Dr Querfeld on Achieving Patient Satisfaction With Mogamulizumab

Until today we had to say it’s kind of a drug rash, but it’s not really a drug rash — patients think a drug rash is an allergic reaction, and they get concerned. If you can say this is your immune system, they see it differently: ‘My immune system doesn’t like it, but it’s not an allergic reaction, and I’m okay to continue.’

For a patient with mycosis fungoides or Sézary syndrome, how a treatment makes them feel day-to-day can determine whether they stay on it — and whether a confusing rash sends them looking for the exit.

Christiane Querfeld, MD, PhD, director of the Cutaneous Lymphoma Program at City of Hope, makes the case that symptom relief and clear communication are as central to mogamulizumab’s success as disease control itself.

In a second part of her discussion at the 6th World Congress of Cutaneous Lymphoma (WCCL), Querfeld turned from the molecular signatures behind mogamulizumab response to what those responses mean for patients’ quality of life and willingness to stay on therapy.

When the burdensome symptoms of these diseases — itching, skin flaking, burning, pain, and visible skin involvement — begin to recede, patients feel better, and that improvement on mogalmulizumab reinforces their commitment to staying on treatment.

That link between feeling better and staying on therapy matters clinically, Querfeld noted, because adherence feeds back into outcomes. Patients who tolerate and continue treatment tend to achieve better disease control, so symptom relief, adherence, and efficacy are connected rather than separate considerations.

Querfeld tied this to the promise of precision medicine. Patients are highly heterogeneous, but molecular work can identify common signatures that let clinicians set more specific expectations, telling a patient what is likely to happen and what the odds are so they arrive better prepared.

She was most pointed about communication around mogamulizumab-associated rash (MAR). Patients come in well-informed and frequently ask about it, and historically clinicians have called it a drug rash — language that, she cautioned, misleads patients to believe MAR is akin to an allergic reaction.

Reframing it accurately as an immune-system response rather than an allergy changes how patients understand it and makes them far more willing to continue a therapy that is actually working — and one whose rash can itself be managed.