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Stem
A 71-year-old man has a 10-month history of progressive whole-body redness and scale with severe itch. Examination shows erythroderma involving more than 80% BSA, ectropion, palmoplantar keratoderma, and generalised lymphadenopathy. He has been treated for “severe eczema” without lasting benefit. FBC shows lymphocytosis; flow cytometry reveals a CD4+ population with loss of CD7 and CD26, CD4:CD8 ratio 14, absolute Sézary count 1,400/µL, and a clonal TCR peak matching a skin biopsy clone. CT shows lymphadenopathy without visceral masses.
Questions
a) What is the most likely diagnosis, and which clinical and laboratory features fulfil the classic triad and B2 blood involvement? (3 marks)
b) Assign the likely TNMB stage grouping and explain how this differs from erythrodermic mycosis fungoides with B0/B1 blood. (2 marks)
c) Outline a multimodal first-line management plan including supportive care, ECP/systemic options, and infection control. (3 marks)
d) Name two targeted/systemic agents supported by phase 3 CTCL evidence (mogamulizumab; brentuximab context) and state when allogeneic transplant is considered. (2 marks)