Extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma ? the D sseldorf and Munich experience

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Abstract
Extracorporeal photopheresis (ECP) using UVA irradiation of enriched lymphocytes in the presence of 8-methoxypsoralen as a photoactivatable substrate was originally introduced as a therapeutic regimen for cutaneous T-cell lymphoma (CTCL). Whereas ECP has previously been reported to be useful primarily for erythrodermic lymphoma, our purpose was to obtein data on safety and efficacy of ECP in patients suffering from different stages of CTCL. We report on 17 patients, 3 with erythroderma and 14 with plaque or tumour stages. In contrast to other studies our patients were treated predominantly with ECP alone; only a few patients received concomitant therapy. These data have not been published previously, except for preliminary data on four patients. Of the 17 patients, 12 (70%) responded to ECP. In seven patients at least 50% of skin lesions disappeared (defined as partial response) and in five patients at least 25% of skin lesions disappeared (defined as minor response). In two patients the disease remained stable and in three patients the disease progressed under the ECP treatment. No complete remission was observed. Partial responses were achieved not only in patients with early CTCL (stage I b) but also in those with far progressed tumours (stage IV a). After treatment for 6 months partial responders showed an increase in the number of NK cells in their peripheral blood (P<0.01). We cannot confirm a relationship between this treatment and CD8 cell counts, as reported by others. Overall, our results indicate that ECP is a safe and effective regimen for the treatment of all stages of CTCL.