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Leukocytes (WBC) and lymphocytes (Ly) trend during the treatment with mogamulizumab. Basal value: 12/02/2020. First cycle of mogamulizumab: 12/23/2020. Second cycle of mogamulizumab on 01/21/2021. End of mogamulizumab: 06/01/2021.
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Since the second administration of mogamulizumab, a clear clinical benefit on itching and erythroderma was observed, as well as a progressive reduction of peripheral leukocytosis and lymphocytosis (Figure 1).
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Right lesions of the leg before (A) and after (B) four cycles of mogamulizumab.
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A rapid improvement of the skin lesions was observed until the complete disappearance of plaques and nodules after 4 cycles with a persistence of brownish macular areas without infiltration (Figure 2).
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Diffuse erythema with scaling covering approximately 60% of BSA, onychodystrophy, ectropion, mild palmo-plantar hyperkeratosis.
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San Martino Policlinic) on November 2020 with generalized exfoliative erythroderma started on July 2020 covering approximately 60% of BSA, onychodistrophy, ectropion, mild palmo-plantar hyperkeratosis (Figure 3) and intense pruritus (VAS pruritus: 7). Skin biopsies showed an epidermotropic infiltrate with Pautrier's microabscesses, atypical lymphocytes and a patchy lichenoid infiltrate in the papillary dermis (Figure 4).
Epidermotropic infiltrate with Pautrier's microabscesses with atypical lymphocytes and a patchy lichenoid infiltrate in the papillary dermis.
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San Martino Policlinic) on November 2020 with generalized exfoliative erythroderma started on July 2020 covering approximately 60% of BSA, onychodistrophy, ectropion, mild palmo-plantar hyperkeratosis (Figure 3) and intense pruritus (VAS pruritus: 7). Skin biopsies showed an epidermotropic infiltrate with Pautrier's microabscesses, atypical lymphocytes and a patchy lichenoid infiltrate in the papillary dermis (Figure 4).
Already after the first cycle of mogamulizumab the patient achieved prompt clinical response with >90% clearance of skin disease.
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Skin and blood responses were maintained (Figure 5).
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Skin involvement before (A) and after (B) therapy with mogamulizumab.
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After six cycles of mogamulizumab, a sustained blood complete response, a near complete response in skin (Figure 6) and a partial response for histologic criteria of residual disease in the last cutaneous biopsy are maintained.
Cytogenetic abnormalities before and after mogamulizumab administration. After the first course of mogamulizumab, the hypothetraploid clone showed by karyotype and confirmed by FISH (A) was cleared and only a second clone remained detectable by FISH (B).
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The cytogenetic response was achieved already after the first cycle and maintained at the last follow-up (Figure 7).  
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Mogamulizumab-induced lichenoid reaction developed after 15 infusions. An erythematous-desquamative, confluent lichenoid eruption mainly localized on the lower abdomen can be observed. Note how the eruption arose within healthy skin revealing the excellent response obtained by treatment.
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After 15 infusions, the patient had an intensely pruritic, confluent lichenoid eruption on lower trunk and upper limbs (Figure 8).
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Eruptive yellowish papules located on face and forehead. (A-C). Lesions on the forehead and the cheeks. (D). Dermoscopy showing the presence of well-demarcated yellow globule structures, divided by septa constituted by focused reddish capillaries.
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A 46-year-old man with a 4-year-long history of SS referred to the outpatient's surgery showed eruptive yellowish papules located on his face and forehead (Figure 9). All the lesions developed on the forehead and the cheeks (Figure 9A-C). Dermoscopy showed the presence of well-demarcated yellow globule structures, divided by septa constituted by focused reddish capillaries (Figure 9D).