Durable loss of a malignant T-cell clone in a stage IV cutaneous T-cell lymphoma patient treated with high-dose interferon and photopheresis

• Published in: Journal of the American Academy of Dermatology Vol. 41; no. 5; pp. 880 - 883
• Main Authors: Haley, Heather R., Davis, Daniel A., Sams, W.Mitchell
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-11-1999; Elsevier
• Subjects: Adult; AIDS/HIV; Antineoplastic Agents - therapeutic use; Biological and medical sciences; CD4-CD8 Ratio; Clone Cells - immunology; Combined Modality Therapy; Dermatology; Gene Rearrangement, T-Lymphocyte; Humans; Interferon-alpha - therapeutic use; Lymphoma, T-Cell, Cutaneous - immunology; Lymphoma, T-Cell, Cutaneous - pathology; Lymphoma, T-Cell, Cutaneous - therapy; Male; Medical sciences; Photopheresis; Skin Neoplasms - immunology; Skin Neoplasms - pathology; Skin Neoplasms - therapy; Tumors of the skin and soft tissue. Premalignant lesions; Human; Skin disease; Treatment efficiency; Cytokine; Malignant hemopathy; Lymphoma; Case study; Cutaneous hematologic disease; Lymphoproliferative syndrome; T-Lymphocyte; Interferon; Skin; Photopheresis; Combined treatment
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/S0190-9622(99)70351-8

Stage IV cutaneous T-cell lymphoma (CTCL) has a notoriously poor prognosis and many treatment options exist. We describe the successful treatment of a case of stage IV CTCL with combination photopheresis and high-dose interferon alfa (IFNα). The patient was treated with combination therapy of monthly photopheresis and daily doses of IFNα up to 36 MU. Response to therapy was followed by clinical observation and Southern blot analysis for the detection of a malignant clone. The findings of this case were compared with others using a computer-based literature review. A complete clinical response lasting 64 months was achieved. Clinical relapse was preceded by an increase in the CD4/CD8 ratio and by reappearance of the T-cell receptor gene rearrangement. Combined photopheresis and high-dose IFNα led to a durable and sustained complete response in stage IV CTCL. CD4/CD8 ratios and T-cell gene rearrangements may be helpful in patient management. (J Am Acad Dermatol 1999;41:880-3.)