The treatment of cutaneous T-cell lymphoma (CTCL) is different from that of lymphomas that mainly affect lymph nodes. The chemotherapy that is effective for common types of non-Hodgkin's lymphoma is not effective in patients with CTCL.
Treatment options depend on several factors, including the extent of skin involved, the type of lesions, and the involvement of nodes or other organs. Those whose disease is limited to the skin have excellent responses to treatment. For those with visceral organ or node involvement, however, the aim of treatment is palliation (controlling symptoms and improving the quality of life).
Electron beam therapy:
Radiation is an effective treatment for CTCL. Electron beams are a type of radiation that treats superficial tissues like the skin but does not penetrate deeply enough to affect other organs. This type of treatment is ideal for CTCL as large areas of the skin need to be treated, without causing radiation damage to bone marrow and several other organs. Unless only a small area of skin is involved, the entire skin of the body is treated with electron beams. This kind of treatment requires a specialized and experienced facility for treatment. Treatment lasts for several weeks.
Topical chemotherapy (chemo on the skin):
Chemotherapy agents like nitrogen mustard and carmustine can be used as treatment for CTCL. These drugs are available as ointment-based preparations, and need to be applied to the skin for several weeks. An allergy-like skin reaction indicates that the drug is effective and is a pointer to the correct dose for each patient. Both agents are effective and lead to disappearance of disease in the majority of patients, though maintenance treatment may be required to prevent the lesions from coming back.
Phototherapy with UV light:
Ultraviolet (UV) light can cause DNA damage in lymphocytes (the cells that turn into lymphomas), but ordinary skin cells are unaffected because they have means to protect themselves from UV light damage. Both UV-A and UV-B light – different in terms of their wavelength – are effective against CTCL. UV-A light is used with a substance called psoralen (this is called PUVA therapy). Psoralen is administered by mouth, or occasionally on the skin dissolved in bath water. Both forms of UV light can clear 60 to 90 percent of skin lesions and some patients may be controlled for a long time or even cured.
Bexarotene (Targretin):
Bexarotene (Targretin) belongs to the class of drugs called retinoids. Retinoids are useful for a variety of skin disorders including lymphomas of the skin. Bexarotene gel is used once or twice a day for one or two months in early stage CTCL with limited skin involvement. A skin inflammation (dermatitis) occurs and the dose is reduced for two more months. Once the drug is stopped the skin lesions reduce. For those with extensive involvement and in patients with relapse of skin lymphoma, oral formulations of bexarotene are available. When used alone, oral bexarotene has relatively good response rates.
Denileukin Difitox:
Denileukin difitox is a type of drug called a monoclonal antibody. Monoclonal antibodies are drugs that target a specific molecule on the surface of cells. Denileukin difitox is a monoclonal antibody that binds to the receptor for interleukin-2 (IL-2), a substance that activates T-cells to multiply and become cancerous. Attached to the monoclonal antibody is a toxin or poison that kills the cell to which it binds. Denileukin difitox binds to T-cells that have become the cancer cells of cutaneous T-cell lymphoma and the toxin kills the cell. It is used mostly as salvage treatment after other treatments have failed.
Interferon alpha :
Interferon alpha is a biological agent that is used in many conditions including cancers. Though not commonly used for CTCL, it produces good results when used with PUVA therapy or a salvage treatment of this lymphoma. Interferon alpha is used as an injection that is administered subcutaneously (just below the skin).
Chemotherapy infusions or oral pills:
Chemotherapy agents are used rarely in CTCL, mainly as a treatment of advanced disease. Chemotherapy may be administered either as infusions in the veins or as oral pills. The most common chemotherapy pills used are methotrexate, chlorambucil or etoposide. Pegylated doxorubicin is the most effective chemotherapy infusion. Some short-term benefit may be gained by chemotherapy to those who have advanced disease that has not responded to other therapies.
