Extracorporeal Photochemotherapy in the Treatment of Cutaneous T Cell Lymphoma
Cutaneous T cell lymphoma (CTCL) and its leukemic erythrodermic form (Sézary syndrome) are malignancies of CD4+ T lymphocytes. Extracorporeal photochemotherapy (ECP) selectively affects autoreactive as well as malignant T lymphocytes. The efficacy of ECP depends strongly upon adequate serum/buffy coat levels of the photosensitizer 8-methoxypsoralen (8-MOP). The resorption of orally applied 8-MOP varies inter- and intraindividually within a broad range, meaning that sufficient therapeutic drug levels cannot always be achieved. Therefore, since July 1994 we have exclusively used a liquid 8-MOP preparation which is added directly into the buffy coat fraction of the ECP circuit, resulting in constant high drug levels of approximately 190 ng/ml. Twelve CTCL patients (six with Sézary syndrome, six with mycosis fungoides) received between six and 25 ECP treatments. Some of them had already prior therapy without success.
All patients with Sézary syndrome declared a destinct reduction of pruritus intensity. Three patients who received liquid 8-MOP extracorporeally showed a partial remission on the basis of skin scores. From the patients receiving 8-MOP orally two remained clinically unchanged, on showed a progression of the disease. In these cases, subtherapeutic 8-MOP plasma levels were often found. From the six mycosis fungoides patients, one achieved a complete, two a partial remission, and another two patients a minor response. This five patients were treated with liquid 8-MOP. One patient showed no change in skin lesions. He received 8-MOP orally and achieved subtherapeutic photosensitizer plasma levels.
Our treatment protocols confirm the beneficial effects of ECP on CTCL at any stage, but it seems that ECP efficiency is ensured only when a 8-MOP solution is applied extracorporeally.
KeywordsPartial Remission Mycosis Fungoides Minor Response Skin Score Sezary Syndrome
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