Edelson suggests that prior treatment with chemotherapy might explain the failure of ECP treatment to affect survival in our patients with Sézary syndrome (SS). In fact, only 4 patients had been treated with high-dose chemotherapy such as fludarabine or pentostatin prior to starting ECP therapy. Most had received phototherapy (16 patients) or low-dose oral chemotherapy with chlorambucil (16 patients). This is still a popular first-line therapy with many dermatologists, and it seems highly likely that other studies of ECP also included patients who had been similarly pretreated. Indeed, in Edelson's original study,1 28 of 37 patients had received systemic chemotherapy prior to ECP.
Russell-Jones R, Whittaker S, Fraser-Andrews E. Sézary Syndrome, Cutaneous T-Cell Lymphoma, and Extracorporeal Photopheresis—Reply. Arch Dermatol. 1999;135(5):601. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-5-dlt0599