Maintenance phase in psoralen-ultraviolet A phototherapy of early-stage mycosis fungoides. A critically appraised topic

Abstract

A 65-year-old patient affected by mycosis fungoides (MF) stage IB achieved complete remission (CR) after a cycle of PUVA phototherapy. The U.S. Cutaneous Lymphoma Consortium (USCLC) guidelines suggest that the patient should be kept in the maintenance phase, defined as a 'period of gradual decrease of frequency of UVL [ultraviolet light] while in clinical remission before discontinuation of phototherapy' by slowly tapering the number of psoralen-ultraviolet A (PUVA) applications over time up to clinical relapse. The USCLC guidelines also suggest a standardized schedule for the maintenance phase. Alternatively, the patient could end PUVA therapy and go straight to follow-up. The aim of this critically appraised topic (CAT) was to determine if a maintenance phase gives a significant benefit in terms of relapse rate (RR) and RFI in patients affected by early-stage MF who had achieved CR under PUVA phototherapy. Embase, PubMed and TRIP databases were searched for 'mycosis fungoides' AND [('photochemotherapy' OR 'puva') OR 'psoralen'] in June 2016. Three articles matched our inclusion criteria and are discussed in this CAT. In this field of research the literature is poor and the reported level of evidence is low. Only one of the studies was conducted prospectively, and none were randomized. No significant difference in terms of reduction in relapse rate or increase in RFI in patients who underwent a PUVA maintenance phase emerged when compared with those who went for simple follow-up. Further randomized clinical trials (RCTs) are required in order to evaluate maintenance phase vs. no treatment before it can be favoured as the standard protocol of treatment in early-stage MF. At the time of writing this paper, we report an ongoing Austrian multicentre RCT (Clinical Trial.gov identifier: NCT01686594) that will hopefully give useful results in this topic.

Bexarotene as maintenance treatment after therapies other than skin‐directed therapy in advanced‐stage mycosis fungoides: a pilot study

“…Editor Cutaneous melanoma (CM) accounts for the majority of deaths from skin cancer and its development is an interplay between phenotypic characteristics, 1 environmental exposures 2 and genetic risk factors. 3 Several genetic variants have been found to be strongly associated with risk of melanoma using a candidate gene approach. The aim of our study was to identify, novel CM genetic factors, using all candidate genes encompassed in the MelGene database (www.melgene.org), a comprehensive online database, [3][4][5] by assessing their association in the largest genome wide association study (GWAS) published up to date.…”

“…3 Several genetic variants have been found to be strongly associated with risk of melanoma using a candidate gene approach. The aim of our study was to identify, novel CM genetic factors, using all candidate genes encompassed in the MelGene database (www.melgene.org), a comprehensive online database, [3][4][5] by assessing their association in the largest genome wide association study (GWAS) published up to date. 6 Promising signals were selected for replication in UK-Biobank (https://www.ukbioba nk.ac.uk/), a prospective cohort study of 500 000 participants and two independent samples of CM patients and healthy controls from Greece and Cyprus.…”

Current Approach to Phototherapy Applications in Dermatology Practice: Part 2. Phototherapy in Vitiligo, Mycosis Fungoides, Atopic Dermatitis, Sclerosing Diseases and Psoriasis

“…Ancak, çok uzun idame protokollerinin relapssız süreyi uzatıp uzatmayacağını mevcut verilerle söyleyebilmenin mümkün olmadığı da belirtilmektedir. Sonuç olarak, idame PUVA uygulama ya da uygulamama kararı vermek için, uygun şekilde dizayn edilmiş randomize bir çalışmanın sonuçlarının beklenmesi önerisinde bulunulmuştur (50). Buna karşılık, İngiliz Fotodermatoloji Grubu'nun 2015 PUVA rehberinde, MF'de, hızlı rekürrens gösteren hastalıkta relapsı önlemek için idame PUVA yapılabileceği, bu yönde herhangi bir kanıt olmaksızın, uzman görüşü olarak önerilmektedir.…”

Psoralen-ultraviolet A maintenance in mycosis fungoides: the underlying question

“…In this issue of the BJD , Grandi and colleagues report from a systematic search analysis that the scarce evidence published does not support the notion that PUVA maintenance reduces the risk of clinical relapse or prolongs remission. Despite these remarks, the authors also point out that the debate is not over and that randomized studies with particular methodologies to evaluate the benefits of maintenance are still needed.…”