Is PUVA maintenance therapy necessary in patients with early stage mycosis fungoides ? Evaluation of a treatment guideline.
Keywords:
Mycoses fungoides, treatment, manteinance, relapses, clinical practice guidelinesAbstract
Objective: To evaluate the clinical guide “Phototherapy in mycosis fungoides”
Setting: Centro dermatológico CES, Sabaneta, Colombia.
Desing: Single-center prospective cohort analysis.
Materials and metods: A total of 31 patients diagnosed as having mycosis fungoides stage IA (n=16) and IB (n=15) who achieved completed remission after treatment with a minimum of 58 PUVA sessions were enrolled. We evaluated long-term outcome, time and dose of phototherapy and history of relapse. For classification and staging, patients underwent complete physical examination and comprehensive analysis. All patients were staged according to the TNMB classification. The cohort was divided in non-relapse (n=22) and relapse (n=9) groups.
Results: History of relapse was the most important difference in baseline characteristics between patients in the non-relapse and relapse groups. And it is highly associated with future relapse risk [RR=8,56, IC95%, 2,72-26,94]. Maintenance therapy and other characteristics between groups do not show any statistical differences.
Conclusion: : Our study suggests that maintenance therapy does not prevent relapse and should be avoided in order to minimize the total UVA dose, and that the history of relapse is a stronger predictor of future relapses.
Author Biographies
Miguel Felipe Gaitán
Médico, residente de Dermatología, Universidad CES, Medellín, Colombia
Silvia Catalina Díaz
Médico, residente de Dermatología, Universidad CES, Medellín, Colombia.
María Adelaida Sánchez
Médico, residente de Dermatología, Universidad CES, Medellín, Colombia.
Ángela Zuluaga
Médica dermatóloga, coordinadora del Grupo de Investigación de Dermatología, Universidad CES, Medellín, Colombia.
Sol Beatriz Jiménez
Médica dermatóloga, docente de Dermatología, Universidad CES, Medellín, Colombia.
Yolanda Torres de Galvis
Magíster en Salud Pública, especialista en Epidemiología, docente, Universidad CES, Medellín, Colombia.
References
2. Latkowski JA, Heald P. Cutaneous T cell lymphomas. In: Fitzpatrick T, Freedberg IM. Fitzpatrick’s dermatology in general medicine, 6th. edition.United States Of America: McGraw-Hill; 2003. P. 1537-58.
3. Kim EJ, Hess S, Richardson SK, Newton S, Showe LC, Benoit BM, et al. Immunopathogenesis and therapy of cutaneous T cell lymphoma. Clin Invest. 2005;118:790-812.
4. Kulin PA, Marglin SI, Shuman WP, Chew DE, Olerud JE. Diagnostic imaging in the initial staging of mycosis fungoides and Sézary syndrome. Arch Dermatol. 1990;126:914-8.
5. Whittaker SJ, Marsdex JR, Spittle MS, Russell R. Joint British Association of Dermatologists and U.K Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell Lymphomas. Br J Dermatol. 2003;149:1095.
6. Baron E, Stevens S. Phototherapy for cutaneos T- cell lymphoma. Dermatol Ther. 2003;16:303-10.
7. MacKie, Rona M. Cutaneous lymphomas and lymphocytic infiltrates. En: Rook/Wilkinson/Ebling. Textbook of dermatology. 6th edition. Oxford: Blackwell Science; 1998. P. 2373-402.
8. Trautingera F, Knoblera R, Willemzeb R, Perisc K, Stadlerd R, Larochee L, et al. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome. European Journal of Cancer. 2006;42:1014-30.
9. Scarisbrick JJ. Staging and management of cutaneous T-cell lymphoma. Clin Exp Dermatol. 2006;31:181-6.
10. Siegel R, Pandolfino T, Guitar J, Rosen S, Kuzel T. Primary cutaneous T- cell lymphoma: review and current concepts. Review J Clin Oncol. 2000;18:2908-25.
11. Moreno D, Herrera A, Camacho F. Diagnóstico y tratamiento de los linfomas cutáneos de células T. Med Cutan Iber Lat Am. 2003;3:75-100.
12. Hofer A, Cerroni L, Kerl H. Narrowband (311-nm) UVB therapy for small plaque parapsoriasis and early-stage mycosis fungoides. Arch Dermatol. 1999;135:1377-80.
13. Lansigan F, Choi J, Foss FM. Cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. 2008; 22: 979-96.
14. Fung M, Murphy MJ, Hoss D, Grant-Kels J. practical evaluation and management of cutaneous lymphoma. J Am Acad Dermatol. 2002;46:325-57.
15. Diamandidou E, Colome M, Fayad L, Duvic M, Kurzrock R. Prognostic factor analysis in mycosis fungoides/Sézary syndrome. J Am Acad Dermatol. 1999;40:914-24.
16. Tancre`de-Bohin E, Ionescu MA, La Salmonie`re P, Dupuy A, Rivet J, Rybojad M, et al. Prognostic value of blood eosinophilia in primary cutaneous T-cell lymphomas. Arch Dermatol. 2004;140:1057-61.
17. Cruelfeld C, Rosen ST, Kuzel TM, Kirby KA, Roenigk HH, Prinz BM, et al. Arch Dermatol. 2005;141:305.
18. Forero O, Zuluaga A. Evaluación del resultado de la terapia con PUVA en pacientes en estadio temprano; seguimiento a 8 años (tesis). Medellín: CES; 2005.
19. Kim YH, Liu HL, Mraz-Gernhard S, Varghese A, Hoppe RT. Long-term outcome of 525 patients with mycosis fungoides and Sézary syndrome: clinical prognostic factors and risk for disease progression. Arch Dermatol. 2003;139:857-66.
20. Ellen K, Stephen H, Stephen R, Sara N, Louise S, Benoit BM. Inmunopathogenesis and therapy of cutaneous T cell lymphoma. J Clin Invest. 2005;115:798.
How to Cite
Downloads
Downloads
Published
How to Cite
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
