Roenigk H H, Kuzel T M, Skoutelis A P, Springer E, Yu G, Caro W, Gilyon K, Variakojis D, Kaul K, Bunn P A
Department of Dermatology, Northwestern University, Chicago, Illinois 60611.
J Invest Dermatol. 1990 Dec;95(6 Suppl):198S-205S. doi: 10.1111/1523-1747.ep12875523.
Eighty-two patients with either mycosis fungoides (MF) or parapsoriasis en plaques were treated with psoralens ultraviolet A light (PUVA). Clinical and histologic parameters were followed for a period from 6 months to 10 years. Complete clinical clearing of lesions was observed in 51 patients (62%) and most of them were in limited-plaque MF group or parapsoriasis en plaque. The mean total dose of PUVA for complete clearing was less for early MF. Thirty-one patients (38%) relapsed and responded to additional PUVA. Patients in early stages of the disease remained clear for up to 68 months after the first course of PUVA. Post-treatment skin biopsies with early MF showed histologic clearing. A new combination therapy for MF is presented in 15 patients. Recombinant interferon alpha-2a (Roferon-A), administered intramuscularly combined with PUVA were tested in a phase I trial. Interferon doses were from 6-30 million units three times weekly. Disease stages ranged from I-B to IV-B. Complete responses were obtained in 12 of 15 patients, and partial responses seen in 2 of 15 patients, for an overall response rate of 93%. The median duration of response exceeded 23 months (range, 3 to 25 months). All responding patients have been maintained on therapy. The dose-limiting toxicities were constitutional symptoms such as fevers and malaise (93.3%), leukopenias (40.0%), mental status changes consisting of depression and confusion (33.3%), and photosensitivity (26.6%). Interferon plus PUVA appear to be highly effective regimens for the treatment of patients with cutaneous T-cell lymphomas.
82例蕈样肉芽肿（MF）或斑块状副银屑病患者接受了补骨脂素紫外线A光（PUVA）治疗。对临床和组织学参数进行了6个月至10年的随访。51例患者（62%）病变完全临床清除，其中大多数为局限性斑块状MF组或斑块状副银屑病患者。早期MF完全清除所需的PUVA平均总剂量较少。31例患者（38%）复发，再次接受PUVA治疗有效。疾病早期的患者在第一个疗程的PUVA治疗后长达68个月保持病情缓解。早期MF患者治疗后的皮肤活检显示组织学清除。15例MF患者采用了一种新的联合治疗方法。在I期试验中测试了重组干扰素α-2a（罗扰素-A）肌肉注射联合PUVA的治疗方案。干扰素剂量为每周3次，每次600万至3000万单位。疾病分期从I-B到IV-B。15例患者中有12例获得完全缓解，15例中有2例获得部分缓解，总缓解率为93%。缓解的中位持续时间超过23个月（范围为3至25个月）。所有有反应的患者均持续接受治疗。剂量限制性毒性为全身症状，如发热和不适（93.3%）、白细胞减少（40.0%）、由抑郁和意识模糊组成的精神状态改变（33.3%）以及光敏反应（26.6%）。干扰素联合PUVA似乎是治疗皮肤T细胞淋巴瘤患者的高效方案。
