Combined modality treatment of cutaneous T cell lymphoma

Results of a 6-year follow-up

C. F. Winkler, E. A. Sausville, D. C. Ihde, A. B. Fischmann, G. P. Schechter, P. P. Kumar, J. R. Nibhanupdi, J. D. Minna, R. W. Makuch, J. L. Eddy

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Abstract

Thirty-nine patients with cutaneous T cell lymphoma (CTCL; including mycosis fungoides or the Sezary syndrome) with no previous treatment other than topical therapy or oral corticosteroids, received total skin electron beam irradiation (TSEB) and either sequential or simultaneous systemic chemotherapy. Median follow-up, measured from the time of initiation of therapy to the time of analysis, is in excess of 6 years and extends to 100+ months. Thirteen patients with stage I disease (limited to skin with no adenopathy) received 3,000 rad total skin electron beam irradiation followed by three 2-week courses of daily intravenous (IV) mechlorethamine. Twenty-six patients with advanced disease (stage II-IV) received 2,400 rad of TSEB and simultaneous chemotherapy with two alternating three-drug regimens: vinblastine, doxorubicin, and bleomycin (VAB) alternating with cyclophosphamide, methotrexate, and prednisone (CMP) administered over 54 weeks. The overall response rate was 92% with 16 of 39 patients (41%) achieving a histologically documented complete response (CR). Stage I patients had a significantly increased CR rate (77%) compared with stage II-IV (P < .01). The overall 6-year survival was 92% for stage I patients and 26% for stage II-IV patients (23%) (P < .001). Among ten completely responding stage I patients, six remain alive and disease-free in excess of 72 months. The median disease-free survival is 26 months for completely responding stage II-IV patients (P = .04), but none are continuous disease-free survivors after protocol treatment. We conclude that combined modality treatment can be safely administered and produces prolonged disease-free survival in some stage I patients, but not in more advanced stage patients.

Original languageEnglish (US)
Pages (from-to)1094-1100
Number of pages7
JournalJournal of Clinical Oncology
Volume4
Issue number7
StatePublished - 1986

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Cutaneous T-Cell Lymphoma
Therapeutics
Skin
Electrons
Disease-Free Survival
Sezary Syndrome
Drug Therapy
Mechlorethamine
Mycosis Fungoides
Vinblastine
Bleomycin
Clinical Protocols
Prednisone
Methotrexate
Doxorubicin
Cyclophosphamide
Survivors
Adrenal Cortex Hormones

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Winkler, C. F., Sausville, E. A., Ihde, D. C., Fischmann, A. B., Schechter, G. P., Kumar, P. P., ... Eddy, J. L. (1986). Combined modality treatment of cutaneous T cell lymphoma: Results of a 6-year follow-up. Journal of Clinical Oncology, 4(7), 1094-1100.

Combined modality treatment of cutaneous T cell lymphoma : Results of a 6-year follow-up. / Winkler, C. F.; Sausville, E. A.; Ihde, D. C.; Fischmann, A. B.; Schechter, G. P.; Kumar, P. P.; Nibhanupdi, J. R.; Minna, J. D.; Makuch, R. W.; Eddy, J. L.

In: Journal of Clinical Oncology, Vol. 4, No. 7, 1986, p. 1094-1100.

Research output: Contribution to journalArticle

Winkler, CF, Sausville, EA, Ihde, DC, Fischmann, AB, Schechter, GP, Kumar, PP, Nibhanupdi, JR, Minna, JD, Makuch, RW & Eddy, JL 1986, 'Combined modality treatment of cutaneous T cell lymphoma: Results of a 6-year follow-up', Journal of Clinical Oncology, vol. 4, no. 7, pp. 1094-1100.
Winkler CF, Sausville EA, Ihde DC, Fischmann AB, Schechter GP, Kumar PP et al. Combined modality treatment of cutaneous T cell lymphoma: Results of a 6-year follow-up. Journal of Clinical Oncology. 1986;4(7):1094-1100.
Winkler, C. F. ; Sausville, E. A. ; Ihde, D. C. ; Fischmann, A. B. ; Schechter, G. P. ; Kumar, P. P. ; Nibhanupdi, J. R. ; Minna, J. D. ; Makuch, R. W. ; Eddy, J. L. / Combined modality treatment of cutaneous T cell lymphoma : Results of a 6-year follow-up. In: Journal of Clinical Oncology. 1986 ; Vol. 4, No. 7. pp. 1094-1100.
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abstract = "Thirty-nine patients with cutaneous T cell lymphoma (CTCL; including mycosis fungoides or the Sezary syndrome) with no previous treatment other than topical therapy or oral corticosteroids, received total skin electron beam irradiation (TSEB) and either sequential or simultaneous systemic chemotherapy. Median follow-up, measured from the time of initiation of therapy to the time of analysis, is in excess of 6 years and extends to 100+ months. Thirteen patients with stage I disease (limited to skin with no adenopathy) received 3,000 rad total skin electron beam irradiation followed by three 2-week courses of daily intravenous (IV) mechlorethamine. Twenty-six patients with advanced disease (stage II-IV) received 2,400 rad of TSEB and simultaneous chemotherapy with two alternating three-drug regimens: vinblastine, doxorubicin, and bleomycin (VAB) alternating with cyclophosphamide, methotrexate, and prednisone (CMP) administered over 54 weeks. The overall response rate was 92{\%} with 16 of 39 patients (41{\%}) achieving a histologically documented complete response (CR). Stage I patients had a significantly increased CR rate (77{\%}) compared with stage II-IV (P < .01). The overall 6-year survival was 92{\%} for stage I patients and 26{\%} for stage II-IV patients (23{\%}) (P < .001). Among ten completely responding stage I patients, six remain alive and disease-free in excess of 72 months. The median disease-free survival is 26 months for completely responding stage II-IV patients (P = .04), but none are continuous disease-free survivors after protocol treatment. We conclude that combined modality treatment can be safely administered and produces prolonged disease-free survival in some stage I patients, but not in more advanced stage patients.",
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AU - Ihde, D. C.

AU - Fischmann, A. B.

AU - Schechter, G. P.

AU - Kumar, P. P.

AU - Nibhanupdi, J. R.

AU - Minna, J. D.

AU - Makuch, R. W.

AU - Eddy, J. L.

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AB - Thirty-nine patients with cutaneous T cell lymphoma (CTCL; including mycosis fungoides or the Sezary syndrome) with no previous treatment other than topical therapy or oral corticosteroids, received total skin electron beam irradiation (TSEB) and either sequential or simultaneous systemic chemotherapy. Median follow-up, measured from the time of initiation of therapy to the time of analysis, is in excess of 6 years and extends to 100+ months. Thirteen patients with stage I disease (limited to skin with no adenopathy) received 3,000 rad total skin electron beam irradiation followed by three 2-week courses of daily intravenous (IV) mechlorethamine. Twenty-six patients with advanced disease (stage II-IV) received 2,400 rad of TSEB and simultaneous chemotherapy with two alternating three-drug regimens: vinblastine, doxorubicin, and bleomycin (VAB) alternating with cyclophosphamide, methotrexate, and prednisone (CMP) administered over 54 weeks. The overall response rate was 92% with 16 of 39 patients (41%) achieving a histologically documented complete response (CR). Stage I patients had a significantly increased CR rate (77%) compared with stage II-IV (P < .01). The overall 6-year survival was 92% for stage I patients and 26% for stage II-IV patients (23%) (P < .001). Among ten completely responding stage I patients, six remain alive and disease-free in excess of 72 months. The median disease-free survival is 26 months for completely responding stage II-IV patients (P = .04), but none are continuous disease-free survivors after protocol treatment. We conclude that combined modality treatment can be safely administered and produces prolonged disease-free survival in some stage I patients, but not in more advanced stage patients.

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