Therapy of Cutaneous Lymphoma – Current Practice and Future Developments

Abstract

Cutaneous lymphomas include various types of clonal lymphoproliferative disorders. The adequate treatment approach depends on the exact diagnosis and should be non-aggressive in most cases. In early stages, local approaches such as UV or radiotherapy are preferred. In advanced stages, systemic drugs such as interferon-α or bexarotene can be administered. Experimental approaches for cutaneous lymphomas include vaccination and gene therapy.

WHO-EORTC classification for cutaneous lymphomas

“…As long as the disease is confined to the skin, skin-targeted therapies as photo (chemo)-therapy (eg, psoralen plus ultraviolet A [PUVA]), topical application of nitrogen mustard or chlormustine (BCNU), or radiotherapy, including total skin electron beam irradiation, are preferred. [58][59][60] In patients with limited patch-stage disease topical steroids or bexarotene gel can be used. Biologicals such as interferon alpha and other cytokines (eg, interleukin-12 ), traditional and new retinoids such as bexarotene, and receptor-targeted cytotoxic fusion proteins (eg, DAB 389 IL-2; denileukin diftitox), are increasingly used in the treatment of MF.…”

“…Biologicals such as interferon alpha and other cytokines (eg, interleukin-12 ), traditional and new retinoids such as bexarotene, and receptor-targeted cytotoxic fusion proteins (eg, DAB 389 IL-2; denileukin diftitox), are increasingly used in the treatment of MF. 58,[60][61][62][63] However, the exact place of these new treatments, either as single-agent therapy or in combination with other therapies (eg, PUVA) in the treatment of MF remains to be established. Multiagent chemotherapy is generally used in case of unequivocal lymph node or systemic involvement, or in cases with widespread tumor-stage MF refractory to skin-targeted therapies, but should not be considered in early patch/plaque stage disease.…”

EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome

“…7,13 The choice of treatment is often determined by physician or patient preference, or institutional experience, particularly as there is a paucity of data from phase III trials and a lack of consensus concerning treatment for later stages of MF/SS. 3,[14][15][16] However, a number of authors have published recommendations or reviews on the management of CTCL, 1,3,7,15,17 , and guidelines have been published jointly by the British Association of Dermatologists and the UK Cutaneous Lymphoma Group. 16 Nonetheless, treatment choices vary across Europe and there are, as yet, no uniform European guidelines for the management of CTCL.…”

Oncolytic measles virus in cutaneous T-cell lymphomas mounts antitumor immune responses in vivo and targets interferon-resistant tumor cells

“…Palliative chemotherapy can also be an option in the treatment of advanced stages of CTCL. 1 However, it has no proven effect on survival time 2 and leads to a further immunosuppression with an increased risk of infection.…”