This retrospective multicenter cohort study (6 US tertiary centers, Jan 2011–Oct 2023) examined clinicopathologic features and long-term outcomes in 224 adults (≥18 years) with biopsy-confirmed hypopigmented mycosis fungoides (HMF), with a median follow-up of 39 months.
98% presented with early-stage disease; 77% achieved complete or partial response to treatment (26% CR, 51% PR), mostly with skin-directed therapy alone (90%). Only 6% progressed to a higher stage overall, and just 2% of early-stage patients advanced to advanced-stage disease. Peripheral blood TCR monoclonality (found in 27%) was linked to poorer treatment response but not to disease progression.
Retrospective design with inherent selection bias from tertiary referral centers; immunophenotyping and peripheral blood TCR data were unavailable for a substantial subset of patients (only 141/224 had immunophenotyping, only 85/224 had TCR testing); median follow-up of ~39 months may be insufficient to capture late progression events.
Adult HMF, which disproportionately affects Black women, follows an indolent course and responds well to skin-directed therapy regardless of CD8 vs. CD4 predominance or mixed-variant presentation. Peripheral blood TCR monoclonality may signal lower treatment response and warrants closer monitoring, but should not alone escalate therapy.
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