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August 2002

Treatment of Cutaneous T-Cell Lymphoma With Combined Immunomodulatory Therapy: A 14-Year Experience at a Single Institution

Author Affiliations

From the Department of Dermatology and the General Clinical Research Center of the Hospital of the University of Pennsylvania, Philadelphia.

Arch Dermatol. 2002;138(8):1054-1060. doi:10.1001/archderm.138.8.1054

Objective  To determine the efficacy of multimodality biologic response therapy for patients with cutaneous T-cell lymphoma (CTCL).

Design  Retrospective cohort study over a 14-year period.

Setting  Tertiary care university hospital.

Patients  A consecutive sample of patients was studied, all 47 of whom carried the clinical and laboratory diagnosis of CTCL: 68% of patients had stage III or IV disease, and 89% had circulating malignant T cells.

Interventions  All 47 patients received photopheresis for 6 or more cycles. Thirty-one patients received treatment with a combination of photopheresis and 1 or more systemic immunostimulatory agents, including interferon alfa, interferon gamma, sargramostim, or systemic retinoids for 3 or more months.

Main Outcome Measures  Differences in pretreatment prognostic factors, response rates, and survival between patients receiving multimodality therapy and single-modality therapy or historical controls.

Results  A total of 79% of patients responded to therapy: 26% had complete remission, and 53% had a partial remission. Median survival from initiation of therapy was 74 months. Median survival for patients with stages III and IV and peripheral blood involvement was 55 months compared with 31 months for historical controls. Compared with the photopheresis monotherapy group, the patients receiving combination immunomodulatory therapy had a worse prognosis at the time of treatment initiation based on multiple prognostic factors. The positive response rates and median survival times were 84% and 74 months, respectively, compared with 75% and 66 months, respectively, for the combination immunomodulatory and photopheresis monotherapy groups (P = .47 for positive response rates and P = .51 for survival).

Conclusions  Patients with advanced CTCL and multiple poor prognostic factors who receive treatment with combination immunomodulatory therapy experience higher clinical response rates and longer survival than historical controls. Although the group who received combination therapy had worse prognostic factors at baseline, they had better response rates and overall survival compared with those receiving photopheresis monotherapy.