Treatment of mycosis fungoides with photochemotherapy (PUVA): Long-term follow-up

Herrmann, James J.; Roenigk, Henry H.; Hurria, Arti; Kuzel, Timothy M.; Samuelson, Ellen; Rademaker, Alfred; Rosen, Steven T.

doi:10.1016/0190-9622(95)90241-4

Cited by 211 publications

(130 citation statements)

References 25 publications

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“…Early stage lesions are treated with psoralen and ultraviolet light A (PUVA), topical chemotherapy, extracorporeal photophoresis, interferon, and/or electron beam irradiation. 5,6 Advanced disease is treated with interferon, retinoids or combination chemotherapy regimens, with mixed results. 5,7 To our knowledge, we report the first case of reinduction of clinical and histologic remission following withdrawal of immunosuppressive medication after allogeneic hematopoietic stem cell transplantation, providing evidence for an immunologic graft-versus-MF effect.…”

Section: Discussionmentioning

confidence: 99%

Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides: evidence of a graft-versus-tumor effect

Burt

Guitart

Traynor

et al. 2000

Bone Marrow Transplant

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Summary:Allogeneic hematopoietic stem cell transplantation should be considered as a therapeutic option for patients with generalized erythoderma or tumor stage MF. Indeed, the only curative option for MF may be an allogeneic transplant. Bone Marrow Transplantation (2000) 25, 111-113. Keywords: allogeneic hematopoietic stem cell transplant; mycosis fungoides; cutaneous T cell lymphoma Mycosis fungoides (MF) is a low-grade lymphoma that primarily manifests as cutaneous plaques or tumors. 1,2 Progression is accompanied by spread to lymph nodes and visceral organs. Histopathology reveals an epidermotropic lymphocytic infiltrate composed of atypical lymphocytes. 3 The atypical cells may also be seen in the peripheral blood and are characterized by their cerebriform or hyperconvoluted nuclear detail. MF cells are of the T cell lineage and usually have a CD4 ϩ CD45RO ϩ memory-helper phenotype. 4 The natural history of MF is usually indolent. Over many years MF may evolve from premalignant cutaneous lesions and scaly erythematous patches into palpable plaques and finally tumors. The mean survival for patients with early patch lesions may exceed 10-15 years. However, patients with generalized erythroderma or tumor at the time of presentation have a poorer prognosis with a median survival of 2-4 years. Early stage lesions are treated with psoralen and ultraviolet light A (PUVA), topical chemotherapy, extracorporeal photophoresis, interferon, and/or electron beam irradiation. 5,6 Advanced disease is treated with interferon, retinoids or combination chemotherapy regimens, with mixed results. 5,7 To our knowledge, we report the first case of reinduction of clinical and histologic remission following withdrawal of immunosuppressive medication after allogeneic hematopoietic stem cell transplantation, providing evidence for an immunologic graft-versus-MF effect. Case reportA 27-year-old black woman was diagnosed with mycosis fungoides (stage T3 N1 M0). She had failed multiple prior therapies including PUVA, PUVA and interferon, six cycles of CHOP (cyclophosphamide, adriamycin, vincristine, prednisone), and two cycles of 9-aminocamptothecin. The patient's skin was diffusely infiltrated with patches, plaques and tumors. Lymphatic and visceral organs were involved. An allogeneic HLA matched sibling transplant was performed using an unmanipulated marrow and CD34 immunoselected blood graft. Conditioning was with cyclophosphamide (200 mg/kg) and total body irradiation (1200 cGy). The post-transplant course was complicated by acute graft-versus-host disease (grade II) that resolved on corticosteroid and cyclosporine immunosuppressive therapy.The patient remained in complete remission for 9 months when new plaques were noted over the right thigh and chest (Figure 1a). Relapse of MF was confirmed by skin biopsy (Figure 1b and c). Since there was no clinical evidence of GVHD, prophylactic immunosuppression with cyclosporine was discontinued. Within 1 month, the plaques resolved and were replaced by flat and scaly hypopigmented patches....

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Section: Discussionmentioning

confidence: 99%

Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides: evidence of a graft-versus-tumor effect

Burt

Guitart

Traynor

et al. 2000

Bone Marrow Transplant

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“…Response rates to PUVA therapy in patients with patch disease are high with CR rates of approximately 58% to 83% and overall response rates of up to 95%. 23,24 Furthermore, remission is often prolonged with a reported mean duration of 43 months. 23 Maintenance treatment with weekly or fortnightly therapy can be effective in maintaining remission.…”

Section: Overviewmentioning

confidence: 99%

“…23,24 Furthermore, remission is often prolonged with a reported mean duration of 43 months. 23 Maintenance treatment with weekly or fortnightly therapy can be effective in maintaining remission. PUVA therapy is generally well tolerated; however, acute side effects include nausea (from the oral psoralens) or photosensitivity.…”

Section: Overviewmentioning

confidence: 99%

How I treat mycosis fungoides and Sézary syndrome

Prince

Whittaker

Hoppe

2009

Blood

136

109

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The most common subtypes of primary cutaneous T-cell lymphomas are mycosis fungoides (MF) and Sézary syndrome (SS). The majority of patients have indolent disease; and given the incurable nature of MF/SS, management should focus on improving symptoms and cosmesis while limiting toxicity. Management of MF/SS should use a “stage-based” approach; treatment of early-stage disease (IA-IIA) typically involves skin directed therapies that include topical corticosteroids, phototherapy (psoralen plus ultraviolet A radiation or ultraviolet B radiation), topical chemotherapy, topical or systemic bexarotene, and radiotherapy. Systemic approaches are used for recalcitrant early-stage disease, advanced-stage disease (IIB-IV), and transformed disease and include retinoids, such as bexarotene, interferon-α, histone deacetylase inhibitors, the fusion toxin denileukin diftitox, systemic chemotherapy including transplantation, and extracorporeal photopheresis. Examples of drugs under active investigation include new histone deacetylase inhibitors, forodesine, monoclonal antibodies, proteasome inhibitors, and immunomodulatory agents, such as lenalidomide. It is appropriate to consider patients for novel agents within clinical trials if they have failed front-line therapy and before chemotherapy is used.

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“…Similarly, Herrmann and colleagues reported an ORR of 95% and a CR rate of 65% in a series of 82 patients, of whom 83% had stage IA or IB MF. 83 In addition, Molin and colleagues reported a CR rate of 58% in 51 patients with T1 or T2 disease. 84 Thus, there is good overall evidence that PUVA is an effective treatment in early-stage MF.…”

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confidence: 99%

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

Trautinger

Knobler

Willemze

et al. 2006

European Journal of Cancer

391

308

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Treatment of mycosis fungoides with photochemotherapy (PUVA): Long-term follow-up

Cited by 211 publications

References 25 publications

Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides: evidence of a graft-versus-tumor effect

Allogeneic hematopoietic stem cell transplantation for advanced mycosis fungoides: evidence of a graft-versus-tumor effect

How I treat mycosis fungoides and Sézary syndrome

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

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