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Extracorporeal photopheresis for the treatment of Sézary syndrome using a novel treatment protocol

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Various studies have reported that extracorporeal photopheresis is effective in producing meaningful responses in patients with Sézary syndrome. A single-center, 5-year retrospective analysis was performed on our patients with Sézary syndrome who received extracorporeal photopheresis using a novel protocol. Thirteen patients were treated with extracorporeal photopheresis consistently for a minimum of 2 months. All patients received a modified protocol of one treatment per week for 6 sessions, one session every 2 weeks for 6 sessions, and then one session per month. The overall response rate was 62%: two patients achieved a complete response and 6 patients achieved a partial response. The median time to response was 10 months. The 2- and 4-year predicted overall survivals were 82%. This study was limited by its retrospective nature and small sample size. Response and survival compare favorably with those of previous studies. Our modified treatment protocol appears to produce outcomes similar to the two-day protocol.

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Study design

A single-center retrospective cohort analysis was performed of patients with SS who received a minimum of 2 months of ECP at our center between 2002 and 2007. Medical records of each patient were reviewed. A number of clinical, hematologic, and immunologic parameters were monitored during treatment and correlated with clinical outcome. Baseline variables were also recorded to identify any predictors of a favorable response to ECP.

Patient selection criteria

Patients were eligible for inclusion in this analysis if they

Patient characteristics

Thirteen patients, 7 female and 6 male, were analyzed in this study. Two further patients who discontinued photopheresis before 2 months of treatment were not studied; these patients ceased because of poor venous access and a concurrent diagnosis of lung carcinoma, respectively. Photopheresis was administered to 9 of the 13 patients by heparinized peripheral access lines and 4 patients required arteriovenous fistulae formation to continue with long-term treatment.

The median age at the start of

Responses

Overall, 8 patients (62%) responded to ECP. Two patients achieved complete response (1 patient achieved CCR and the second achieved CCR and complete hematologic response) and 6 patients achieved a partial response. Five patients did not respond to photopheresis: 3 patients maintained stable disease, and two patients had progressive disease. At a median follow-up of living patients of 27.5 months (range 8-115 months), the median OS has not been reached (Fig 1). The 2- and 4-year predicted OS is

Discussion

ECP induces clinical and symptomatic responses in patients with erythrodermic CTCL,7 but response rates of previous studies vary considerably. In this study of 13 patients with SS, 8 patients responded to photopheresis. Our OR rate of 62% is lower than the previously reported OR rate of 83% in erythrodermic CTCL reported by Edelson et al7 and 83% in SS reported by Gottlieb et al.12 Our OR rate is, however, comparable with more recent studies, such as by Evans et al21 (57% OR rate) and

References (26)

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Funding sources: None.

Conflicts of interest: None declared.

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