BMT in Mycosis Fungoides/Cutaneous T-cell Lymphoma

John Han-Chih Chang, MD and Kenneth Blank, MD
Last Modified: November 1, 2001

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Question
Dear OncoLink "Ask the Experts,"
My brother, was diagnosed last August as having mycosis fungoides/cutaneous T-cell lymphoma (MF/CTCL) stage IV. Under the supervision of his doctor at, he received methotrexate, CHOP, 2-DCA without getting any temporary responses except from CHOP. The doctor who is treating him now has been suggesting bone marrow transplant (BMT). However, they say there is no published data about BMT in MF patients. Do you have any useful information on this matter?  
Thank you in advance for your help!
S. Y.


Answer
John Han-Chih Chang, MD and Kenneth Blank, MD, Editorial Assistants for Oncolink, respond:

Thank you for your interest and question.

Mycosis fungoides/cutaneous T-cell lymphoma (MF/CTCL) is a clonal neoplasm of mature CD4+ helper/inducer T cells. This diaease has 4 phases:

  1. Premycotic phase: asymptomatic scaling red raised lesions in the sun shielded regions of the body ("bathing trunk distribution")
  2. Patch phase: thin lesions which are red and eczema-like
  3. Plaque phase: very palpable red lesions
  4. Tumor phase: cancer extends below the upper dermis, which is the "second layer" of the skin
Mycosis fungoides/cutaneous T-cell lymphoma also has 4 stages based on extent of skin lesions, lymph node involvement and spread of disease to other organs, with stage IV being positive peripheral lymph nodes or involvement of distant organs.

Treatment of this disease has been difficult. You are correct in that there is no data published to support Bone Marrow Transplant (BMT) as a treatment for this disease. I would be wary of this treatment modality, but this may be the only option at this time. BMT is a very tough regimen to endure. Ask your oncologists whether they have considered cutaneous photochemotherapy, local external beam irradiation or total skin electron beam therapy.

Cutaneous photochemotherapy utilizes a light sensitizer taken orally and UV-A light applied to the skin lesions locally. Treatments are three times a week for 3 - 6 months. Local external beam irradiation treats the skin lesions locally with x-rays or electrons. Treatments are 5 times a week for 4 - 5 weeks. Total skin electron beam therapy is reserved for patients who are refractory to cutaneous photochemotherapy or too extensive for local external beam irradiation. Patients are treated 4 times a week for about 9 weeks. The common theme in these 3 treatment modalities is that they treat the skin aspect of the disease. Being that your brother was on systemic chemotherapy, my assumption is that his disease has spread to distant organs or peripheral lymph nodes. Interferon has be utilized in situations where other systemic agents have failed. Interferon has many side effects which include a flu-like syndrome initially, chronic fatigue, neuropathy, dementia, myelopathy, and pancytopenia in the long-term.

Mycosis fungoides/cutaneous T-cell lymphomaposes a very challenging problem both to the patient and physician. Discuss with your brother's oncologist thoroughly before pursuing any therapy.



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