From the Guidelines
I strongly recommend a stage-adapted conservative therapeutic approach for mycosis fungoides, prioritizing skin-directed therapies such as topical steroids, PUVA, or narrowband UVB phototherapy for early-stage disease. This approach is supported by the most recent and highest quality study, which emphasizes the importance of adapting treatment to the stage of the disease 1.
Treatment Options
- For early-stage mycosis fungoides (stage IA–IIA), skin-directed therapies including topical steroids, PUVA, narrowband UVB, or mechlorethamine are recommended 1.
- Narrowband UVB can be used in patients with patches or very thin plaques, while PUVA therapy is preferred for patients with thicker plaques 1.
- In patients developing one or few infiltrated plaques or tumors (stage IIB), additional low-dose local radiation therapy may suffice 1.
Advanced Disease
- For patients with more extensive infiltrated plaques and tumors or patients refractory to skin-directed therapies, a combination of PUVA and interferon alfa or PUVA and retinoids, or total skin electron beam therapy (TSEBT) can be considered 1.
- TSEBT has been given to total doses of 30–36 Gy, but recently lower doses (10–12 Gy) have been employed with the advantages of shorter duration of the treatment period, fewer side effects, and opportunity for re-treatment 1.
Systemic Treatments
- For more advanced disease, systemic treatments may include retinoids (bexarotene 300 mg/m² daily), interferon alfa (3-9 million units 3 times weekly), or targeted therapies like mogamulizumab or brentuximab vedotin.
- Regular follow-up appointments are essential to monitor disease progression and treatment response, as mycosis fungoides is chronic but often manageable with proper medical care.
From the FDA Drug Label
Mycosis fungoides (cutaneous T cell lymphoma) - Therapy with methotrexate as a single agent appears to produce clinical responses in up to 50% of patients treated. Dosage in early stages is usually 5 to 50 mg once weekly. Dose reduction or cessation is guided by patient response and hematologic monitoring. Methotrexate has also been administered twice weekly in doses ranging from 15 to 37. 5 mg in patients who have responded poorly to weekly therapy.
Methotrexate may be used to treat mycosis fungoides, with a response rate of up to 50% of patients. The typical dosage is 5-50 mg once weekly, with adjustments based on patient response and hematologic monitoring 2.
- Key points:
- Methotrexate can produce clinical responses in mycosis fungoides patients.
- The dosage is usually 5-50 mg once weekly.
- Dose adjustments are guided by patient response and hematologic monitoring.
From the Research
Treatment Options for Mycosis Fungoides
- Mycosis fungoides is a type of cutaneous T-cell lymphoma that can be treated with various therapies, including topical steroids, phototherapy, photochemotherapy, and systemic therapies 3, 4, 5, 6.
- Phototherapy, such as narrowband UVB and psoralen-UVA, is a common treatment option for early-stage mycosis fungoides, with narrowband UVB being more effective and having fewer side effects than psoralen-UVA 3, 5.
- Systemic therapies, such as interferon, retinoids, and cytotoxic chemotherapy, may be used for more advanced stages of the disease or for patients who do not respond to topical therapies 4, 7, 6.
Response to Treatment
- The response to treatment for mycosis fungoides can vary, with some patients achieving complete remission and others experiencing partial remission or progressive disease 3, 7.
- The mean relapse-free interval for patients treated with narrowband UVB was 24.5 months, compared to 22.8 months for patients treated with psoralen-UVA 3.
- The use of combination therapies, such as phototherapy and systemic treatments, may be beneficial for patients with refractory or advanced disease 5, 6.
Adverse Effects of Treatment
- The adverse effects of treatment for mycosis fungoides can range from mild symptoms to lethal complications, depending on the type of treatment used 7.
- Common adverse effects of phototherapy include erythema, irritation, and nausea, while systemic therapies can cause more severe side effects, such as flu-like symptoms and organ toxicity 7, 5.
- The use of maintenance therapy, such as PUVA, may help to reduce the risk of relapse and improve treatment outcomes 7.