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3 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | First-line systemic | Extracorporeal photopheresis with or without interferon or bexarotene (EORTC 2023). | 74 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Later lines | Mogamulizumab (MAVORIC), methotrexate, pralatrexate, brentuximab vedotin for CD30-positive disease, romidepsin or vorinostat; allogeneic transplant for fit responders. | 83 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Sezary syndrome: treatment aimed at the blood as well as the skin | 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. | Methoxsalen (extracorporeal photopheresis)MogamulizumabBexaroteneInterferon alfa-2a/2bMethotrexateRomidepsinAlemtuzumabChlorambucilPrednisoneAllogeneic stem cell transplantationMAVORIC: mogamulizumab versus vorinostat in previously treated cutaneous T-cell lymphomaSkin-directed therapy in mycosis fungoides: creams, light and small radiotherapy fieldsInfection prophylaxis in lymphoma: PJP, herpes, fungal risk and vaccination | NCCN Primary Cutaneous Lymphomas; ESMO; MAVORIC | 92 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.