Cutaneous T-cell lymphoma (CTCL) is classified as an indolent hematologic malignancy with distinct clinicopathologic features. Mycosis Fungoides is a subset of CTCL. Although prognosis varies depending on the stage, patients who have cutaneous tumors, lymph node or visceral involvement, or peripheral blood involvement (Sézary syndrome) generally have a poor outcome.
For advanced disease, systemic treatment options include low-dose methotrexate, photopheresis, biologic response modifiers such as bexarotene capsules, vorinostat (Zolinza), interferons, denileukin diftitox (Ontak), and single-agent chemotherapy. Combination therapies can be used when single agents fail or when patients have advanced or progressive disease.
Interferon is a valuable agent in the armamentarium; alfa interferon (IFN)as a single agent has shown partial remission rates of > 50% and complete responses of > 20%. Pegasys is a pegylated and pharmacologically dsitinct type of interferon. It has not been extensively studied for cutaneous lymphoma, although the first report already appeared in 1993. Most studies have been retrospective and/or were in combination with other drugs or therapies. In a recent retrospective cohort study reported in 2011 in Journal of the European Academy of Dermatology and Venereology: PEG-Interferon Alfa-2b and Ultraviolet Light Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Mycosis Fungoides/Sezary Syndrome, NCT00724061, myelosuppression and liver toxicity occured more frequently during PEG-IFN α-2b plus PUVA treatment than during standard IFN α-2a plus PUVA therapy [77.8 vs. 50% (odds ratio 1.477) and 77.8 vs. 50% (odds ratio 1.692), respectively]. The overall response rate in the PEG-IFN α-2b plus PUVA group (89%) was significantly superior.
Several other similar studies showed comparable results. However, there are no randomized controlled studies against other treatments than interferon and no guideline recommendations.
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