Long-term experience with low-dose interferon-alpha and PUVA in the management of early mycosis fungoides.
OBJECTIVE
Combined high-dose Interferon-alpha and psoralen plus ultraviolet A irradiation (PUVA) have been reported to be effective in the treatment of early mycosis fungoides (MF); however, our study is the first controlled prospective study in the literature exploring the activity and tolerability of the combination with low dosages and evaluating further clinical outcome of early-MF patients.


METHODS
We carried out a multicentric prospective Phase II clinical study on 89 patients with early-stage IA to IIA MF treated for 14 months with low-dose IFN-alpha2b (6-18 MU/wk) and PUVA. Treatment success was analysed in terms of freedom from treatment failure.


CONCLUSIONS
Complete remission (CR) was achieved in 84% and an overall response rate in 98% of cases: six-month CR was associated with a non-confluent skin infiltrate at histology (P = 0.044) and 14-month CR with high epidermal CD1a+ dendritic-cell density (P = 0.030). The combination protocol was successfully tolerated and the most common reason of 'failure' was related to relapse and not to toxicity. Sustained remissions were achieved in 20% of patients. High CD8+ lymphoid T-cell density was associated with a lower relapse rate (P = 0.002). We think that our combination therapy can be considered an alternative approach compared with other modalities. Good immunological host surveillance in the skin lesions seems to be an optimal basis for the therapeutic success.
Rupoli
Serena
S
Clinic of Hematology, Politechnic University of Marche, School of Medicine, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy. s.rupoli@ao-umbertoprimo.marche.it
Goteri
Gaia
G
Pulini
Stefano
S
Filosa
Alessandra
A
Tassetti
Angela
A
Offidani
Massimo
M
Filosa
Giorgio
G
Mozzicafreddo
Giorgio
G
Giacchetti
Alfredo
A
Brandozzi
Giuliano
G
Cataldi
Ivana
I
Barulli
Sara
S
Ranaldi
Renzo
R
Scortechini
Anna Rita
AR
Capretti
Roberta
R
Fabris
Guidalberto
G
Leoni
Pietro
P
D000368:Aged; D018414:CD8-Positive T-Lymphocytes; D003713:Dendritic Cells; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000188:drug therapy* / Q000401:mortality; D011701:PUVA Therapy; D012008:Recurrence; D012074:Remission Induction; D012867:Skin / Q000276:immunology / Q000382:microbiology; D016019:Survival Analysis; D016896:Treatment Outcome
D016898:Interferon-alpha