Fraser-Andrews E, Seed P, Whittaker S, Russell-Jones R
St John's Institute of Dermatology (United Medical School of Guy's Hospital), London, England.
Arch Dermatol. 1998 Aug;134(8):1001-5. doi: 10.1001/archderm.134.8.1001.
Several retrospective studies have claimed that extracorporeal photopheresis (ECP) prolongs survival in patients with erythrodermic cutaneous T-cell lymphoma. In a retrospective study of 44 patients with Sézary syndrome, we compared survival in patients treated with ECP with that of patients treated conventionally at the same institute. All patients had genotypic evidence of a peripheral blood T-cell clone.
Twenty-nine patients received ECP (group 1); 15 patients did not receive ECP, 8 patients when ECP was available (group 2) and 7 before ECP was available (group 3). Forty-three of 44 patients received other conventional treatments. Median survival from diagnosis of Sézary syndrome was 39 months in group 1, 22 months in group 2, and 27.5 months in group 3 (Kaplan-Meier analysis). Cox regression analysis showed no significant difference between the 3 groups after correcting for age, sex, and initial Sézary cell count (hazard ratio, 0.56; 95% confidence interval, 0.26-1.17; P = .12).
This study does not support the contention that ECP prolongs survival in patients with Sézary syndrome. The median survival in the ECP-treated group is considerably less than that reported in other published series, possibly because genotypic evidence of clonality in the peripheral blood was required for inclusion in this study. We believe that a randomized trial comparing ECP with standard chemotherapy is urgently needed.
多项回顾性研究称，体外光化学疗法（ECP）可延长红皮病型皮肤T细胞淋巴瘤患者的生存期。在一项对44例 Sézary 综合征患者的回顾性研究中，我们比较了接受ECP治疗的患者与在同一机构接受传统治疗的患者的生存期。所有患者均有外周血T细胞克隆的基因分型证据。
29例患者接受了ECP治疗（第1组）；15例患者未接受ECP治疗，其中8例在有ECP可用时未接受治疗（第2组），7例在ECP可用之前未接受治疗（第3组）。44例患者中有43例接受了其他传统治疗。经Kaplan-Meier分析，Sézary综合征诊断后的中位生存期在第1组为39个月，第2组为22个月，第3组为27.5个月。校正年龄、性别和初始Sézary细胞计数后，Cox回归分析显示3组之间无显著差异（风险比，0.56；95%置信区间，0.26 - 1.17；P = 0.12）。
本研究不支持ECP可延长Sézary综合征患者生存期这一观点。接受ECP治疗组的中位生存期远低于其他已发表系列报道的生存期，可能是因为本研究纳入的患者要求有外周血克隆性的基因分型证据。我们认为迫切需要进行一项比较ECP与标准化疗的随机试验。
