Efficacy of treatments for mycosis fungoides and Sézary syndrome: Nationwide survey responses

Background: Numerous treatments have been used to treat the mycosis fungoides (MF) and Sézary syndrome (SS) variants of cutaneous T-cell lymphoma (CTCL). The relative efficacy of different treatments is largely unknown. Objective: To determine the frequency of therapies ranked most effective and least effective for treatment of MF and SS in a sampling of dermatologists in the United States. Methods: Fellow members in the American Academy of Dermatology in the United States between the ages of 35 and 65 years were surveyed regarding demographic variables and treatment efficacy for patch/plaque MF (stages Ia-Ib CTCL), tumor stage MF (stage IIb), and erythrodermic MF/SS (stage III). Results: Based on 1,399 responses, PUVA was preferred for the management of patch/ plaque MF. Total skin electron beam (TSEB) therapy was preferred for tumor stage MF. Photopheresis (extracorporeal photochemotherapy) was preferred for erythrodermic MF/SS, followed closely by TSEB. Especially for tumor stage and erythrodermic MF/SS, physicians without a clear preference comprised the largest group. No significant variation depending on practice type, degree of practitioner experience, or geographic location was identified. Conclusion: PUVA was the preferred treatment for Stage Ia and Ib MF. The predominance of surveys with indeterminate responses suggests limited experience and in the treatment of CTCL, especially in advanced stages.