Haas Professorship supports multidisciplinary cutaneous lymphoma program

Youn Kim, MD, professor of dermatology, has been appointed as first recipient of the Joanne and Peter Haas Jr. Professorship for Cutaneous Lymphoma Research.

Longtime Stanford donors Joanne and Peter E. Haas, Jr., established the endowed professorship to help support a multidisciplinary program in the clinical care and research of a rare group of cancers designated as cutaneous lymphomas. Dr. Kim is an international renowned expert in cutaneous lymphomas and leads a team of physicians and clinical/research staff who are dedicated to the care and discovery of new knowledge to improve the lives of those affected with cutaneous lymphomas.

“Dr. Kim’s commitment to building this program and to innovative clinical research exemplifies the Stanford Cancer Center’s mission to apply the best basic research to patient care,” said Beverly S. Mitchell, MD, deputy director of the Cancer Center. “The Haas Professorship stands as a testimonial to what the multidisciplinary team has accomplished.”

Dr. Kim has been director of the Cutaneous Lymphoma Clinic and Program since 1992. The multidisciplinary team (pictured above), which includes Richard T. Hoppe, MD, Henry S. Kaplan-Harry Lebeson Professor of Cancer Biology and chair of radiation oncology; Ranjana Advani, MD, associate professor of medicine-oncology; Sunil Reddy, MD, clinical instructor/staff physician in medicine-oncology; Sabine Kohler, MD, professor of surgical pathology and dermatology; and Uma N. Sundram, MD, PhD, assistant professor of surgical pathology and dermatology, provides true multidisciplinary care, attracting patients from across the country.

'The overall mission of Stanford’s multidisciplinary cutaneous lymphoma group is to provide excellence in patient care and leadership in scientific investigation of cutaneous lymphomas that will lead to greater knowledge and development of newer therapies to improve the survival and quality of life of patients with cutaneous lymphoma.'

Cutaneous lymphoma is a disease caused when infection-fighting white blood cells in the lymphatic system – called lymphocytes – become malignant and affect the skin. Cutaneous lymphomas can be of T-cell, B-cell or NK-cell type, and the clinical behavior can be very variable depending on the type of cutaneous lymphoma. The most common type of cutaneous lymphoma is mycosis fungoides, which is a form of cutaneous T-cell lymphoma.

In the disease, interactions of these malignant lymphocytes with other cells in the skin cause visible changes, such as rashes and tumor formation. In cutaneous T-cell lymphoma, the malignant T-cells may also circulate in the blood, as in Sézary syndrome, and may accumulate in lymph nodes or affect internal organs. Diagnosis is often delayed at first due to the condition’s resemblance to less harmful skin conditions such as eczema or psoriasis. Mycosis fungoides is a rare disease, with only 1,000 to 1,500 new diagnoses per year in the United States. The other types of cutaneous lymphoma are even less common.

A valuable resource for researchers

The Stanford Multidisciplinary Cutaneous Lymphoma Program maintains an ongoing cutaneous lymphoma database dating back to the 1950s, with long-term follow-up periods of more than 50 years on some patients. The cutaneous T-cell lymphoma database contains information on more than 1,000 patients, making it a valuable resource for researchers. There are nearly 200 patients with cutaneous B-cell lymphoma followed in the program. Stanford has the largest longitudinal single-institution database in the world, which has served to produce leading publications of clinical outcome that have been the backbone of staging systems and management guidelines in cutaneous lymphomas.

The cutaneous lymphoma clinic provides state-of-the-art immunohistochemical and molecular technology for diagnosis and treatment of mycosis fungoides and other cutaneous lymphomas. In addition to offering standard therapies, the multidisciplinary group participates in investigative protocols of new and novel therapies and provides patients with up-to-date information on cutaneous lymphomas and treatment alternatives.

Expanding basic and clinical research in cutaneous lymphomas

Although there are therapies to control various cutaneous lymphomas, no treatments have achieved long-term remission or cures for many of these diseases. The multidisciplinary team members and their collaborators are trying to understand better the possible causes of cutaneous lymphomas by using newer molecular biology and tissue techniques. They are also expanding their clinical research to improve the ability to diagnose and stage cutaneous lymphomas, as well as to identify the important prognostic factors and analyze the impact of conventional and investigative therapies. Finally and most importantly, they are developing and testing new therapies that may provide better long-term results.

Program scientists use a molecular method called cDNA microarray analysis and have successfully begun to distinguish various cutaneous lymphoma entities based on their gene expression patterns. With this technology they may be able to identify differential gene expression that may correlate with prognosis, with the hope that this will contribute to understanding the causes of cutaneous lymphomas and improve the ability to select the appropriate therapy and predict prognosis on a case-by-case basis. Also in collaboration with Stanford colleagues in pathology, the research group is actively studying and developing protocols that improve the use of newer molecular methods for earlier and more accurate diagnosis of cutaneous lymphomas.

The integrated PET/CT imaging technology at Stanford has enabled investigators to study more accurately the spread of the cutaneous lymphomas. They have shown that this technique, which combines anatomic and metabolic information about tissues, can better predict lymphomatous involvement of lymph nodes and internal organs than conventional imaging studies obtained separately. The Stanford group was the first to report these results, which have received much attention from other investigators.

Promising new therapies

The team of Stanford researchers also is developing and testing promising new therapies for patients with the cutaneous lymphomas, including a novel immunotherapy under the direction of Ron Levy, MD, professor of medicine-oncology, a world-renowned expert in immunotherapy in lymphomas. Dr. Levy has served as an advisor and collaborator for the cutaneous lymphoma program.

The goal of this immunotherapy is to boost the patients’ immune reaction specifically against their cancer cells, which can result in not only fighting the active lymphoma cells but preventing new sites of lymphoma in the skin or elsewhere. The immune strategy involves using a newer, powerful immune stimulant called CpG, which when combined with another agent that kills tumor cells (radiation or chemotherapy) can effectively generate an immune reaction against the specific cancer targets.

The cutaneous lymphoma team has active partnerships with industry leaders who are devoted to developing newer and better therapies for patients with cutaneous lymphomas. In the last decade, these collaborations with industry have lead to FDA approval of new therapies for cutaneous T-cell lymphoma, including bexarotene, denileukin diftitox and vorinostat. The new therapies that are currently under development include improved targeted therapies, such as the fully human anti-CD4 antibody (CD 4 is a marker on T-cells), a novel purine nucleoside inhibitor, new histone deacetylase inhibitors, new chemotherapy agents and a novel gene-transfer immunotherapy using gamma interferon.

For information on research updates, clinical trials that are enrolling participants and patient support programs, as well as educational information about cutaneous lymphomas, visit cutaneouslymphoma.stanford.edu.

March 2011

Youn Kim, MD (7th from right) with Stanford's Cutaneous Lymphoma Group