Jiang S B, Dietz S B, Kim M, Lim H W
The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, USA.
Photodermatol Photoimmunol Photomed. 1999 Oct;15(5):161-5. doi: 10.1111/j.1600-0781.1999.tb00077.x.
Cutaneous T-cell lymphoma (CTCL) is an indolent lymphoma usually of CD4+ T lymphocytes in which the aggressive treatment for the advanced stages does not increase survival. Photopheresis has been established as an alternative modality for the therapy of erythrodermic CTCL and reportedly improves survival in patients with advanced stages of the disease. The objective of this study is to review the experience of treating patients with erythrodermic CTCL with extracorporeal photochemotherapy (ECP) at the New York Veteran Affairs Medical Center/NYU Medical Center between September 1987 and April 1997. Forty-one patients with erythrodermic CTCL (stages III and IV) received photopheresis; 25 of them fulfilled the inclusion criterion, i.e., the completion of greater than or equal to 6 cycles of photopheresis. Skin score was defined as a product of severity and percentage of involved surface area. Complete clinical response was defined as disappearance of measurable disease for at least one month, and partial response was defined as greater than or equal to 50% clearance of measurable disease for at least one month. The profile of the patients was: 20 men, 5 women; average age: 64.2 years; 17 patients had stage III disease, and 8 had stage IV disease. Five of the 25 patients (20%) achieved complete clinical response, another 15 (60%) had partial response, and 5 (20%) had no response. The mean time (+/- SD) to achieve complete clinical clearance was 12.6 +/- 10 months (range: 4-30 months) and the mean time (+/- SD) to obtain partial clinical response, including complete response, was 9.7 +/- 5.3 months (range: 4-17 months). Remission duration ranged from 9 to 67 months. The median survival time from the time of initiation of photopheresis is estimated at 70 months. The complete responder group had a lower median CD4/CD8 ratio compared to the non-responders at baseline (3.8 vs 7.2, respectively), although the difference was not statistically significant (P = 0.40). At the time of maximal response, the CD4/CD8 ratio of the complete responder group decreased towards normal values (median = 1.2), whereas this ratio increased among the non-responders (median = 11.0; P = 0.04). Side effects were minimal. Extracorporeal photochemotherapy is an effective and safe treatment for erythrodermic CTCL. In some of these patients, it can induce a long-term and complete clinical remission.
皮肤T细胞淋巴瘤（CTCL）是一种通常累及CD4+ T淋巴细胞的惰性淋巴瘤，晚期阶段的积极治疗并不能提高生存率。光分离置换疗法已被确立为红皮病型CTCL的一种替代治疗方式，据报道可提高该疾病晚期患者的生存率。本研究的目的是回顾1987年9月至1997年4月期间在纽约退伍军人事务医疗中心/纽约大学医学中心采用体外光化学疗法（ECP）治疗红皮病型CTCL患者的经验。41例红皮病型CTCL（III期和IV期）患者接受了光分离置换疗法；其中25例符合纳入标准，即完成了大于或等于6个周期的光分离置换疗法。皮肤评分定义为严重程度与受累表面积百分比的乘积。完全临床缓解定义为可测量疾病消失至少1个月，部分缓解定义为可测量疾病清除率大于或等于50%至少1个月。患者概况如下：男性20例，女性5例；平均年龄：64.2岁；17例患者为III期疾病，8例为IV期疾病。25例患者中有5例（20%）实现了完全临床缓解，另外15例（60%）有部分缓解，5例（20%）无反应。实现完全临床清除的平均时间（±标准差）为12.6±10个月（范围：4 - 30个月），获得部分临床缓解（包括完全缓解）的平均时间（±标准差）为9.7±5.3个月（范围：4 - 17个月）。缓解持续时间为9至67个月。从开始光分离置换疗法时起估计的中位生存时间为70个月。完全缓解组在基线时的中位CD4/CD8比值低于无反应组（分别为3.8和7.2），尽管差异无统计学意义（P = 0.40）。在最大反应时，完全缓解组的CD4/CD8比值降至正常值（中位值 = 1.2），而无反应组的该比值升高（中位值 = 11.0；P = 0.04）。副作用极小。体外光化学疗法是治疗红皮病型CTCL的一种有效且安全的方法。在一些此类患者中，它可诱导长期且完全的临床缓解。
