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July 2009

Efalizumab and Progression of Undiagnosed Follicular Mycosis Fungoides—Reply

Arch Dermatol. 2009;145(7):844. doi:10.1001/archdermatol.2009.133

In reply

We respectfully disagree with Di Lernia's comment that patients with pilar MF, F-MF, or folliculotropic cutaneous T-cell lymphoma (CTCL) “should always be considered to have tumor-stage disease.”

We are familiar with the 2002 article by van Doorn et al1 that describes 51 patients with F-MF who had disease-specific survival rates of 68% at 5 years and 26% at 10 years and posits that the prognosis for F-MF is similar to that for epidermotropic tumor-stage disease.1 However, Di Lernia did not cite 2 more recent reports that give much better survival rates for F-MF. In a 2005 report,2 the European Organization for Research on the Treatment of Cancer classifies F-MF as a distinct subgroup. The 5-year survival rate of 86 patients with F-MF is reported to be 80%, while that of 800 patients with classic MF is 88%.2 A 2008 report by Gerami et al3 comparing a United States group of 43 patients with F-MF to age- and stage-matched patients with epidermotropic MF found that those with early F-MF (up to and including stage IIA) had a 10-year survival of 82% and a 15-year survival rate of 41%. The 43 control patients who had epidermotropic MF had a 91% survival rate at both 10 and 15 years. However, patients with later-stage F-MF (stage IIB or higher) had outcomes similar to those with conventional epidermotropic MF of a similar stage. And the 10-year progression-free survival rate was 25% in the patients with stage IIB or higher F-MF compared with 8% in the epidermotropic MF group. While the authors conclude that F-MF is a more aggressive variant of CTCL, especially in the early stages, there was no evidence of worse prognosis in stage IIB or more advanced disease.

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