Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium

• Published in: Journal of the American Academy of Dermatology Vol. 74; no. 1; pp. 27 - 58
• Main Authors: Olsen, Elise A., MD, Hodak, Emilia, MD, Anderson, Thomas, MD, Carter, Joi B., MD, Henderson, Marsha, MD, Cooper, Kevin, MD, Lim, Henry W., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2016
• Subjects: cutaneous T-cell lymphoma; Dermatology; Female; Humans; Male; mycosis fungicides; Mycosis Fungoides - diagnosis; Mycosis Fungoides - therapy; NB-UVB; phototherapy; Phototherapy - methods; Practice Guidelines as Topic; Prognosis; PUVA; PUVA Therapy - methods; Risk Assessment; Sezary Syndrome - diagnosis; Sezary Syndrome - therapy; Skin Neoplasms - diagnosis; Skin Neoplasms - therapy; Societies, Medical; Sézary syndrome; Treatment Outcome; Ultraviolet Therapy - methods; United States; UVL; United States; MPD; UVB; UVA; complete clinical response; UVC; cutaneous T-cell lymphoma; USCLC; ultraviolet A light; UVL; mycosis fungoides; IFN; relapse-free interval; UVR; mycosis fungicides; ultraviolet C light; Sézary syndrome; RFI; PUVA; broadband ultraviolet B light; MF; phototherapy; total skin electron beam; SS; BB-UVB; psoralen plus ultraviolet A light photochemotherapy; United States Cutaneous Lymphoma Consortium; complete response; narrowband ultraviolet B light; methoxypsoralen; interferon; Sézary syndrome; MED; ultraviolet light; CR; MOP; ultraviolet radiation; minimal phototoxic dose; SCC; CCR; ultraviolet B light; NB-UVB; minimal erythema dose; TSEB; squamous cell carcinoma
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2015.09.033

Background Ultraviolet light (UVL) is a long established treatment for mycosis fungoides (MF) and Sézary syndrome (SS), subtypes of cutaneous T-cell lymphoma (CTCL). Treatments have traditionally included broadband, narrowband ultraviolet B light (UVB) and psoralen plus ultraviolet A light photochemotherapy (PUVA), but more recently, treatment options have expanded to include UVA1 and excimer laser. UVL is used either as monotherapy or as an adjuvant to systemic therapy, demonstrating efficacy in many cases that equal or surpass systemic medications. Despite its utility and duration of use, the current practice of using UVL guidelines for psoriasis to treat patients with MF/SS is problematic because the goals of prolonging survival and preventing disease progression are unique to CTCL compared to psoriasis. Objectives We sought to develop separate guidelines for phototherapy for MF/SS for both clinical practice and for clinical trials. Methods Literature review and cutaneous lymphoma expert consensus group recommendations. Results This paper reviews the published literature for UVB and UVA/PUVA in MF/SS and suggests practical standardized guidelines for their use. Limitations New standardization of phototherapy. Conclusions These guidelines should allow the comparison of results with phototherapy in MF/SS across different stages of patients, centers, and in combination with other agents in practice and in clinical trials.