American Journal of Clinical Dermatology

, Volume 7, Issue 3, pp 155–169 | Cite as

Management of Refractory Early-Stage Cutaneous T-Cell Lymphoma

  • Margit A. Huber
  • Gyde Staib
  • Hubert Pehamberger
  • Karin Scharffetter-Kochanek
Review Article


Cutaneous T-cell lymphoma (CTCL) is a heterogeneous group of non-Hodgkin’s lymphomas that manifest primarily in the skin. Mycosis fungoides is recognized as the most common type of CTCL. Patients with early-stage CTCL usually have a benign and chronic disease course. However, although there is a wide array of therapeutic options for early-stage CTCL, not all patients respond to these individual therapies, resulting in refractory cutaneous disease over time. Refractory early-stage CTCL poses an important therapeutic challenge, as one of the principal treatment goals is to keep the disease confined to the skin, thereby preventing disease progression.

Much of the focus of current research has been on the evaluation of already available skin-directed therapies and biologic response modifiers and combination regimens thereof, such as the combination of psoralen and UVA (PUVA) with interferon-α or retinoids. Recent novel developments include oral bexarotene, a retinoid X receptor-selective retinoid that has activity in all stages of CTCL and has been shown to be effective in patients with refractory early-stage disease as well as advanced-stage disease. Likewise, the topical gel formulation of bexarotene has proved to be an important therapeutic option in patients with refractory or relapsed lesions. Oral bexarotene and topical bexarotene have been approved by the US FDA for the treatment of refractory CTCL. Systemic chemotherapy is typically reserved for advanced-stage CTCL and is usually not recommended for early-stage, skin-limited disease. However, recent exploratory studies indicate that low-dose methotrexate may represent an overall well tolerated therapy in a subset of patients with refractory early-stage CTCL, as may pegylated liposomal doxorubicin, which is currently being investigated in this specific clinical setting. Another recently FDA-approved therapy is the interleukin-2 fusion toxin denileukin diftitox, which is now well established to play a role in the treatment of refractory CTCL, including early-stage extensive plaque disease. The value of other agents, such as topical tazarotene, topical methotrexate, and topical imiquimod, and of novel immunomodulatory approaches including monoclonal antibodies, still needs to be assessed for refractory early-stage CTCL.


Retinoid Imiquimod Mycosis Fungoides Etretinate Tazarotene 



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of the review.


  1. 1.
    Muche JM, Gellrich S, Sterry W. Treatment of cutaneous T-cell lymphomas. Semin Cutan Med Surg. 2000; 19: 142–8PubMedCrossRefGoogle Scholar
  2. 2.
    Willemze R, Kerl H, Sterry W, et al. EORTC classification for primary cutaneous lymphomas: a proposal from the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer. Blood. 1997; 90: 354–71PubMedGoogle Scholar
  3. 3.
    Jaffe ES, Harris NL, Stein H, et al. World Health Organization classification of tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon: IARC Press, 2001Google Scholar
  4. 4.
    Willemze R, Jaffe ES, Burg G, et al. WHO-EORTC classification for cutaneous lymphomas. Blood. 2005; 105: 3768–85PubMedCrossRefGoogle Scholar
  5. 5.
    Smith BD, Wilson LD. Management of mycosis fungoides. Part 1: diagnosis, staging, and prognosis. Oncology (Huntingt). 2003; 17: 1281–8Google Scholar
  6. 6.
    Burg G, Dummer R, Haeffner A, et al. From inflammation to neoplasia: mycosis fungoides evolves from reactive inflammatory conditions (lymphoid infiltrates) transforming into neoplastic plaques and tumors [comment]. Arch Dermatol. 2001; 137: 949–52PubMedGoogle Scholar
  7. 7.
    Kempf W, Kettelhack N, Duvic M, et al. Topical and systemic retinoid therapy for cutaneous T-cell lymphoma. Hematol Oncol Clin North Am. 2003; 17: 1405–19PubMedCrossRefGoogle Scholar
  8. 8.
    Dummer R, Michie SA, Kell D, et al. Expression of bel-2 protein and Ki-67 nuclear proliferation antigen in benign and malignant cutaneous T-cell infiltrates. J Cutan Pathol. 1995; 22: 11–7PubMedCrossRefGoogle Scholar
  9. 9.
    Weinstock MA, Gardstein B. Twenty-year trends in the reported incidence of mycosis fungoides and associated mortality. Am J Public Health. 1999; 89: 1240–4PubMedCrossRefGoogle Scholar
  10. 10.
    Demierre MF, Foss FM, Koh HK. Proceedings of the International Consensus Conference on Cutaneous T-Cell Lymphoma (CTCL) Treatment Recommendations. Boston, Massachusetts, Oct. 1 and 2, 1994. J Am Acad Dermatol. 1997; 36: 460–6PubMedCrossRefGoogle Scholar
  11. 11.
    Bunn Jr PA, Lamberg SI. Report of the Committee on Staging and Classification of Cutaneous T-Cell Lymphomas. Cancer Treat Rep. 1979; 63: 725–8PubMedGoogle Scholar
  12. 12.
    Knobler E. Current management strategies for cutaneous T-cell lymphoma. Clin Dermatol. 2004; 22: 197–208PubMedCrossRefGoogle Scholar
  13. 13.
    Sausville EA, Eddy JL, Makuch RW, et al. Histopathologic staging at initial diagnosis of mycosis fungoides and the Sezary syndrome: definition of three distinctive prognostic groups. Ann Intern Med. 1988; 109: 372–82PubMedGoogle Scholar
  14. 14.
    Foss F. Mycosis fungoides and the Sezary syndrome. Curr Opin Oncol. 2004; 16: 421–8PubMedCrossRefGoogle Scholar
  15. 15.
    Zackheim HS, Amin S, Kashani-Sabet M, et al. Prognosis in cutaneous T-cell lymphoma by skin stage: long-term survival in 489 patients. J Am Acad Dermatol. 1999; 40: 418–25PubMedCrossRefGoogle Scholar
  16. 16.
    van Doom R, van Haselen CW, van Voorst Vader PC, et al. Mycosis fungoides: disease evolution and prognosis of 309 Dutch patients. Arch Dermatol. 2001; 136: 504–10Google Scholar
  17. 17.
    Kim YH, Chow S, Varghese A, et al. Clinical characteristics and long-term outcome of patients with generalized patch and/or plaque (T2) mycosis fungoides. Arch Dermatol. 1999; 135: 26–32PubMedCrossRefGoogle Scholar
  18. 18.
    Kaye FJ, Bunn PA, Steinberg SM, et al. A randomized trial comparing combination electron-beam radiation and chemotherapy with topical therapy in the initial treatment of mycosis fungoides. N Engl J Med. 1989; 321: 1784–90PubMedCrossRefGoogle Scholar
  19. 19.
    Dummer R, Haffner AC, Hess M, et al. A rational approach to the therapy of cutaneous T-cell lymphomas. Onkologie. 1996; 19: 226–30CrossRefGoogle Scholar
  20. 20.
    Zackheim HS, Kashani-Sabet M, Amin S. Topical corticosteroids for mycosis fungoides: experience in 79 patients. Arch Dermatol. 1998; 134: 949–54PubMedCrossRefGoogle Scholar
  21. 21.
    Zackheim HS. Treatment of patch-stage mycosis fungoides with topical corticosteroids. Dermatol Ther. 2003; 16: 283–7PubMedCrossRefGoogle Scholar
  22. 22.
    Dummer R, Kempf W, Hess Schmid M, et al. Therapy of cutaneous lymphoma: current practice and future developments. Onkologie. 2003; 26: 366–72PubMedCrossRefGoogle Scholar
  23. 23.
    Apisamthanarax N, Talpur R, Duvic M. Treatment of cutaneous T cell lymphoma. Am J Clin Dermatol. 2002; 3: 193–215CrossRefGoogle Scholar
  24. 24.
    Smith BD, Wilson LD. Management of mycosis fungoides. Part 2: treatment. Oncology (Huntingt). 2003; 17: 1419–28Google Scholar
  25. 25.
    Kim YH, Martinez G, Varghese A, et al. Topical nitrogen mustard in the management of mycosis fungoides: update of the Stanford experience. Arch Dermatol. 2003; 139: 165–73PubMedCrossRefGoogle Scholar
  26. 26.
    Zackheim HS, Epstein Jr EH, Crain WR. Topical carmustine (BCNU) for cutaneous T cell lymphoma: a 15-year experience in 143 patients. J Am Acad Dermatol. 1990; 22: 802–10PubMedCrossRefGoogle Scholar
  27. 27.
    Zackheim HS. Topical carmustine (BCNU) in the treatment of mycosis fungoides. Dermatol Ther. 2003; 16: 299–302PubMedCrossRefGoogle Scholar
  28. 28.
    Zhang C, Duvic M. Retinoids: therapeutic applications and mechanisms of action in cutaneous T-cell lymphoma. Dermatol Ther. 2003; 16: 322–30PubMedCrossRefGoogle Scholar
  29. 29.
    Zhang C, Hazarika P, Ni X, et al. Induction of apoptosis by bexarotene in cutaneous T-cell lymphoma cells: relevance to mechanism of therapeutic action. Clin Cancer Res. 2002; 8: 1234–40PubMedGoogle Scholar
  30. 30.
    Breneman D, Duvic M, Kuzel T, et al. Phase 1 and 2 trial of bexarotene gel for skin-directed treatment of patients with cutaneous T-cell lymphoma. Arch Dermatol. 2002; 138: 325–32PubMedCrossRefGoogle Scholar
  31. 31.
    Heald P, Mehlmauer M, Martin AG, et al. Topical bexarotene therapy for patients with refractory or persistent early-stage cutaneous T-cell lymphoma: results of the phase III clinical trial. J Am Acad Dermatol. 2003; 49: 801–15PubMedCrossRefGoogle Scholar
  32. 32.
    Apisarnlhanarax N, Talpur R, Ward S, et al. Tazarotene 0.1% gel for refractory mycosis fungoides lesions: an open-label pilot study. J Am Acad Dermatol. 2004; 50: 600–7CrossRefGoogle Scholar
  33. 33.
    Demierre MF, Vachon L, Ho V, et al. Phase 1/2 pilot study of methotrexate-laurocapram topical gel for the treatment of patients with early-stage mycosis fungoides. Arch Dermatol. 2003; 139: 624–8PubMedCrossRefGoogle Scholar
  34. 34.
    Dummer R, Urosevic M, Kempf W, et al. Imiquimod induces complete clearance of a PUVA-resistant plaque in mycosis fungoides. Dermatology. 2003; 207: 116–8PubMedCrossRefGoogle Scholar
  35. 35.
    Deeths MJ, Chapman JT, Dellavalle RP, et al. Treatment of patch and plaque stage mycosis fungoides with imiquimod 5% cream. J Am Acad Dermatol. 2005; 52: 275–80PubMedCrossRefGoogle Scholar
  36. 36.
    Baron ED, Stevens SR. Phototherapy for cutaneous T-cell lymphoma. Dermatol Ther. 2003; 16: 303–10PubMedCrossRefGoogle Scholar
  37. 37.
    Girardi M, Knobler R, Edelson R. Selective immunotherapy through extracorporeal photochemotherapy: yesterday, today, and tomorrow. Hematol Oncol Clin N Am. 2003; 17: 1391–403CrossRefGoogle Scholar
  38. 38.
    Zic JA. The treatment of cutaneous T-cell lymphoma with photopheresis. Dermatol Ther. 2003; 16: 337–46PubMedCrossRefGoogle Scholar
  39. 39.
    Krueger JG, Wolfe JT, Nabeya RT, et al. Successful ultraviolet B treatment of psoriasis is accompanied by a reversal of keratinocyte pathology and by selective depletion of intraepidermal T cells. J Exp Med. 1995; 182: 2057–68PubMedCrossRefGoogle Scholar
  40. 40.
    Herrmann JJ, Roenigk Jr HH, Honigsmann H. Ultraviolet radiation for treatment of cutaneous T-cell lymphoma. Hematol Oncol Clin N Am. 1995; 9: 1077–88Google Scholar
  41. 41.
    Ramsay DL, Lish KM, Yalowitz CB, et al. Ultraviolet-B phototherapy for early-stage cutaneous T-cell lymphoma. Arch Dermatol. 1992; 128: 931–3PubMedCrossRefGoogle Scholar
  42. 42.
    Resnik KS, Vonderheid EC. Home UV phototherapy of early mycosis fungoides: long-term follow-up observations in thirty-one patients. J Am Acad Dermatol. 1993; 29: 73–7PubMedCrossRefGoogle Scholar
  43. 43.
    Hofer A, Cerroni L, Kerl H, et al. Narrowband (311-nm) UV-B therapy for small plaque parapsoriasis and early-stage mycosis fungoides. Arch Dermatol. 1999; 135: 1377–80PubMedCrossRefGoogle Scholar
  44. 44.
    Clark C, Dawe RS, Evans AT, et al. Narrowband TL-01 phototherapy for patch-stage mycosis fungoides. Arch Dermatol. 2001; 136: 748–52CrossRefGoogle Scholar
  45. 45.
    Diederen PV, van Weelden H, Sanders CJ, et al. Narrowband UVB and psoralen-UVA in the treatment of early-stage mycosis fungoides: a retrospective study. J Am Acad Dermatol. 2003; 48: 215–9PubMedCrossRefGoogle Scholar
  46. 46.
    Herrmann JJ, Roenigk HH, Hurria A, et al. Treatment of mycosis fungoides with photochemotherapy (PUVA): long-term follow-up. J Am Acad Dermatol. 1995; 33: 234–42PubMedCrossRefGoogle Scholar
  47. 47.
    Mostow EN, Neckel SI, Oberhelman L, et al. Complete remissions in psoralen and UV-A (PUVA)-refractory mycosis fungoides-type cutaneous T-cell lymphoma with combined interferon-alfa and PUVA. Arch Dermatol. 1993; 129: 747–52PubMedCrossRefGoogle Scholar
  48. 48.
    Wolf P, Fink-Puches R, Cerroni L, et al. Photodynamic therapy for mycosis fungoides after topical photosensitization with 5-aminolevulinic acid. J Am Acad Dermatol. 1994; 31: 678–80PubMedCrossRefGoogle Scholar
  49. 49.
    Leman JA, Dick DC, Morton CA. Topical 5-ALA photodynamic therapy for the treatment of cutaneous T-cell lymphoma. Clin Exp Dermatol. 2002; 27: 516–8PubMedCrossRefGoogle Scholar
  50. 50.
    Yoo EK, Rook AH, Elenitsas R, et al. Apoptosis induction of ultraviolet light A and photochemotherapy in cutaneous T-cell lymphoma: relevance to mechanism of therapeutic action. J Invest Dermatol. 1996; 107: 235–42PubMedCrossRefGoogle Scholar
  51. 51.
    Jones GW, Hoppe RT, Glatstein E. Electron beam treatment for cutaneous T-cell lymphoma. Hematol Oncol Clin N Am. 1995; 9: 1057–76Google Scholar
  52. 52.
    Chinn DM, Chow S, Kim YH, et al. Total skin electron beam therapy with or without adjuvant topical nitrogen mustard or nitrogen mustard alone as initial treatment of T2 and T3 mycosis fungoides. Int J Radial Oncol Biol Phys. 1999; 43: 951–8CrossRefGoogle Scholar
  53. 53.
    Hoppe RT. Mycosis fungoides: radiation therapy. Dermatol Ther. 2003; 16: 347–54PubMedCrossRefGoogle Scholar
  54. 54.
    Jones GW, Kacinski BM, Wilson LD, et al. Total skin electron radiation in the management of mycosis fungoides: consensus of the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group. J Am Acad Dermatol. 2002; 47: 364–70PubMedCrossRefGoogle Scholar
  55. 55.
    Dummer R. Immunomodulators in the treatment of cutaneous lymphomas. Expert Opin Biol Ther. 2002; 2: 279–86PubMedCrossRefGoogle Scholar
  56. 56.
    Rook AH, Kuzel TM, Olsen EA. Cytokine therapy of cutaneous T-cell lymphoma: interferons, interleukin-12, and interleukin-2. Hematol Oncol Clin N Am. 2003; 17: 1435–48CrossRefGoogle Scholar
  57. 57.
    Rook AH, McGinnis KS, Richardson SK, et al. The use of cytokines, fusion proteins and antibodies to treat cutaneous T-cell lymphoma. Dermatol Ther. 2003; 16: 331–6PubMedCrossRefGoogle Scholar
  58. 58.
    Jumbou O, N’Guyen JM, Tessier MH, et al. Long-term follow-up in 51 patients with mycosis fungoides and Sezary syndrome treated by interferon-alfa. Br J Dermatol. 1999; 140: 427–31PubMedCrossRefGoogle Scholar
  59. 59.
    Olsen EA. Interferon in the treatment of cutaneous T-cell lymphoma. Dermatol Ther. 2003; 16: 311–21PubMedCrossRefGoogle Scholar
  60. 60.
    Olsen EA, Bunn PA. Interferon in the treatment of cutaneous T-cell lymphoma. Hematol Oncol Clin N Am. 1995; 9: 1089–107Google Scholar
  61. 61.
    Lundin J, Osterborg A. Therapy for mycosis fungoides. Curr Treat Options Oncol. 2004; 5: 203–14PubMedCrossRefGoogle Scholar
  62. 62.
    Thomsen K, Hammar H, Molin L, et al. Retinoids plus PUVA (RePUVA) and PUVA in mycosis fungoides, plaque stage: a report from the Scandinavian Mycosis Fungoides Group. Acta Derm Venereol. 1989; 69: 536–8PubMedGoogle Scholar
  63. 63.
    Duvic M, Hymes K, Heald P, et al. Bexarotene is effective and safe for treatment of refractory advanced-stage cutaneous T-cell lymphoma: multinational phase II–III trial results. J Clin Oncol. 2001; 19: 2456–71PubMedGoogle Scholar
  64. 64.
    Duvic M, Martin AG, Kim Y, et al. Phase 2 and 3 clinical trial of oral bexarotene (Targretin capsules) for the treatment of refractory or persistent early-stage cutaneous T-cell lymphoma. Arch Dermatol. 2001; 137: 581–93PubMedGoogle Scholar
  65. 65.
    Talpur R, Ward S, Apisarnthanarax N, et al. Optimizing bexarotene therapy for cutaneous T-cell lymphoma. J Am Acad Dermatol. 2002; 47: 672–84PubMedCrossRefGoogle Scholar
  66. 66.
    Rook AH, Wood GS, Yoo EK, et al. Interleukin-12 therapy of cutaneous T-cell lymphoma induces lesion regression and cytotoxic T-cell responses. Blood. 1999; 94: 902–8PubMedGoogle Scholar
  67. 67.
    Rook AH, Zaki MH, Wysocka M, et al. The role for interleukin-12 therapy of cutaneous T cell lymphoma. Ann N Y Acad Sci. 2001; 941: 177–84PubMedCrossRefGoogle Scholar
  68. 68.
    Lenihan DJ, Alencar AJ, Yang D, et al. Cardiac toxicity of alemtuzumab in patients with mycosis fungoides/Sezary syndrome. Blood. 2004; 104: 655–8PubMedCrossRefGoogle Scholar
  69. 69.
    Kuzel TM. Systemic chemotherapy for the treatment of mycosis fungoides and Sezary syndrome. Dermatol Ther. 2003; 16: 355–61PubMedCrossRefGoogle Scholar
  70. 70.
    Zinzani P, Baliva G, Magagnoli M, et al. Gemcitabine treatment in pretreated cutaneous T-cell lymphoma: experience in 44 patients. J Clin Oncol. 2001; 18: 2603–6Google Scholar
  71. 71.
    Kurzrock R, Pilat S, Duvic M. Pentostatin therapy of T-cell lymphomas with cutaneous manifestations. J Clin Oncol. 1999; 17: 3117–21PubMedGoogle Scholar
  72. 72.
    Foss F. Activity of pentostatin (Nipent) in cutaneous T-cell lymphoma: single-agent and combination studies. Semin Oncol. 2001; 27: 58–63Google Scholar
  73. 73.
    Quaglino P, Fierro MT, Rossotto GL, et al. Treatment of advanced mycosis fungoides/Sezary syndrome with fludarabine and potential adjunctive benefit to subsequent extracorporeal photochemotherapy. Br J Dermatol. 2004; 150: 327–36PubMedCrossRefGoogle Scholar
  74. 74.
    Foss FM, Ihde DC, Linnoila IR, et al. Phase II trial of fludarabine phosphate and interferon alfa-2a in advanced mycosis fungoides/Sezary syndrome. J Clin Oncol. 1994; 12: 2051–9PubMedGoogle Scholar
  75. 75.
    Fung MA, Murphy MJ, Hoss DM, et al. Practical evaluation and management of cutaneous lymphoma. J Am Acad Dermatol. 2002; 46: 325–57PubMedCrossRefGoogle Scholar
  76. 76.
    Aviles A, Neri N, Fernandez R, et al. Nasal NK/T-cell lymphoma with disseminated disease treated with aggressive combined therapy. Med Oncol. 2003; 20: 13–7PubMedCrossRefGoogle Scholar
  77. 77.
    Kuzel TM, Junghans R, Foss FM. Novel agents for cutaneous T-cell lymphoma. Hematol Oncol Clin N Am. 2003; 17: 1459–66CrossRefGoogle Scholar
  78. 78.
    Zackheim HS, Kashani-Sabet M, Hwang ST. Low-dose methotrexate to treat erythrodermic cutaneous T-cell lymphoma: results in twenty-nine patients. J Am Acad Dermatol. 1996; 34: 626–31PubMedCrossRefGoogle Scholar
  79. 79.
    Zackheim HS, Kashani-Sabet M, McMillan A. Low-dose methotrexate to treat mycosis fungoides: a retrospective study in 69 patients. J Am Acad Dermatol. 2003; 49: 873–8PubMedCrossRefGoogle Scholar
  80. 80.
    Sarris AH, Phan A, Duvic M, et al. Trimetrexate in relapsed T-cell lymphoma with skin involvement. J Clin Oncol. 2002; 20: 2876–80PubMedCrossRefGoogle Scholar
  81. 81.
    Wollina U, Graefe T, Katie K. Treatment of relapsing or recalcitrant cutaneous T-cell lymphoma with pegylated liposomal doxorubicin. J Am Acad Dermatol. 2001; 42: 40–6CrossRefGoogle Scholar
  82. 82.
    Wollina U, Graefe T, Kaatz M. Pegylated doxorubicin for primary cutaneous T-cell lymphoma: a report on ten patients with follow-up. J Cancer Res Clin Oncol. 2001; 127: 128–34PubMedCrossRefGoogle Scholar
  83. 83.
    Wollina U, Dummer R, Brockmeyer NH, et al. Multicenter study of pegylated liposomal doxorubicin in patients with cutaneous T-cell lymphoma. Cancer. 2003; 98: 993–1001PubMedCrossRefGoogle Scholar
  84. 84.
    Foss FM, Waldmann TA. Interleukin-2 receptor-directed therapies for cutaneous lymphomas. Hematol Oncol Clin N Am. 2003; 17: 1449–58CrossRefGoogle Scholar
  85. 85.
    Olsen E, Duvic M, Frankel A, et al. Pivotal phase III trial of two dose levels of denileukin diftitox for the treatment of cutaneous T-cell lymphoma. J Clin Oncol. 2001; 19: 376–88PubMedGoogle Scholar
  86. 86.
    Foss FM, Bacha P, Osann KE, et al. Biological correlates of acute hypersensitivity events with DAB(389)IL-2 (denileukin diftitox, ONTAK) in cutaneous T-cell lymphoma: decreased frequency and severity with steroid premedication. Clin Lymphoma. 2001; 1: 298–302PubMedCrossRefGoogle Scholar
  87. 87.
    Gorgun G, Foss F. Immunomodulatory effects of RXR rexinoids: modulation of high-affinity IL-2R expression enhances susceptibility to denileukin diftitox. Blood. 2002; 100: 1399–403PubMedCrossRefGoogle Scholar
  88. 88.
    Foss F, Demierre MF, Divenuti G. A phase-1 trial of bexarotene and denileukin diftitox in patients with relapsed or refractory cutaneous T-cell lymphoma. Blood. 2005; 106: 454–7PubMedCrossRefGoogle Scholar
  89. 89.
    Duvic M, Apisarnthanarax N, Cohen DS, et al. Analysis of long-term outcomes of combined modality therapy for cutaneous T-cell lymphoma. J Am Acad Dermatol. 2003; 49: 35–49PubMedCrossRefGoogle Scholar
  90. 90.
    Kuzel TM, Roenigk Jr HH, Samuelson E, et al. Effectiveness of interferon alfa-2a combined with phototherapy for mycosis fungoides and the Sezary syndrome. J Clin Oncol. 1995; 13: 257–63PubMedGoogle Scholar
  91. 91.
    Stadler R, Otte HG, Luger T, et al. Prospective randomized multicenter clinical trial on the use of interferon-2a plus acitretin versus interferon-2a plus PUVA in patients with cutaneous T-cell lymphoma stages I and II. Blood. 1998; 92: 3578–81PubMedGoogle Scholar
  92. 92.
    Huber MA, Kunzi-Rapp K, Staib G, et al. Management of refractory early-stage cutaneous T-cell lymphoma (mycosis fungoides) with a combination of oral bexarotene and psoralen plus ultraviolet A bath therapy. J Am Acad Dermatol. 2004; 50: 475–6PubMedCrossRefGoogle Scholar
  93. 93.
    Singh F, Lebwohl MG. Cutaneous T-cell lymphoma treatment using bexarotene and PUVA: a case series. J Am Acad Dermatol. 2004; 51: 570–3PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Margit A. Huber
    • 1
  • Gyde Staib
    • 2
  • Hubert Pehamberger
    • 1
  • Karin Scharffetter-Kochanek
    • 2
  1. 1.Department of Dermatology, Division of General DermatologyVienna Medical UniversityViennaAustria
  2. 2.Department of Dermatology and AllergologyUniversity of UlmUlmGermany

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