte destruction. Dermatology. 2015; 230(2): 143–149. https://doi.org/10.1159/000368772