American Journal of Clinical Dermatology

, Volume 15, Issue 5, pp 451–456 | Cite as

Interferon-Based Treatment for Patients with Mycosis Fungoides and Hepatitis C Virus Infection: A Case Series

  • Andreas Kyvernitakis
  • Madeleine Duvic
  • Parag Mahale
  • Harrys A. Torres
Original Research Article



Interferon (IFN) is a treatment option for both mycosis fungoides (MF) and hepatitis C virus (HCV) infection. Chemotherapy and anti-HCV treatment are generally not administered concurrently for fear of overlapping side effects.


Herein, we report on a subset of patients who received IFN-containing therapy for MF and HCV infection simultaneously. We aimed to evaluate whether concomitant treatment for MF and HCV is effective and well tolerated.


We reviewed the records of patients who were seen at MD Anderson Cancer Center from 2008 to 2013 with histologically confirmed MF and chronic HCV infection, and were treated with simultaneous focus on both diseases.


Six HCV-infected patients with MF received simultaneous anti-HCV and anti-MF treatment with IFN-containing therapy. Two patients achieved sustained virological response (regarded as virological cure). They both received antiviral combination therapy with ribavirin. All patients experienced some improvement of their cutaneous lesions, with two of them achieving complete MF remission. All six patients developed side effects while receiving treatment; two of them had grade 4 toxic effects requiring treatment discontinuation.


IFN-based therapy can be administered for MF and HCV infection concurrently to provide not only virological but also oncological benefits to chronically HCV-infected MF patients. However, this regimen is poorly tolerated. Further studies are warranted in this patient population, using different treatment combinations with improved efficacy, safety, and tolerability.



The authors are indebted to Don Norwood for his editorial assistance.

Conflict of Interest Disclosures

Dr. Torres is a consultant for Gilead Sciences, Merck & Co., Inc., Novartis, Astellas, Pfizer, Theravance, Inc., Genentech, and Vertex Pharmaceuticals, and has received research grants from Merck & Co., Inc. and Vertex Pharmaceuticals. Drs. Kyvernitakis, Duvic, and Mahale report no potential conflicts of interest.


No sources of funding were used for conducting this study or preparing this manuscript.


  1. 1.
    Prince HM, Whittaker S, Hoppe RT. How I treat mycosis fungoides and Sezary syndrome. Blood. 2009;114(20):4337–53.PubMedCrossRefGoogle Scholar
  2. 2.
    Apisarnthanarax N, Talpur R, Duvic M. Treatment of cutaneous T cell lymphoma: current status and future directions. Am J Clin Dermatol. 2002;3(3):193–215.PubMedCrossRefGoogle Scholar
  3. 3.
    Duvic M. Cutaneous T-cell lymphomas: mycosis fungoides and Sézary syndrome. In: Younes A, Coiffier B, editors. Lymphoma: diagnosis and treatment. 43rd ed. Totowa: Humana Press; 2013. p. 287–321.CrossRefGoogle Scholar
  4. 4.
    Ghany MG, Nelson DR, Strader DB, Thomas DL, Seeff LB. An update on treatment of genotype 1 chronic hepatitis C virus infection: 2011 practice guideline by the American Association for the Study of Liver Diseases. Hepatology. 2011;54(4):1433–44.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Borchardt RA, Torres HA. Challenges in managing hepatitis C virus infection in cancer patients. World J Gastroenterol. 2014;20(11):2771–6.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Martinot-Peignoux M, Stern C, Maylin S, et al. Twelve weeks posttreatment follow-up is as relevant as 24 weeks to determine the sustained virologic response in patients with hepatitis C virus receiving pegylated interferon and ribavirin. Hepatology. 2010;51(4):1122–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Olsen EA, Whittaker S, Kim YH, et al. Clinical end points and response criteria in mycosis fungoides and Sezary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol. 2011;29(18):2598–607.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Division of AIDS. Division of AIDS table for grading the severity of adult and pediatric adverse events. Bethesda: Division of AIDS; 2004.Google Scholar
  9. 9.
    Gisbert JP, Garcia-Buey L, Arranz R, et al. The prevalence of hepatitis C virus infection in patients with non-Hodgkin’s lymphoma. Eur J Gastroenterol Hepatol. 2004;16(2):135–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee MH, Yang HI, Lu SN, et al. Chronic hepatitis C virus infection increases mortality from hepatic and extrahepatic diseases: a community-based long-term prospective study. J Infect Dis. 2012;206(4):469–77.PubMedCrossRefGoogle Scholar
  11. 11.
    Duberg AS, Nordstrom M, Torner A, et al. Non-Hodgkin’s lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection. Hepatology. 2005;41(3):652–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Diamandidou E, Cohen PR, Kurzrock R. Mycosis fungoides and Sezary syndrome. Blood. 1996;88(7):2385–409.PubMedGoogle Scholar
  13. 13.
    Miertusova S, Bonin S, Trevisan G, Stanta G. Mycosis fungoides is not associated with hepatitis C virus infection. Br J Dermatol. 2004;151(5):1108–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Vallisa D, Bernuzzi P, Arcaini L, et al. Role of anti-hepatitis C virus (HCV) treatment in HCV-related, low-grade, B-cell, non-Hodgkin’s lymphoma: a multicenter Italian experience. J Clin Oncol. 2005;23(3):468–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Garcia-Garcia I, Gonzalez-Delgado CA, Valenzuela-Silva CM, et al. Pharmacokinetic and pharmacodynamic comparison of two “pegylated” interferon alpha-2 formulations in healthy male volunteers: a randomized, crossover, double-blind study. BMC Pharmacol. 2010;10:15.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Mahale P, Miller ED, Blechacz B, Herlong HF, Davila M, Torres HA. The effect of antiviral therapy on progression of liver disease in hepatitis C virus-infected patients with malignancies. Hepatology. 2013;58(S4):909A.Google Scholar
  17. 17.
    Groopman JE, Itri LM. Chemotherapy-induced anemia in adults: incidence and treatment. J Natl Cancer Inst. 1999;91(19):1616–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Manns MP, Wedemeyer H, Cornberg M. Treating viral hepatitis C: efficacy, side effects, and complications. Gut. 2006;55(9):1350–9.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Khalil F, Cualing H, Cogburn J, Miles L. The criteria for bone marrow recovery post-myelosuppressive therapy for acute myelogenous leukemia: a quantitative study. Arch Pathol Lab Med. 2007;131(8):1281–9.PubMedGoogle Scholar
  20. 20.
    American Association for the Study of Liver Diseases, Infectious Diseases Society of America, International Antiviral Society–USA. Initial treatment of HCV infection in patients starting treatment. Recommendations for testing, managing, and treating hepatitis C. 2014. Accessed 27 May 2014.
  21. 21.
    Ferenci P, Bernstein D, Lalezari J, et al. ABT-450/rombitasvir and dasabuvir with or without ribavirin for HCV. N Engl J Med. 2014;370(21):1983–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Sulkowski MS, Gardiner DF, Rodriguez-Torres M, et al. Daclatasvir plus sofosbuvir for previously treated or untreated chronic HCV infection. N Engl J Med. 2014;370(3):211–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Torres HA, Mahale P, Raad II, Kontoyannis DP. Hepatitis C virus infection in patients with cancer: a single-institution experience in 642 patients. Hepatology. 2013;58(S4):1290A.Google Scholar
  24. 24.
    Makdisi J, Friedman A. Myocosis fungoides—an update on a non-mycotic disease. J Drugs Dermatol. 2013;12(7):825–31.PubMedGoogle Scholar
  25. 25.
    Yanagi T, Shimizu T, Ujiie H, et al. Peginterferon alfa-2b for mycosis fungoides. Arch Dermatol. 2006;142(5):649–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Lange CM, Jacobson IM, Rice CM, Zeuzem S. Emerging therapies for the treatment of hepatitis C. EMBO Mol Med. 2014;6(1):4–15.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Gaetano JN, Reau N. Hepatitis C: management of side effects in the era of direct-acting antivirals. Curr Gastroenterol Rep. 2013;15(1):305.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Andreas Kyvernitakis
    • 1
  • Madeleine Duvic
    • 2
  • Parag Mahale
    • 1
  • Harrys A. Torres
    • 1
  1. 1.Unit 1460, Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of DermatologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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