Pilot Study of a Novel Therapeutic Approach for Refractory Advanced Stage Folliculotropic Mycosis Fungoides
Christina A. Del Guzzo, Neha N. Jariwala, Paul L. Haun, Kelly M. MacArthur, Christen M. Mowad, Elisabeth G. Richard, Joseph P. Holton, Alain H. Rook
Folliculotropic mycosis fungoides is a variant of cutaneous T-cell lymphoma characterized as having a folliculocentric infiltrate of malignant T cells along with a worse prognosis in comparison to the epidermotropic variants. Patients with advanced forms of folliculotropic mycosis fungoides are often poorly responsive to both skin-directed as well as to systemic therapies. We report here a high response rate using a novel therapeutic regimen combining interferon gamma, isotretinoin in low dose and topical carmustine, and in some cases concomitant skin-directed therapies, among 6 consecutive patients with refractory folliculotropic mycosis fungoides with stages IB through IIIB who had previously failed both topical and systemic therapies. The potential mechanisms of this multimodality approach are discussed.
Folliculotropic mycosis fungoides is a distinct subtype of cutaneous T-cell lymphoma with poor prognosis and recalcitrance to conventional therapy. We propose a novel therapeutic approach for refractory folliculotropic mycosis fungoides using interferon gamma in combination with topical carmustine and low dose isotretinoin, and in some cases other skin-directed therapies including phototherapy and local radiation. Among 6 patients with advanced folliculotropic mycosis fungoides who had previously failed prior systemic therapy, four patients experienced complete responses with the other two having nearly complete responses while being treated with this regimen. The potential mechanisms of this treatment approach are discussed.