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September 2005

Treatment of Early-Stage Mycosis Fungoides With Twice-Weekly Applications of Mechlorethamine and Topical Corticosteroids: A Prospective Study

Author Affiliations

Author Affiliations: Department of Dermatology and Pathology, University of Rouen, Rouen (Drs de Quatrebarbes, Cordel, Courville, and Joly); and Departments of Dermatology, Orléans General Hospital, Orléans (Dr Estève), University of Créteil, Créteil (Dr Bagot), University of Reims, Reims (Dr Bernard), University of Bordeaux, Pessac (Drs Beylot-Barry and Delaunay), University of Clermont-Ferrand, Clermont-Ferrand (Drs D’Incan and Souteyrand), and University of Tours, Tours (Dr Vaillant); France.

Group Information: Other members of the French Study Group of Cutaneous Lymphomas are listed at the end of this article.

Arch Dermatol. 2005;141(9):1117-1120. doi:10.1001/archderm.141.9.1117

Objective  To determine if a therapeutic regimen of twice-weekly applications of mechlorethamine hydrochloride and betamethasone dipropionate cream is effective in the treatment of early-stage mycosis fungoides while increasing cutaneous tolerance.

Design  Prospective nonrandomized study conducted from November 1999 to November 2002.

Setting  Eleven university or hospital dermatology departments in France.

Patients  Sixty-four consecutive patients with newly diagnosed early-stage mycosis fungoides (stage IA, n = 33; stage IB, n = 26; stage IIA, n = 5).

Interventions  Patients were treated with twice-weekly applications of a 0.02% aqueous solution of mechlorethamine followed by an application of betamethasone cream during a 6-month period.

Main Outcome Measures  The primary end point was the rate of complete response during the treatment. Secondary end points were mean delay to achieve complete response, rate of severe cutaneous reactions of intolerance, and rate of relapse after achieving complete response.

Results  Thirty-seven patients (58%) had a complete response after a mean ± SD treatment duration of 3.6 ± 2.5 months: 20 (61%) of 33 patients with stage IA disease, 15 (58%) of 26 patients with stage IB disease, and 2 (40%) of 5 patients with stage IIA disease. Eighteen patients (28%) developed severe cutaneous reactions of intolerance that necessitated treatment discontinuation. Relapse was observed in 17 patients (46%) after a mean ± SD time of 7.7 ± 6.5 months.

Conclusions  A regimen of twice-weekly applications of mechlorethamine and betamethasone cream is an effective treatment for early-stage mycosis fungoides. The decreased frequency of applications provides an advantage to the patient by being easy to use with limited adverse effects.