Clinical Characteristics and Long-term Outcome of Patients With Generalized Patch and/or Plaque (T2) Mycosis Fungoides

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Abstract
Objectives: To study the long-term results of treat- ment of patients with generalized patch and/or plaque mycosis fungoides and to identify clinical characteris- tics predictive of survival and response to treatment. Design: A single-center, 35.5-year retrospective co- hort analysis. Setting: Private referral medical center. Patients: One hundred seventy-six patients with gen- eralized patch and/or plaque (T2) mycosis fungoides. Main Outcome Measures: Long-term actuarial sur- vival and freedom-from-relapse results as calculated by the Kaplan-Meier method. Results: Thelong-term(35.5-year)survivalofpatientswith T2 mycosis fungoides is worse than the expected survival of a race-, age-, and sex-matched control population (P,.001). The median survival of the T2 group is 11.7 years. Patients younger than 58 years (median age) at presenta- tion have a more favorable overall and disease-specific sur- vival than the patients who are 58 years or older (P,.001 vs P,.025). Patient sex or race had no significant effect on overall survival. Patients who presented with palpable clini- cally significant lymph nodes (stage IIA) had long-term sur- vivalresultssimilartothosewithoutlymphadenopathy(stage IB), despite improved freedom-from-relapse outcome for patients with stage IB. Twenty-four percent of patients who progressed to more advanced disease had a lower complete response rate to initial therapy than did other patients (21% vs 65%) (P,.001). Patients who received total skin elec- tron beam therapy had a better complete response rate than patients treated with topical mechlorethamine hydrochlo- ride alone; the relapse-free results were superior in patients with a total dose of 30 Gy or higher and in patients who re- ceived topical mechlorethamine as adjuvant therapy follow- ing total skin electron beam therapy. Despite differences in freedom-from-relapse results among different treatment groups, long-term overall or disease-specific survivals were not significantly different. Conclusions: A significant proportion (24%) of pa-