Photodynamic therapy

Psoralen and ultraviolet A (PUVA) radiation therapy.[6-11]

Psoralen and ultraviolet A (PUVA) radiation therapy.[6-11]

Therapeutic trials with PUVA have shown an 80% to 90% complete remission rate in patients, with those in early cutaneous stages achieving the best responses. PUVA may be used in conjunction with systemic treatment.[10] Continued maintenance therapy with PUVA at more protracted intervals is generally required to prolong remission duration.[6-8,10] PUVA combined with interferon alfa-2a is associated with a high response rate.[9,10]

Narrowband ultraviolet B radiation.[12,13]

Narrowband ultraviolet B radiation.[12,13]

Single-arm and retrospective comparisons confirm the efficacy of narrowband ultraviolet B with 80% to 90% complete remission rates, especially for patients with early cutaneous stages.[12,13]

Narrowband ultraviolet B radiation.[12,13]

A Cochrane systematic review and meta-analysis compared PUVA with narrowband ultraviolet B radiation in 778 patients with early-stage mycosis fungoides (stage IA, IB, and IIA). Significantly higher complete responses were seen in patients treated with PUVA (73.8% vs. 62.2%; hazard ratio, 1.68; 95% confidence interval [CI], 1.02–2.76; P = .04). There were no significant differences in adverse effects.[11][Level of evidence B3]

Extracorporeal photophoresis (ECP) alone [14-17] or in combination with TSEB.[18] ECP is particularly applicable for Sézary syndrome and erythrodermic mycosis fungoides.[17]

Extracorporeal photophoresis (ECP) alone [14-17] or in combination with TSEB.[18] ECP is particularly applicable for Sézary syndrome and erythrodermic mycosis fungoides.[17]

In a retrospective analysis of 65 patients, with a median follow-up of 48 months, use of ECP in the first to third line of treatment yielded a longer median time-to-next treatment (TTNT) than other systemic options (P < .03).[17][Level of evidence C3]