Fax: (713) 745-3597
Hydrochlorothiazide and cutaneous T cell lymphoma
Prospective analysis and case series
Version of Record online: 5 SEP 2012
Copyright © 2012 American Cancer Society
Volume 119, Issue 4, pages 825–831, 15 February 2013
How to Cite
Jahan-Tigh, R. R., Huen, A. O., Lee, G. L., Pozadzides, J. V., Liu, P. and Duvic, M. (2013), Hydrochlorothiazide and cutaneous T cell lymphoma. Cancer, 119: 825–831. doi: 10.1002/cncr.27740
- Issue online: 4 FEB 2013
- Version of Record online: 5 SEP 2012
- Manuscript Accepted: 20 JUN 2012
- Manuscript Revised: 19 JUN 2012
- Manuscript Received: 30 APR 2012
- cutaneous T cell lymphoma;
- mycosis fungoides;
- Sézary syndrome;
- risk factor;
- drug rash;
Mycosis fungoides (MF) and leukemic Sézary syndrome (SS) are the most common cutaneous T cell lymphomas (CTCL), but their etiology remains unknown. After patients were observed with hydrochlorothiazide (HCTZ)-associated CTCL, HCTZ was examined as a putative chronic antigen in a cohort of prospectively staged patients.
Demographic and drug exposure data was examined from 1443 confirmed MF and SS patients. Hypertensive CTCL patients were divided into HCTZ users or nonusers for statistical analysis by chi-square and t tests. Causality in a case series was rated by the Naranjo Adverse Drug Reaction Probability Scale.
A total of 815 of 1443 MF and SS patients (56.5%) were hypertensive; 205 (25.2%) were taking HCTZ at initial staging. Comparing stage of patients who were using or not using HCTZ, the most significant difference was between stage I and stage IV (odds ratio of 0.45; 95% confidence interval of 0.25-0.78, P = .003), demonstrating reduced likelihood of being stage IV in patients who were on HCTZ. Seventy-seven percent of the MF patients on HCTZ were stage I. A total of 125 patients of 196 (63.8%) started HCTZ prior to developing CTCL lesions, and 35 of 121 (28.0%) started within 1 year of first skin rash. Thirty-six of 125 patients (28.8%) experienced complete or partial remissions after discontinuing HCTZ. A monoclonal T cell receptor rearrangement was detected more frequently in the hypertensive stage I patients not taking HCTZ as compared with those who were (55.3% vs 69.1%, P = .032). Three patients were rechallenged and developed MF lesions that resolved or improved with discontinuation.
HCTZ is commonly prescribed and may be a putative antigen in a small subset of early MF patients. Careful drug histories and a trial off medication are warranted. Cancer 2013. © 2012 American Cancer Society.