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Treatment of stage I a and I b mycosis fungoides with psoralen UVA monotherapy: an observational study in tertiary hospitals in the C anary I slands

2014; Wiley; Volume: 53; Issue: 11 Linguagem: Inglês

10.1111/ijd.12425

1365-4632

Zaida Hernández, Yeray Peñate, B. Hernández‐Machín, Lina Pérez‐Méndez, José Suárez‐Hernández, Javier Morales Hernández, Ricardo Fernández‐de‐Misa,

Nail Diseases and Treatments

Abstract Background Mycosis fungoides ( MF ) is the most common form of primary cutaneous T cell lymphoma. Psoralen combined with ultraviolet A ( PUVA ) is a first‐line treatment for early‐stage disease. Objectives This study was conducted to assess the clinical effectiveness of and tolerance to PUVA monotherapy in MF . Methods We retrospectively reviewed the files of patients who received PUVA for stage I disease. The study included 31 patients, of whom 32% presented with stage Ia and 67% with stage Ib disease, and 68% presented with patch and 32% with plaque disease. All patients received treatment three times per week. Results Complete response ( CR ) was achieved in 71% of patients. The median cumulative dose of UVA at CR was 211.7 J/cm 2 . There was a significant difference in median cumulative dose at CR between patients with plaque and patch disease, respectively, but not between patients with stage Ia and Ib disease. Median disease‐free survival ( DFS ) was 230 weeks. Patients with patch disease achieved longer DFS than those with plaque disease ( P = 0.004), although DFS was similar in stage Ia and Ib patients. Of the patients who received maintenance therapy, 58% relapsed. Univariate analysis showed patch disease to be a predictive factor for CR , but no predictors of relapse were identified. A total of 71% of patients developed clinical adverse reactions. Conclusions Psoralen with UVA is a safe and effective treatment for early‐stage MF . Patch disease responds more favorably than plaque disease and is associated with a longer period of DFS . Maintenance treatment does not appear to reduce recurrence. Current evidence suggests that the proposed revision to the classification of MF , which takes into account the extent and type of disease, more accurately predicts response to PUVA .