Treatment of mycosis fungoides: total-skin electron-beam irradiation vs topical mechlorethamine therapy

Abstract

Of 42 patients who had mycosis fungoides (MF) confined to the skin with or without dermatopathic lymphadenopathy, 21 were treated with topically applied mechlorethamine hydrochloride and 21 with total-skin electron-beam irradiation. The results of both therapeutic modalities are compared. We conclude that, in the early stage of the disease, both forms of treatment are equally effective. In the later stages of MF, in the absence of lymph node or other systemic involvement, electron-beam irradiation seems to be superior in inducing an initial complete remission. However, because of the large number of patients who have a relapse after this therapy, it should be followed by topical mechlorethamine therapy.

Interventions for mycosis fungoides: critical commentary on a Cochrane Systematic Review

“…16 The safety and efficacy of NM, another common topical medication for MF, had also been reported only in large uncontrolled case series until the publication in the last year of a single blinded, randomized trial comparing NM gel with NM ointment. 14,[17][18][19][20][21][22][23][24][25][26] The results from this trial confirmed previous estimates of a 63-83% overall (complete clinical skin clearance and > 50% improvement) response rates to topical NM.…”

Evaluation of a 1-h exposure time to mechlorethamine in patients undergoing topical treatment

“…, 6 involving continuous application of mechlorethamine, our open study using short‐term (1 h) application of mechlorethamine found no significant reduction of cutaneous intolerance (ICD or ACD). However, the occurrence of cutaneous intolerance was more delayed in our study, showing a rate of 10·5% during the first month compared with 56% in the study of Estève et al ., 6 Concerning late side‐effects, the rate was lower in our study for hyperpigmentation, telangiectasia and xerosis than in that of Hamminga et al 12 . Our therapeutic response rate was lower than that of Ramsay et al 11,13 .…”

“…Bullous skin reactions and Stevens–Johnson syndrome have also been reported 10 . Contact urticaria induced by mechlorethamine is infrequent (between 4·8 and 10%, 11,12 ) and did not occur in our study. It is due to an immediate hypersensitivity reaction mediated by IgE and more rarely by IgG and IgM.…”

Topical treatments for early-stage mycosis fungoides using Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria: A systematic review

“…Ten open-label case series and 1 randomized, controlled, observer-blinded study (RCT) of nitrogen mustard were included (n = 1035, Table II ). 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 A CR was observed in 12%-82% of early-stage MF patients with a durable response for 4-33 months. Seven studies (n = 633) included results on PR with 13%-45% of participants demonstrating PR.…”

“…If a study included participants with more advanced disease, we included only the results from patients with early-stage MF. 19 , 20 , 21 , 22 , 23 , 25 , 26 , 29 , 35 , 37 , 40 …”