COMBINED-MODALITY THERAPY FOR CUTANEOUS T-CELL LYMPHOMA

Background: Cutaneous T-cell lymphoma (CTCL) may respond to many thera pies, but long-term disease-free survival is uncommon. Patients with a dvanced disease have a median survival of approximately 3 years. Objec tive: Our purpose was to combine known effective agents sequentially t o determine whether we could achieve remission in more patients or for longer duration. Methods: Patients with mycosis fungoides (n=23) or S ezary syndrome (n=5) were treated with 4 months of recombinant interfe ron alfa together with isotretinoin, followed by total skin electron b eam therapy alone (for stage I to II disease) or preceded by chemother apy (for stage III to IV disease). Maintenance therapy consisted of in terferon for 1 year and topical nitrogen mustard for 2 years. Results: Twenty-eight patients were treated. The overall response rate (comple te and partial remissions) was 82%. Although the median duration of re mission was 5 months in patients with stage III to IV disease, two pat ients remain in complete remission at 39+ and 46+ months. In patients with stage I to II disease the median duration of remission has not be en reached at a median follow-up of 18 months. Five patients, all with stage III to IV disease, have died. Overall, the regimen was well tol erated with one treatment-related death from neutropenic sepsis. Concl usion: Combined modality therapy may be effective for the treatment of CTCL with similar response rates to other current therapies.