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口服贝沙罗汀联合光疗治疗早期蕈样肉芽肿:系统评价和荟萃分析。

Treatment of early-stage mycosis fungoides with oral bexarotene and phototherapy: A systematic review and meta-analysis.

机构信息

Florida State College of Medicine, Tallahassee, Florida, USA.

Department of Dermatology and Cutaneous Surgery, University of South Florida (USF), Tampa, Florida, USA.

出版信息

Dermatol Ther. 2022 May;35(5):e15418. doi: 10.1111/dth.15418. Epub 2022 Mar 16.

Abstract

Mycosis fungoides (MF) is a rare subtype of non-Hodgkin lymphoma, for which no standard treatment exists. The objective of this study is to provide evidence-based recommendations for adult patients with early-stage MF treated with oral bexarotene and phototherapy. A systematic review and meta-analysis was conducted utilizing studies identified via Embase, Pubmed, Web of Science, and the Cochrane Library from inception to April 2020 to evaluate the clinical efficacy and adverse events of oral bexarotene and phototherapy. Of 645 abstracts retrieved, 17 full-text articles with 143 subjects were included for analysis. There were nine case reports, five retrospective cohort studies, two prospective cohort studies, and one randomized controlled trial. Most subjects were men (24.48%) with stage IB disease (54.4%), and the mean age at presentation was 63. One patient had folliculotropic disease. The retrospective studies' analysis included 67 subjects and indicated that the partial response was 40.36% (95% CI 18.24-64.92), complete response was 34.06% (95% CI 10.73-62.56), and overall response was 64.48% (95% CI 48.56-78.89). Side effects from bexarotene were hypertriglyceridemia (54%), hypothyroidism (50%), and hypercholesterolemia (46%). Similar results were noted in the prospective studies. The literature consists mostly of uncontrolled studies, which suggest that combination therapy with oral bexarotene and phototherapy is a therapeutic option. Future randomized control studies with longer follow-up and standardized definitions of treatment responses and dosages are needed to support the development of evidence-based approaches for the treatment of early-stage MF.

摘要

蕈样肉芽肿(MF)是一种罕见的非霍奇金淋巴瘤亚型,目前尚无标准治疗方法。本研究旨在为接受口服贝沙罗汀和光疗的早期 MF 成年患者提供循证推荐。通过 Embase、Pubmed、Web of Science 和 Cochrane Library 从成立到 2020 年 4 月进行系统评价和荟萃分析,评估口服贝沙罗汀和光疗的临床疗效和不良反应。在 645 篇摘要中,纳入了 17 篇全文文章和 143 例患者进行分析。其中有 9 篇病例报告、5 篇回顾性队列研究、2 篇前瞻性队列研究和 1 篇随机对照试验。大多数患者为男性(24.48%),疾病分期为 IB 期(54.4%),发病时的平均年龄为 63 岁。1 例患者患有滤泡性疾病。回顾性研究分析包括 67 例患者,表明部分缓解率为 40.36%(95%CI 18.24-64.92),完全缓解率为 34.06%(95%CI 10.73-62.56),总缓解率为 64.48%(95%CI 48.56-78.89)。贝沙罗汀的副作用有高甘油三酯血症(54%)、甲状腺功能减退(50%)和高胆固醇血症(46%)。前瞻性研究也有类似结果。文献主要由非对照研究组成,这表明口服贝沙罗汀和光疗联合治疗是一种治疗选择。需要进行未来的随机对照研究,随访时间更长,对治疗反应和剂量进行标准化定义,以支持制定治疗早期 MF 的循证方法。

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