Predictors of response to extracorporeal photopheresis in advanced mycosis fungoides and Sézary syndrome

Abstract

Summary Background Extracorporeal photopheresis (ECP) has been utilized for more than 20 years to treat cutaneous T-cell lymphoma (CTCL), but a clinical response can take up to 9 months to manifest. This study was undertaken to determine whether clinical features, laboratory values, cytokine levels, or gene expression levels of tumor markers are useful to predict the subsequent response to ECP in CTCL patients with blood involvement. Methods Twenty-one patients with CTCL treated with ECP as monotherapy for at least 6 months were retrospectively identified. Laboratory and clinical data and blood obtained at baseline, 3, and 6 months of treatment were used for analysis. Results In pretreatment blood specimens, a lower percentage of Sézary cells and a higher absolute eosinophil count were associated with a favorable clinical response. Clinical evidence of an early response after 3 months of ECP did not reliably predict a favorable response at 6 months or beyond. Comparison of cytokines, gene transcripts, and other laboratory measures of disease did not correlate with the subsequent clinical response, although lactate dehydrogenase levels tended to decrease progressively in ECP-responsive cases and increase progressively in ECP-non-responsive cases. Additionally, serum levels of TNF-α significantly increased from baseline to 6 months of ECP, but was not found to correlate with the clinical response. Conclusions Although we found that increased eosinophils and decreased percentage of Sézary cells were associated with a favorable clinical response to ECP, we were not able to identify the predictors of ECP response within the first 3 months of treatment.

Extracorporeal Photopheresis in the Treatment of Mycosis Fungoides and Sézary Syndrome

“…Comparison of cytokines, gene transcripts, and other laboratory measures of disease did not correlate with the subsequent clinical response. 66 In a more recent analysis of microRNA (miR) levels on a subset of this cohort (n 5 13), McGirt and colleagues 67 discovered that an early increase of PBMC miR-191, miR-223, and miR-342 at 3 months into ECP monotherapy predicted a clinical response to ECP at 6 and 12 months. In a large cohort of patients (n 5 98) with SS treated with ECP and immunostimulatory agents, Raphael and colleagues 63 found the following baseline differences in the CR group as compared with the nonresponse group: lower CD4/CD8 ratio (13.2 vs 44.2), lower median percentage of CD41/ CD26À cells (27.4% vs 57.2%), lower median percentage of CD41/CD7À cells (20.0% vs 41.3%), and higher median monocyte percentage (9.5% vs 7.3%).…”

Extracorporeal photopheresis for the treatment of erythrodermic cutaneous T‐cell lymphoma: a single center clinical experience with long‐term follow‐up data and a brief overview of the literature

“…Based on these criteria, we identified 28 studies, in the majority of cases retrospective and based on single institution series. A total of 407 patients reported as erythrodermic were included (Table ) …”

“…In the recent study by Raphael et al ., a lower CD4/CD8 ratio, a higher percentage of monocytes, and lower numbers of circulating abnormal T cells at baseline were the strongest predictive factors for CR. McGirt et al . found that increased eosinophils and decreased percentage of Sézary cells were associated with a favorable clinical response to ECP, even if they failed to identify predictors of ECP response within the first three months of treatment.…”

Fotoféresis en el tratamiento de Síndrome de Sézary: Caso clínico

“…Los predictores de buena respuesta para FEC como monoterapia incluyen: enfermedad T4 (eritrodermia), recuento de leucocitos < 20.000/ microL, recuento de células de Sézary entre 10 y 20%, menos de dos años desde el inicio del diagnóstico, sin grandes adenopatías, sin enfermedad visceral, no haber utilizado quimioterapia previa, sin elevación de células NK o de CD8 [29][30][31] .…”