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Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium - 18/12/15

Doi : 10.1016/j.jaad.2015.09.033 
Elise A. Olsen, MD a, , Emilia Hodak, MD b, Thomas Anderson, MD c, Joi B. Carter, MD d, Marsha Henderson, MD e, Kevin Cooper, MD f, Henry W. Lim, MD e
a Departments of Dermatology and Medicine, Duke University Medical Center, Durham, North Carolina 
b Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 
c Department of Dermatology, University of Michigan, Ann Arbor, Michigan 
d Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts 
e Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 
f Department of Dermatology, Case Western Reserve University, Cleveland, Ohio 

Correspondence to: Elise A. Olsen, MD, Box 3294, Duke University Medical Center, Durham, NC 27710.

Abstract

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.

Le texte complet de cet article est disponible en PDF.

Key words : cutaneous T-cell lymphoma, phototherapy, PUVA, mycosis fungicides, NB-UVB, Sézary syndrome, UVL

Abbreviations used : BB-UVB, CCR, CR, IFN, MED, MF, MOP, MPD, NB-UVB, PUVA, RFI, SCC, SS, TSEB, USCLC, UVA, UVB, UVC, UVL, UVR


Plan


 Funding sources: None.
 Dr Olsen is on the advisory board of and is consultant for Actelion. Dr Anderson is an investigator for Eisai. Dr Cooper is an investigator for Estee Lauder and L'Oreal, a consultant for Anacor, Avon, GSK, and Takeda, and the Vice President of Fluence Therapeutics. Dr Lim is an investigator for Clinuvel and Estee Lauder and a consultant for Clinuvel, Estee Lauder, Ferndale, La Roche-Posay, Palatin, Pierre Fabre, and Uriage. The other authors have no conflicts of interest to declare.
 These guidelines were developed specifically by members of the United States Cutaneous Lymphoma Consortium based on the need for education and standardization of phototherapy treatment for mycosis fungoides and Sézary syndrome without relevant conflicts of interest by authors and without outside support. Nonetheless, they should not be considered to be sponsored or endorsed by the American Academy of Dermatology because they were not prepared under the American Academy of Dermatology guidelines.
 Reprints not available from the authors.


© 2015  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 74 - N° 1

P. 27-58 - janvier 2016 Retour au numéro
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