Mapping and Targeting the Tumor-Immune-Microbiome Interface in Cutaneous T-Cell Lymphoma to Advance Precision Diagnosis and Therapy

Cutaneous T-cell lymphoma, or CTCL, is a rare blood cancer that affects immune cells called T-cells, which normally help the body fight infection. In CTCL, these cancerous T-cells move to the skin, causing visible patches, plaques, and tumors that can itch, become infected, and severely impact quality of life. Although treatments exist, most patients are not cured, and outcomes are worse for Black and other underserved patients. My research program aims to understand and treat CTCL by exploring how cancer cells, the immune system, and the body’s microbes (the bacteria that live on and inside us) interact to influence disease behavior. The skin provides a unique “window” into this biology, since it can be seen, sampled, and treated directly. Insights from CTCL can also help improve treatment for related blood cancers.

This program has four major projects. The first tests whether combining low-dose radiation with a topical immune-stimulating cream (called imiquimod) can train the immune system to recognize and attack cancer cells throughout the body—essentially turning the tumor itself into a vaccine. The second focuses on reducing racial disparities in CTCL outcomes. Black patients often have more aggressive disease and higher infection risk, partly due to harmful bacteria such as Staphylococcus aureus on the skin. This study tests whether a gentle cleansing and nasal treatment can safely reduce these bacteria, improve immune balance, and enhance treatment response. The third project examines how gut bacteria and their chemical byproducts affect treatment success and immune health. By studying stool samples from patients receiving standard CTCL therapies, we aim to identify “good” bacterial patterns linked to better outcomes and explore whether simple dietary changes could improve them. The fourth project develops noninvasive tools to monitor CTCL activity using tape strips that painlessly collect skin proteins. These tests could one day replace biopsies and allow doctors to track treatment response quickly and safely.

Together, these studies will reveal how the immune system and microbes influence blood cancer progression and therapy response. The ultimate goal is to develop low-toxicity, highly effective, accessible treatments and monitoring tools that improve outcomes for all patients with CTCL and related lymphomas.