Summary of treatment options for MF/SS
| Therapy . | MF . | Sézary syndrome/erythrodermic MF . | Comments . | |
|---|---|---|---|---|
| Early-stage disease . | Advanced-stage disease . | |||
| Topical corticosteroids | ++++ | ++ | +++ | Symptomatic control |
| PUVA | ++++ | + | +++ | Availability may be restricted in nonmetropolitan areas |
| UVB | +++ | + | ++ | More readily accessible than PUVA |
| Topical chemotherapy | + | If limited number of lesions | ||
| Imiquimod | + | If small lesions and limited number of lesions | ||
| Photodynamic therapy | + | If limited number of lesions; limited availability | ||
| Retinoids | + | + | + | Usually second line; less used since bexarotene became available |
| Bexarotene | ++ | +++ | +++ | Usually second line; can be used in combination with PUVA or IFN-α |
| Interferon-α | ++ | +++ | ++++ | Second line |
| HDACi | + | +++ | ++++ | Beyond second line |
| Oral MTX | + | +++ | ++ | Low dose weekly |
| Localized radiotherapy | + | +++ | If localized or large/plaques and tumor nodules | |
| TSEB | + | ++ | + | For widespread disease |
| Systemic chemotherapy | ++ | ++ | Beyond second line | |
| ECP | ++++ | If circulating clone detectable | ||
| Autologous transplantation | + | + | Very selected cases | |
| Allogeneic transplantation | + | + | Very selected cases | |
| Denileukin diftitox | ++ | ++ | Beyond second line | |
| Alemtuzamab | + | + | Beyond second line; immunosuppressive | |
| Proteasome inhibitors | + | Under investigation | ||
| Immunomodulatory agents (lenalidomide) | + | Under investigation | ||
| Therapy . | MF . | Sézary syndrome/erythrodermic MF . | Comments . | |
|---|---|---|---|---|
| Early-stage disease . | Advanced-stage disease . | |||
| Topical corticosteroids | ++++ | ++ | +++ | Symptomatic control |
| PUVA | ++++ | + | +++ | Availability may be restricted in nonmetropolitan areas |
| UVB | +++ | + | ++ | More readily accessible than PUVA |
| Topical chemotherapy | + | If limited number of lesions | ||
| Imiquimod | + | If small lesions and limited number of lesions | ||
| Photodynamic therapy | + | If limited number of lesions; limited availability | ||
| Retinoids | + | + | + | Usually second line; less used since bexarotene became available |
| Bexarotene | ++ | +++ | +++ | Usually second line; can be used in combination with PUVA or IFN-α |
| Interferon-α | ++ | +++ | ++++ | Second line |
| HDACi | + | +++ | ++++ | Beyond second line |
| Oral MTX | + | +++ | ++ | Low dose weekly |
| Localized radiotherapy | + | +++ | If localized or large/plaques and tumor nodules | |
| TSEB | + | ++ | + | For widespread disease |
| Systemic chemotherapy | ++ | ++ | Beyond second line | |
| ECP | ++++ | If circulating clone detectable | ||
| Autologous transplantation | + | + | Very selected cases | |
| Allogeneic transplantation | + | + | Very selected cases | |
| Denileukin diftitox | ++ | ++ | Beyond second line | |
| Alemtuzamab | + | + | Beyond second line; immunosuppressive | |
| Proteasome inhibitors | + | Under investigation | ||
| Immunomodulatory agents (lenalidomide) | + | Under investigation | ||
MF indicates mycosis fungoides; SS, Sézary syndrome; PUVA, psoralan ultraviolet A; UVB, ultraviolet B; ECP, extracorporeal photopheresis; HDACi, histone deacetylase inhibitors; and TSEB, total skin electron beam.
Crosses indicate frequency of use: ++++, almost always; +++, very frequently; ++, moderately frequently; and +, occasionally.