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Abstract

› Cutaneous T-cell lymphoma (CTCL) encompasses a heterogeneous group of non-Hodgkin lymphomas that present primarily in skin.

› Because of clinical heterogeneity, treatment options for CTCL are also diverse, and treatment with more than one modality is common.

› Many patients with CTCL present with disease limited to the skin, providing ideal circumstances for the use of any one of several types of phototherapy, with or without additional therapies.

› Three phototherapies have been employed to treat CTCL with considerable success: (1) conventional broad-spectrum UVB irradiation, (2) UVA irradiation in combination with a systemically administered photosensitizing drug, such as 8-methoxypsoralen, and (3) UVA irradiation in combination with a topically administered photosensitizing drug.

› Successful phototherapy of patients with CTCL may lead to long-term remission and potentially even a cure.

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References

  1. Willemze R, Jaffe ES, Burg G, Cerroni L, Berti E, Swerdlow SH, Ralfkiaer E, Chimenti S, Diaz-Perez JL, Duncan LM, Grange F, Harris NL, Kempf W, Kerl H, Kurrer M, Knobler R, Pimpinelli N, Sander C, Santucci M, Sterry W, Vermeer MH, Wechsler J, Whittaker S, Meijer CJ (2005) WHO-EORTC classification for cutaneous lymphomas. Blood 105:3768–3785

    Article  PubMed  CAS  Google Scholar 

  2. Querfeld C, Rosen ST, Guitart J, Kuzel TM (2005) The spectrum of cutaneous T-cell lymphomas: new insights into biology and therapy. Curr Opin Hematol 12:273–278

    Article  PubMed  Google Scholar 

  3. Foss F (2004) Mycosis fungoides and the Sézary syndrome. Curr Opin Oncol 16:421–428

    Article  PubMed  Google Scholar 

  4. Lamberg SI, Green SB, Byar DP et al (1984) Clinical staging for cutaneous T-cell lymphoma. Ann Intern Med 100:187–192

    PubMed  CAS  Google Scholar 

  5. Kaye FJ, Bunn PA Jr, Steinberg S et al (1989) A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides. N Engl J Med 321:1784–1790

    PubMed  CAS  Google Scholar 

  6. Jörg B, Kerl H, Thiers BH, Bröcker EB, Burg G (1994) Therapeutic approaches in cutaneous lymphoma. Dermatol Clin 12:433–441

    PubMed  Google Scholar 

  7. Parrish JA, Fitzpatrick TB, Tanenbaum L, Pathak MA (1974) Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light. N Engl J Med 291:1207–1211

    PubMed  CAS  Google Scholar 

  8. Milstein HI, Vonderheid EC, Van Scott EJ, Johnson WC (1982) Home ultraviolet phototherapy of early mycosis fungoides: preliminary observations. J Am Acad Dermatol 6:355–362

    Article  PubMed  CAS  Google Scholar 

  9. Resnik KS, Vonderheid EC (1993) Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients. J Am Acad Dermatol 29:73–77

    PubMed  CAS  Google Scholar 

  10. Ramsay DL, Lish KM, Yalowitz CB, Soter NA (1992) Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma. Arch Dermatol 128:931–933

    Article  PubMed  CAS  Google Scholar 

  11. Hofer A, Cerroni L, Kerl H, Wolf P (1999) Narrowband (311-nm) UV-B therapy for small plaque parapsoriasis and early-stage mycosis fungoides. Arch Dermatol 135:1377–1380

    Article  PubMed  CAS  Google Scholar 

  12. Clark C, Dawe RS, Evans AT, Lowe G, Ferguson J (2000) Narrowband TL-01 phototherapy for patch-stage mycosis fungoides. Arch Dermatol 136:748–752

    Article  PubMed  CAS  Google Scholar 

  13. Ghodsi SZ, Hallaji Z, Balighi K, Safar F, Chams-Davatchi C (2005) Narrow-band UVB in the treatment of early stage mycosis fungoides: report of 16 patients. Clin Exp Dermatol 30:376–788

    Article  PubMed  CAS  Google Scholar 

  14. Boztepe G, Sahin S, Ayhan M et al (2005) Narrowband ultraviolet B phototherapy to clear and maintain clearance in patients with mycosis fungoides. J Am Acad Dermatol 53:242–246

    Article  PubMed  Google Scholar 

  15. Volc-Platzer B, Hönigsmann H (1995) Photoimmunology of PUVA and UVB therapy. In: Krutmann J, Elmets CA (eds) Photoimmunology. Blackwell Science, Oxford, pp 265–273

    Google Scholar 

  16. Ozawa M, Ferenczi K, Kikuchi T, et al (1999) 312-nanometer ultraviolet B light (narrow-band UVB) induces apoptosis of T cells within psoriatic lesions. J Exp Med 189:711–718

    Article  PubMed  CAS  Google Scholar 

  17. Plettenberg H, Stege H, Megahed M, Ruzicka T, Hosokawa Y, Tsuji T, Morita A, Krutmann J (1999) Ultraviolet A1 (340–400?nm) phototherapy for cutaneous T-cell lymphoma. J Am Acad Dermatol 41:47–50

    Article  PubMed  CAS  Google Scholar 

  18. Zane C, Leali C, Airo P, De Panfilis G, Pinton PC (2001) “High-dose” UVA1 therapy of widespread plaque-type, nodular, and erythrodermic mycosis fungoides. J Am Acad Dermatol 44:629–633

    Article  PubMed  CAS  Google Scholar 

  19. Gilchrest BA, Parrish JA, Tanenbaum L, Haynes HA, Fitzpatrick TB (1976) Oral methoxsalen photochemotherapy of mycosis fungoides. Cancer 38:683–689

    Article  PubMed  CAS  Google Scholar 

  20. Tanew A, Hönigsmann H (1997) Ultraviolet B and psoralen plus UVA phototherapy for cutaneous T-cell lymphoma. Dermatol Ther 4:38–46

    Google Scholar 

  21. Herrmann Jr, Roenigk HH Jr, Hönigsmann H (1995) Ultraviolet radiation for treatment of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am 9:1077–1088

    PubMed  CAS  Google Scholar 

  22. Abel EA, Sendagorta E, Hoppe RT, Hu CH (1987) PUVA treatment of erythrodermic and plaque-type mycosis fungoides. Arch Dermatol 123:897–901

    Article  PubMed  CAS  Google Scholar 

  23. Querfeld C, Rosen ST, Kuzel TM, Kirby KA, Roenigk HH Jr, Prinz BM, Guitart J (2005) Long-term follow-up of patients with early-stage cutaneous T-cell lymphoma who achieved complete remission with psoralen plus UV-A monotherapy. Arch Dermatol 141:305–311

    Article  PubMed  Google Scholar 

  24. Hönigsmann H, Brenner W, Rauschmeier W, Konrad K, Wolff K (1984) Photochemotherapy for cutaneous T cell lymphoma. J Am Acad Dermatol 10:238–245

    Article  PubMed  Google Scholar 

  25. Powell FC, Spiegel GT, Muller SA (1984) Treatment of parapsoriasis and mycosis fungoides: the role of psoralen and long-wave ultraviolet light A (PUVA). Mayo Clin Proc 59:538–546

    PubMed  CAS  Google Scholar 

  26. Rosenbaum MM, Roenigk HH Jr, Caro WA, Esker A (1985) Photochemotherapy in cutaneous T cell lymphoma and parapsoriasis en plaques. J Am Acad Dermatol 13:613–622

    Article  PubMed  CAS  Google Scholar 

  27. Vella Briffa D, Warin AP, Harrington CI, Bleehen SS (1980) Photochemotherapy in mycosis fungoides. Lancet 2:49–53

    Article  Google Scholar 

  28. Weber F, Schmuth M, Sepp N, Fritsch P (2005) Bath-water PUVA therapy with 8-methoxypsoralen in mycosis fungoides. Acta Derm Venereol 85:329–332

    Article  PubMed  CAS  Google Scholar 

  29. Holloway KB, Flowers FP, Ramos-Caro FA (1992) Therapeutic alternatives in cutaneous T-cell lymphoma. J Am Acad Dermatol 27:367–378

    Article  PubMed  CAS  Google Scholar 

  30. Hoppe R (1991) The management of mycosis fungoides at Stanford—standard and innovative treatment programs. Leukemia 5[Suppl 1]:46–48

    PubMed  Google Scholar 

  31. Vonderheid EC, Tan ET, Kantor AF, Shrager L, Micaily B, van Scott EJ (1989) Long-term efficacy, curative potential, and carcinogenicity of topical mechlorethamine chemotherapy in cutaneous T cell lymphoma. J Am Acad Dermatol 20:416–428

    Article  PubMed  CAS  Google Scholar 

  32. Zackheim HS, Epstein EH Jr, Crain WR (1990) Topical carmustine (BCNU) for cutaneous T cell lymphoma: a 15-year experience in 143 patients. J Am Acad Dermatol 22:802–810

    Article  PubMed  CAS  Google Scholar 

  33. Hamminga B, Noordijk EM, van Vloten WA (1982) Treatment of mycosis fungoides. Total-skin electron-beam irradiation vs topical mechlorethamine therapy. Arch Dermatol 118:150–153

    Article  PubMed  CAS  Google Scholar 

  34. Kim YH, Jensen RA, Watanabe GL, Varghese A, Hoppe RT (1996) Clinical stage la (limited patch and plaque) mycosis fungoides. A long-term outcome analysis. Arch Dermatol 132:1309–1313

    Article  PubMed  CAS  Google Scholar 

  35. Claudy AL, Rouchouse B (1985) Treatment of cutaneous T cell lymphoma with retinoids. In: Saurat JH (ed) Retinoids: new trends in research and therapy. Retinoid symposium, Geneva, 1984. Karger, Basel, pp 335–340

    Google Scholar 

  36. Kessler JF, Jones SE, Levine N, Lynch PJ, Rohman Both A, Meyskens L Jr (1987) Isotretinoin and cutaneous helper T cell lymphoma (mycosis fungoides). Arch Dermatol 123:201–204

    Article  PubMed  CAS  Google Scholar 

  37. Mahrle G, Thiele B (1987) Retinoids in cutaneous T cell lymphomas. Dermatologica 175[Suppl 1]:145–150

    PubMed  Google Scholar 

  38. Molin L, Thomsen K, Volden G et al (1987) Oral retinoids in mycosis fungoides and Sézary syndrome: a comparison of isotretinoin and etretinate. Acta Derm Venereol (Stockh) 67:232–236

    CAS  Google Scholar 

  39. Thomsen K, Molin L, Volden G, Lange Wantzin G, Hellbe L (1984) 13-cis-retinoic acid effective in mycosis fungoides. Acta Derm Venereol (Stockh) 64:563–566

    CAS  Google Scholar 

  40. Thomsen K, Hammar H, Molin L, Volden G (1989) Retinoids plus PUVA (RePUVA) and PUVA in mycosis fungoides, plaque stage. Acta Derm Venereol (Stockh) 69:536–538

    CAS  Google Scholar 

  41. Serri F, De Simone C, Venier A, Rusciani L, Marchetti E (1990) Combination of retinoids and PUVA (Re-PUVA) in the treatment of cutaneous T-cell lymphomas. Curr Probl Dermatol 19:252–257

    PubMed  CAS  Google Scholar 

  42. Singh F, Lebwohl MG (2004) Cutaneous T-cell lymphoma treatment using bexarotene and PUVA: a case series. J Am Acad Dermatol 51:570–573

    Article  PubMed  Google Scholar 

  43. Coors EA, Von den Driesch P (2005) Treatment of mycosis fungoides with bexarotene and psoralen plus ultraviolet A. Br J Dermatol 152:1379–1381

    Article  PubMed  CAS  Google Scholar 

  44. Zhang C, Duvic M (2003) Retinoids: therapeutic applications and mechanisms of action in cutaneous T-cell lymphoma. Dermatol Ther 16:322–330

    Article  PubMed  Google Scholar 

  45. Bunn PA Jr, Foon KA, Ihde DC et al (1984) Recombinant leukocyte A interferon: an active agent in advanced cutaneous T-cell lymphomas. Ann Intern Med 101:484–487

    PubMed  Google Scholar 

  46. Olsen EA, Bunn PA (1995) Interferon in the treatment of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am 9:1089–1107

    PubMed  CAS  Google Scholar 

  47. Thestrup-Pedersen K (1990) Interferon therapy in cutaneous T-cell lymphoma. Curr Probl Dermatol 19:258–263

    PubMed  CAS  Google Scholar 

  48. Kuzel TM, Gilyon K, Springer E et al (1990) Interferon alfa-2a combined with phototherapy in the treatment of cutaneous T-cell lymphoma. J Natl Cancer Inst 82:203–207

    Article  PubMed  CAS  Google Scholar 

  49. Kuzel TM, Roenigk HH Jr, Samuelson E et al (1995) Effectiveness of interferon alfa-2a combined with phototherapy for mycosis fungoides and the Seizure syndrome. J Clin Oncol 13:257–263

    PubMed  CAS  Google Scholar 

  50. Otte HG, Herges A, Stadler R (1992) Kombinationstherapie mit Interferon α2a und PUVA bei kutanen T-Zell-Lymphomen. Hautarzt 43:695–699

    PubMed  CAS  Google Scholar 

  51. Mostow EN, Neckel SL, Oberhelman L, Anderson TF, Cooper KD (1993) Complete remissions in psoralen and UVA (PUVA)-refractory mycosis fungoides-type cutaneous T-cell lymphoma with combined interferon alfa and PUVA. Arch Dermatol 129:747–752

    Article  PubMed  CAS  Google Scholar 

  52. Stadler R, Otte HG, Luger T, Henz BM, Kuhl P, Zwingers T, Sterry W (1998) Prospective randomized multicenter clinical trial on the use of interferon-2α plus acitretin versus interferon-2α plus PUVA in patients with cutaneous T-cell lymphoma stages I and II. Blood 92:3578–3581

    PubMed  CAS  Google Scholar 

  53. Rupoli S, Goteri G, Pulini S, Filosa A, Tassetti A, Offidani M, Filosa G, Mozzicafreddo G, Giacchetti A, Brandozzi G, Cataldi I, Barulli S, Ranaldi R, Scortechini AR, Capretti R, Fabris G, Leoni P (2005) Marche Regional Multicentric Study Group of Cutaneous Lymphomas. Long-term experience with low-dose interferon-alpha and PUVA in the management of early mycosis fungoides. Eur J Haematol 75:136–145

    Article  PubMed  CAS  Google Scholar 

  54. Kuzel TM, Roenigk HH Jr, Samuelson E, Rosen ST (1992) Suppression of anti-interferon α-2a antibody formation in patients with mycosis fungoides by exposure to longwave UV radiation in the A range and methoxsalen ingestion. J Natl Cancer Inst 84:119–121

    Article  PubMed  CAS  Google Scholar 

  55. Rajan GP, Seifert B, Prümmer O, Joller-Jemelka HI, Burg G, Dummer R (1996) Incidence and in-vivo relevance of antiinterferon antibodies during treatment of low-grade cutaneous T-cell lymphomas with interferon alpha-2a combined with acitretin or PUVA. Arch Dermatol Res 288:543–548

    Article  PubMed  CAS  Google Scholar 

  56. Tanew A, Ortel B, Rappersberger K, Hönigsmann H (1988) 5-Methoxypsoralen (Bergapten) for photochemotherapy. J Am Acad Dermatol 18:333–339

    Article  PubMed  CAS  Google Scholar 

  57. Henseler T, Wolff K, Hönigsmann H, Christophers E (1981) Oral 8-methoxypsoralen photochemotherapy of psoriasis. Lancet i:853–857

    Article  Google Scholar 

  58. Roenigk HH Jr (1977) Photochemotherapy for mycosis fungoides. Arch Dermatol 113:1047–1051

    Article  PubMed  Google Scholar 

  59. Wolff K, Gschnait F, Hönigsmann H, Konrad K, Parrish JA, Fitzpatrick TB (1977) Phototesting and dosimetry for photochemotherapy. Br J Dermatol 96:1–10

    Article  PubMed  CAS  Google Scholar 

  60. Lowe NJ, Cripps DJ, Dufton PA, Vickers CFH (1979) Photochemotherapy for mycosis fungoides. A clinical and histological study. Arch Dermatol 115:50–53

    Article  PubMed  CAS  Google Scholar 

  61. Volden G, Thune PO (1977) Light sensitivity in mycosis fungoides. Br J Dermatol 97:279–284

    Article  PubMed  CAS  Google Scholar 

  62. Molin L, Volden G (1987) Treatment of light-sensitive mycosis fungoides with PUVA and prednisolone. Photodermatol Photoimmunol Photomed 4:106–107

    CAS  Google Scholar 

  63. Du Vivier A, Vollum DI (1980) Photochemotherapy and topical nitrogen mustard in the treatment of mycosis fungoides. Br J Dermatol 102:319–322

    Article  PubMed  Google Scholar 

  64. Whittaker SJ, Marsden JR, Spittle M, Russell Jones R (2003) British Association of Dermatologists; U.K. Cutaneous Lymphoma Group Joint British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous T-cell lymphomas. Br J Dermatol 149:1095–1107

    Article  PubMed  CAS  Google Scholar 

  65. Johnson R, Staiano-Coico L, Austin L, Cardinale I, Nabeya-Tsukifuji R, Krueger JG (1996) PUVA treatment selectively induces a cell cycle block and subsequent apoptosis in human T-lymphocytes. Photochem Photobiol 63:566–571

    Article  PubMed  CAS  Google Scholar 

  66. Hönigsmann H, Tanew A, Wolff K (1987) Treatment of mycosis fungoides with PUVA. Photodermatol Photoimmunol Photomed 4:55–58

    Google Scholar 

  67. Maier H, Schemper M, Ortel B, Binder M, Tanew A, Hönigsmann H (1996) Skin tumors in photochemotherapy for psoriasis. A single center follow-up of 496 patients. Dermatology 193:185–191

    Article  PubMed  CAS  Google Scholar 

  68. Stern RS, Lunder EJ (1998) Risk of squamous cell carcinoma and methoxsalen (psoralen) and UV-A radiation (PUVA). A meta-analysis. Arch Dermatol 134:1582–1585

    Article  PubMed  CAS  Google Scholar 

  69. Studniberg HM, Weller P (1993) PUVA, UVB, psoriasis, and nonmelanoma skin cancer. J Am Acad Dermatol 29:1013–102

    Article  PubMed  CAS  Google Scholar 

  70. Abel EA, Sendagorta E, Hoppe RT (1986) Cutaneous malignancies and metastatic squamous cell carcinoma following topical therapies for mycosis fungoides. J Am Acad Dermatol 14:1029–1038

    Article  PubMed  CAS  Google Scholar 

  71. Smoller BR, Marcus R (1994) Risk of secondary cutaneous malignancies in patients with long-standing mycosis fungoides. J Am Acad Dermatol 30:201–204

    PubMed  CAS  Google Scholar 

  72. Herrmann JJ, Roenigk HH Jr, Hurria A et al (1995) Treatment of mycosis fungoides with photochemotherapy (PUVA): long-term follow-up. J Am Acad Dermatol 33:234–242

    Article  PubMed  CAS  Google Scholar 

  73. Swanbeck G, Roupe G, Sandström MH (1994) Indications of a considerable decrease in the death rate in mycosis fungoides by PUVA treatment. Acta Derm Venereol (Stockh) 74:465–466

    CAS  Google Scholar 

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Hönigsmann, H., Tanew, A. (2009). Photo(chemo)therapy for Cutaneous T-Cell Lymphoma. In: Hönigsmann, H., Elmets, C., Krutmann, J. (eds) Dermatological Phototherapy and Photodiagnostic Methods. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-36693-5_6

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