A retrospective comparative outcome analysis following systemic therapy in Mycosis Fungoides and Sezary Syndrome

Background: Cutaneous T-cell lymphomas (CTCL), with few exceptions, remain incurable and treatment is largely palliative. We performed a retrospective analysis of systemic treatment outcomes of patients diagnosed with MF/SS at the University of Michigan. Methods: We identified 223 patients with MF/SS evaluated at the University of Michigan from 1997-2013. Disease stage at diagnosis, time of treatment, treatments received and reasons for treatment cessation were retrospectively analyzed using our CTCL database. The primary endpoint was time to next treatment (TTNT). Treatment outcomes were analyzed using Kaplan-Meier method and comparisons among groups were made using log-rank analysis. Results: A superior time to next treatment (TTNT) was associated with retinoid (47.2 months) or interferon (21.7 months) therapies when compared with HDAC inhibitors (6.4 months) or systemic chemotherapy (5.1 months). Retinoids and interferon were associated with superior TTNT in both limited-stage (62.7 and 32.6 months, respectively) and advanced stage (22.1 months and 14.9 months, respectively) disease. ECP had a superior TTNT in Sezary Syndrome (17.5 months). HDAC inhibitors and chemotherapy were associated with inferior TTNT in both limited stage disease (3.3 months and 4.1 months, respectively) and advanced stage disease (8.2 months and 5.4 months, respectively). Conclusions: With the exception of interferon, retinoids, or ECP, durable responses are rarely achieved with systemic therapies in MF/SS patients, particularly those with advanced-stage disease. Therefore, clinical trial participation with novel agents should be encouraged. This article is protected by copyright. All rights reserved.