Acta Dermato-Venereologica 98-10CompleteContent | Page 10
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CLINICAL REPORT
Treatment of Early Folliculotropic Mycosis Fungoides with Special
Focus on Psoralen plus Ultraviolet A
Iris AMITAY-LAISH 1,2 , Hadas PRAG-NAVEH 1 , Adam DALAL 1 , Lev PAVLOVSKY 1,2 , Meora FEINMESSER 2,3 and Emmilia HODAK 1,2
Department of 1 Dermatology and 3 Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, and 2 Sackler Faculty of Medicine, Tel
Aviv University, Tel Aviv, Israel
Data on the treatment of early folliculotropic myco-
sis fungoides, a recently defined clinicopathological
subgroup of folliculotropic mycosis fungoides with an
indolent course, is limited. Treatment outcomes were
studied in a retrospective cohort of 47 adults with
early folliculotropic mycosis fungoides, with a focus
on psoralen plus ultraviolet A (PUVA) monotherapy,
including dosimetric data, and the findings were com-
pared with data for PUVA in 18 adults with early-clas-
sic mycosis fungoides. PUVA was given to 27 patients
with early folliculotropic mycosis fungoides: 70%
achieved complete response and 26% partial response.
Significantly more treatments were needed to achieve
complete response in stage IB compared with stage
IA. There was no significant difference in the com-
plete response rate from classic plaque-stage disease,
although the early folliculotropic mycosis fungoides
group required more treatments to achieve complete
response, and a higher cumulative dose of UVA. Thus,
PUVA is an effective treatment for early folliculotropic
mycosis fungoides. Its complete response rate might
be equal to early-classic mycosis fungoides; however,
a longer induction phase is needed to achieve comple-
te response.
Key words: folliculotropic; mycosis fungoides; psoralen and ul-
traviolet A; PUVA; phototherapy; cutaneous T-cell lymphoma.
Accepted Aug 7, 2018; Epub ahed of print Aug 7, 2018
Acta Derm Venereol 2018; 98: 951–955.
Corr: Iris Amitay-Laish, Department of Dermatology, Rabin Medical Cen-
ter – Beilinson Hospital, Petach Tikva 4941492, Israel. E–mail: amitay-
[email protected]
F
olliculotropic mycosis fungoides (FMF) has long
been considered an aggressive variant of mycosis
fungoides (MF) (1, 2). However, our experience has
shown that FMF presents with 2 distinct patterns of
clinicopathological features representing an early variant
and an advanced tumour variant. Their prognostic impli-
cations differ, with early FMF following a more indolent
course (3). These findings were validated by the Dutch
Cutaneous Lymphoma Group (4).
Traditionally, treatment recommendations for FMF
have followed those for classic tumour-stage MF. Re-
cently, the Dutch Cutaneous Lymphoma Group reported
a response of patients with early FMF to skin-targeted
therapy, and specifically psoralen plus ultraviolet A
(PUVA) (5). In fact, in a few earlier publications (6–10)
SIGNIFICANCE
Since data on the treatment of early folliculotropic mycosis
fungoides is limited, we studied the treatment outcomes
in patients with this subset of mycosis fungoides. The ma-
jority of patients responded to nonaggressive treatments
and had an indolent course. Systemic PUVA was the most
common first line treatment, associated with a high re-
sponse rate, whereas narrowband UVB was found to have
low efficacy. Although PUVA, according to our study, might
be an equally effective treatment as for early classic my-
cosis fungoides, significantly more exposures were needed
to achieve complete response in early folliculotropic
mycosis fungoides.
PUVA was found to be beneficial in a subset of cases of
FMF, which, based on recent insights into the disease (3,
4), can be redefined as early FMF. In addition, in a small
study of adults and children with clinicopathological
features that were defined by us as those of early FMF,
we observed a beneficial effect of skin-targeted therapy
with PUVA bath and, in few cases, systemic PUVA (11,
12). Yet, data on the treatment outcome of PUVA in early
FMF is still scarce, and there is no data on the specific
protocol including the dosimetric parameters needed to
achieve optimal response.
Early-classic MF is histologically characterized by
the infiltration of lymphocytes into the epidermis, the
dermo–epidermal junction, and the papillary dermis
(13). By contrast, early FMF is characterized by epi
thelial infiltration to the follicle (3). The different and
frequently deeper location of the dominant pathological
focus in early FMF (3) may make it less accessible to
skin-targeted therapy than early-classic MF. No compari-
sons of the efficacy of PUVA have been reported between
early FMF and early-classic MF.
The aim of the present study was to assess the response
of early FMF to initial treatments, especially systemic
PUVA monotherapy, with an emphasis on dosimetric
data, and to compare the findings with those for early-
classic MF.
PATIENTS AND METHODS
A retrospective cohort design was used. The study group con-
sisted of consecutive patients treated for early FMF from January
1995 to June 2016 at the tertiary Cutaneous Lymphoma Clinic of
Rabin Medical Center. FMF was defined according to the World
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3013
Acta Derm Venereol 2018; 98: 951–955