 |
|
Treatment of Cutaneous T-Cell Lymphoma With Combined Immunomodulatory Therapy
A 14-Year Experience at a Single Institution
Karen Rebecca Suchin, MD;
Andrew J. Cucchiara, PhD;
Scott L. Gottleib, MD;
Jonathan T. Wolfe, MD;
Barbara J. DeNardo, RN;
William H. Macey, RN;
Patricia G. Bromley, RN;
Carmela C. Vittorio, MD;
Alain H. Rook, MD
Arch Dermatol. 2002;138:1054-1060.
Objective To determine the efficacy of multimodality biologic response therapy
for patients with cutaneous T-cell lymphoma (CTCL).
Design Retrospective cohort study over a 14-year period.
Setting Tertiary care university hospital.
Patients A consecutive sample of patients was studied, all 47 of whom carried
the clinical and laboratory diagnosis of CTCL: 68% of patients had stage III
or IV disease, and 89% had circulating malignant T cells.
Interventions All 47 patients received photopheresis for 6 or more cycles. Thirty-one
patients received treatment with a combination of photopheresis and 1 or more
systemic immunostimulatory agents, including interferon alfa, interferon gamma,
sargramostim, or systemic retinoids for 3 or more months.
Main Outcome Measures Differences in pretreatment prognostic factors, response rates, and
survival between patients receiving multimodality therapy and single-modality
therapy or historical controls.
Results A total of 79% of patients responded to therapy: 26% had complete remission,
and 53% had a partial remission. Median survival from initiation of therapy
was 74 months. Median survival for patients with stages III and IV and peripheral
blood involvement was 55 months compared with 31 months for historical controls.
Compared with the photopheresis monotherapy group, the patients receiving
combination immunomodulatory therapy had a worse prognosis at the time of
treatment initiation based on multiple prognostic factors. The positive response
rates and median survival times were 84% and 74 months, respectively, compared
with 75% and 66 months, respectively, for the combination immunomodulatory
and photopheresis monotherapy groups (P = .47 for
positive response rates and P = .51 for survival).
Conclusions Patients with advanced CTCL and multiple poor prognostic factors who
receive treatment with combination immunomodulatory therapy experience higher
clinical response rates and longer survival than historical controls. Although
the group who received combination therapy had worse prognostic factors at
baseline, they had better response rates and overall survival compared with
those receiving photopheresis monotherapy.
From the Department of Dermatology and the General Clinical Research
Center of the Hospital of the University of Pennsylvania, Philadelphia.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Primary Cutaneous T-Cell Lymphomas
Rosen and Querfeld
ASH Education Book 2006;2006:323-330.
ABSTRACT
| FULL TEXT
The Addition of Interferon Gamma to Oral Bexarotene Therapy With Photopheresis for Sezary Syndrome
McGinnis et al.
Arch Dermatol 2005;141:1176-1178.
FULL TEXT
Low-Dose Bexarotene and Low-Dose Interferon Alfa-2b for Adult T-Cell Leukemia/Lymphoma Associated With Human T-Lymphotropic Virus 1
Richardson et al.
Arch Dermatol 2005;141:301-304.
FULL TEXT
Enhancement of the host immune responses in cutaneous T-cell lymphoma by CpG oligodeoxynucleotides and IL-15
Wysocka et al.
Blood 2004;104:4142-4149.
ABSTRACT
| FULL TEXT
The Pathogenesis of Mycosis Fungoides
Girardi et al.
NEJM 2004;350:1978-1988.
FULL TEXT
Psoralen Plus Long-Wave UV-A (PUVA) and Bexarotene Therapy: An Effective and Synergistic Combined Adjunct to Therapy for Patients With Advanced Cutaneous T-Cell Lymphoma
McGinnis et al.
Arch Dermatol 2003;139:771-775.
ABSTRACT
| FULL TEXT
|
