This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (18)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Hematology/ Hematologic Malignancies  • Leukemias/ Lymphomas  • Drug Therapy  • Adverse Effects  • Alert me on articles by topic

Update of the Stanford Experience

Youn H. Kim, MD; Gina Martinez, BA; Anna Varghese, BA; Richard T. Hoppe, MD

Arch Dermatol. 2003;139:165-173.

Objective  To evaluate and update the response and survival outcomes and toxic effects in patients treated with topical nitrogen mustard (mechlorethamine hydrochloride) as primary therapy.

Design  A single-center, retrospective cohort analysis.

Setting  Academic referral center for cutaneous lymphoma.

Patients  A total of 203 patients with mycosis fungoides (clinical stages I-III) treated with topical nitrogen mustard as initial therapy.

Main Outcome Measures  Long-term actuarial survival, freedom-from-relapse, and freedom-from-progression results as calculated by the Kaplan-Meier method.

Results  The overall response rate for the 203 patients was 83%, with a complete response rate of 50%. The median time to achieve complete response was 12 months (T1, 10 months; T2, 19 months), and the median time to relapse was 12 months. The duration of complete response increased with longer maintenance therapy; however, after completion of therapy, the response duration or relapse rate was similar regardless of maintenance regimen. Patients with T1 disease had better response and survival outcomes than those with T2 disease, with overall and complete response rates in T1 of 93% and 65%, respectively, and in T2, 72% and 34%, respectively. A similar clinical response was seen for patients with stage IIA vs IB. Sixty-eight percent of 203 patients received only topical nitrogen mustard therapy throughout their follow-up course, including most of the patients who achieved an initial complete response. The clinical response to topical nitrogen mustard as salvage therapy was similar to initial response rates. The efficacy results were similar in patients treated with aqueous vs ointment preparations. Freedom-from-progression rates in T1 disease (no progression to higher T classification or worse clinical stage) at 5 and 10 years were 92% and 85%, respectively, and in T2, 83% at 5 and 10 years. Fewer than 10% of patients experienced contact hypersensitivity reactions when topical nitrogen mustard was used as an ointment preparation. Only 8 patients (4%) developed secondary cutaneous malignancy, none attributable to topical nitrogen mustard monotherapy. Pediatric patients experienced no significant toxic effects with topical nitrogen mustard therapy.

Conclusions  Topical nitrogen mustard remains an effective primary initial or salvage therapy in mycosis fungoides for patients with T1 and T2 disease. Long-term follow-up results confirm its safety.

From the Departments of Dermatology (Dr Kim and Mss Martinez and Varghese) and Radiation Oncology (Dr Hoppe), Stanford University School of Medicine, Stanford, Calif.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Treatment of Early-Stage Mycosis Fungoides With Twice-Weekly Applications of Mechlorethamine and Topical Corticosteroids: A Prospective Study
de Quatrebarbes et al.
Arch Dermatol 2005;141:1117-1120.
ABSTRACT | FULL TEXT  

Long-term Follow-up of Patients With Early-Stage Cutaneous T-Cell Lymphoma Who Achieved Complete Remission With Psoralen Plus UV-A Monotherapy
Querfeld et al.
Arch Dermatol 2005;141:305-311.
ABSTRACT | FULL TEXT