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3 treatment settings, 3 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Extracorporeal photopheresis with or without interferon or bexarotene (EORTC 2023).
Uvadex is the drug used in photopheresis, where a patient's white cells are drawn off, treated with methoxsalen and ultraviolet light, and returned; it is approved for the skin symptoms of cutaneous T-cell lymphoma and widely used for graft-versus-host disease.
Bexarotene (Targretin) is a vitamin A-like capsule and gel for the skin disease of cutaneous T-cell lymphoma when other treatments have stopped working.
Interferon alfa was the first biologic cancer drug (1986). It treated hairy cell leukaemia, CML, melanoma, kidney cancer and Kaposi sarcoma, and has been replaced almost everywhere by better-tolerated agents.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
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Mogamulizumab (MAVORIC), methotrexate, pralatrexate, brentuximab vedotin for CD30-positive disease, romidepsin or vorinostat; allogeneic transplant for fit responders.
Mogamulizumab is an antibody that clears cancerous T cells from the blood in mycosis fungoides and Sézary syndrome, the leukaemic form of skin lymphoma.
The 1948 antifolate that produced the first chemotherapy remissions in childhood leukaemia and the first cure of a solid tumour; still essential in ALL, lymphoma, osteosarcoma and CNS lymphoma.
Pralatrexate was the first drug approved specifically for relapsed peripheral T-cell lymphoma; about a third of patients respond.
The ADC that made the modern field credible (2011), for Hodgkin lymphoma and CD30+ lymphomas.
Romidepsin is an epigenetic drug for T-cell lymphomas of the skin and lymph nodes; its US lymph-node indication was withdrawn when a confirmatory trial failed.
Vorinostat (Zolinza) was the first drug of its kind, a capsule that loosens the chemical packaging of DNA. It treats the skin disease of cutaneous T-cell lymphoma after two other treatments have failed.
Mogamulizumab improved progression-free survival over vorinostat in previously treated mycosis fungoides and Sezary syndrome; approved in August 2018.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · ECHELON-1, A+AVD arm | 91% | 82% |
| Febrile neutropenia · ECHELON-1, A+AVD arm | 19% | 19% |
| Peripheral sensory neuropathy · ECHELON-1, A+AVD arm | 65% | 10% |
| Vomiting · ECHELON-1, A+AVD arm | 33% | 3% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
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Sezary syndrome is the leukaemic form: erythroderma covering most of the body, lymphadenopathy, intractable itch and a clone of malignant T cells in the blood. It is treated as advanced disease from the start, and treatment has to reduce the blood compartment, not only the skin. Extracorporeal photopheresis is the treatment most specific to it: the patient's white cells are drawn off, exposed to methoxsalen and ultraviolet A light, and returned, usually on two consecutive days every two to four weeks. It is well tolerated, works slowly over months, and is often combined with interferon alfa or bexarotene. It has been approved for the skin manifestations of cutaneous T-cell lymphoma in the United States since 1999. Mogamulizumab is the systemic drug of choice where the blood is heavily involved, because in MAVORIC the response rate in the blood compartment was 68 per cent, far above its skin response; median progression-free survival was 7.7 against 3.1 months for vorinostat. Other options are bexarotene, interferon, low-dose methotrexate, romidepsin, alemtuzumab at low subcutaneous dose, chlorambucil with prednisolone for an older patient, and allogeneic transplant with reduced-intensity conditioning for fit younger patients, which is the only treatment that produces durable remission. Skin care, control of itch and prevention of staphylococcal sepsis matter at least as much as the lymphoma treatment; erythrodermic skin loses heat, fluid and protein and is an open door to infection.
Uvadex is the drug used in photopheresis, where a patient's white cells are drawn off, treated with methoxsalen and ultraviolet light, and returned; it is approved for the skin symptoms of cutaneous T-cell lymphoma and widely used for graft-versus-host disease.
Mogamulizumab is an antibody that clears cancerous T cells from the blood in mycosis fungoides and Sézary syndrome, the leukaemic form of skin lymphoma.
Bexarotene (Targretin) is a vitamin A-like capsule and gel for the skin disease of cutaneous T-cell lymphoma when other treatments have stopped working.
Interferon alfa was the first biologic cancer drug (1986). It treated hairy cell leukaemia, CML, melanoma, kidney cancer and Kaposi sarcoma, and has been replaced almost everywhere by better-tolerated agents.
The 1948 antifolate that produced the first chemotherapy remissions in childhood leukaemia and the first cure of a solid tumour; still essential in ALL, lymphoma, osteosarcoma and CNS lymphoma.
Romidepsin is an epigenetic drug for T-cell lymphomas of the skin and lymph nodes; its US lymph-node indication was withdrawn when a confirmatory trial failed.
Alemtuzumab (Campath) is an antibody that wipes out lymphocytes carrying the CD52 marker. It is approved for chronic lymphocytic leukaemia and is supplied in the US through a restricted distribution programme.
Chlorambucil (Leukeran) is a gentle oral chemotherapy tablet used for decades in chronic lymphocytic leukaemia and low-grade lymphomas, mainly in older patients.
Prednisone is the everyday steroid tablet in cancer care. It is the P in CHOP and MOPP for lymphoma, part of childhood leukaemia treatment, and taken with abiraterone in prostate cancer.
Allogeneic stem cell transplantation replaces a patient's blood system with a donor's after conditioning chemotherapy, so donor immune cells hunt down leukaemia left behind. It remains the only cure for adverse-risk acute myeloid leukaemia, high-risk acute lymphoblastic leukaemia and Richter transformation, at the price of graft-versus-host disease.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.