Mikozis fungoides tedavisinde dbUVB ve PUVA: Retrospektif değerlendirme

Yıl 2015, Cilt: 25 Sayı: 3, 89 - 94, 01.09.2015

Mehmet Unal Hüseyin Tol Şükrü Balevi Gülbahar Ürün Unal

Öz

Amaç: Mikozis fungoides MF ’de darband UVB dbUVB ve psoralen+UVA PUVA tedavilerinin etkinlikleri karşılaştırmalı şekilde değerlendirildi. Gereç ve yöntem: MF tanısıyla takipli ve dbUVB ve PUVA tedavisi alan 61 hasta retrospektif olarak değerlendirildi. Hastaların cinsiyet, yaş, ek hastalık, tanı zamanı, başlangıç lezyonları, şikayet başlangıcı ile tanı zamanı arası süre, hastalık evresi, lenfadenopati varlığı, verilen fototerapi türü, varsa kombine olarak verilen sistemik tedaviler, remisyona ulaşan hastalarda remisyona kadar olan süre, seans ve doz, idame tedavi süreleri, remisyona ulaşıldıktan sonraki takip süreleri ve remisyon süreleri, nüks durumları ve nüks olan hastalarda remisyon ile nüks arası süre, toplam takip süreleri, toplam verilen PUVA ve dbUVB dozları, yan etkiler ile ilgili bilgiler kaydedildi. Bulgular: DbUVB ve PUVA’nın erken evre MF’de benzer etkinliğe sahip olduğunu tespit ettik.Tam remisyona ulaşma süresi ve tam remisyon relaps arası sürenin dbUVB grubunda daha kısa olduğunu gözlemledik.Tam remisyon oranı evre 2A’da daha düşüktü.Kombinasyon tedavilerinin fototerapi sonuçlarını anlamlı bir şekilde değiştirmediği gözlemlendi. Sonuç: Çalışmamızda dbUVB ve PUVA’nın erken evre MF’te kullanışlı ve kabul edilebilir başarılı sonuçlara ulaştığını. tam remisyona ulaşma süresi ve tam remisyon relaps arası sürenin dbUVB grubunda daha kısa olduğunu gözlemledik

Anahtar Kelimeler

Mikozis fungoides, dbUVB, PUVA

NB-UVB and PUVA in mycosis fungoides therapy: A retrospective study

Öz

Objectives: The efficiency of narrowband UVB NB-UVB and psoralen+UVA PUVA in treatment of MF was evaluated. Material and methods: Sixy-one patients diagnosed with MF treated with NBUVB or PUVA were studied retrospectively. Gender, age, time of diagnose, duration from initial lesion/lesions to diagnose and treatment, lypmhadenopathy, MF stage, phototherapy regime, systemic agents, mean time to complete remission CR , mean number of treatment to CR, mean irradiation dose to CR, mean duration of maintenance therapy, mean relapse-free interval, relapse rate, total follow-up duration, advers effects during treatment and comor- bidities obtained from patients dermatological charts were recorded. Results: Our results indicate that NB-UVB and PUVA have similar conclusions in treatment of early-stage MF. Mean time to CR and mean duration from CR to relapse were shorter for patients who treated with NB-UVB than PUVA group. CR rate was lower in stage 2A. Combination of systemic agents with phototherapy did not have a statistically significant impact as expected. Conclusion: At the end of the our study, we observed that NB-UVB and PUVA are usefull and have acceptably good results in patients with early-stage MF. Mean time to CR and mean duration from CR to relapse were shorter for NB-UVB group

Anahtar Kelimeler

Mycosis fungoides, NB-UVB, PUVA

Kaynakça

• Willemze R, Kerl H, Sterry W, et al. EORTC classification for pri- mary cutaneous lymphomas: a proposal from the Cutaneous Ly- mphoma Study Group of the European Organization for Research and Treatment of Cancer. Blood 1997;90:354-71.
• Willemze R. Cutaneus T-cell lyphoma. In: Bolognia JL, Jorizzo JL, Rapini RP eds. Dermatology. Edinburg; Mosby. 2012;1867-86.
• Willemze R, Jaffe ES, Burg G. WHO-EORTC classification for cu- taneous lyphomas. Blood 2005;105:3768-85.
• Santucci M, Burg G, Feller AC. Interrater and interrater reliability of histologic criteria in early cutaneous T cell lemphoma: an EO- RTC cutaneous project study group. Dermatol Clinic 1994;12:329- 34
• Rijlaarsdam JU, Scheffer E, Meijer CJ, Willemze R. Cutaneous pseudo T cell lymphomas. A clinicopathologic study of 20 pa- tients. Cancer 1992;69:717-24
• Ralfkiaer E. Controversies and discussion on early diagnosis of cutaneous T-cell lymphoma. Phenotyping. Dermatol Clin 1994; 12:329-34.
• Diederen PVMM, van Weelden H, Sanders CJG, Toonstra J, van Vloten WA. Narrowband UVB and psoralen-UVA in the treat- ment of early-stage mycosis fungoides: a retrospective study. J Am Acad Dermatol 2003;48:215-9.
• El-Mofty M, El-Darouty M, Salonas M et al:Narrowband UVB (311 nm), psoralen UVB (311 nm) and PUVA therapy in the tre- atment of earlystage mycosis fungoides: a right-left comparative study. Photodermatol Photoimmunol Photomed 2005;21:281-6.
• Ponte P, Serrao V, Apetato M.Efficacy of narrowband UVB vs. PUVA in patients with early-stage mycosis fungoides. J Eur Acad Dermatol Venereol 2010;24:716-21.
• Ahmad K, Rogers S, McNicholas PD et al. Narrowband UVB and PUVA in the treatment of mycosis fungoides: a retrospective study. Acta Derm Venereol 2007;87:413–7.
• Herrmann JJ, Roenigk HH, Hurria A et al. Treatment of mycosis fungoides with photochemotherapy (PUVA): longterm follow-up. J Am Acad Dermatol 1995;33:234-42.
• Ghodsi SZ, Hallaji Z, Balighi K, Safar F, Chambs-Davatchi C. Nar- row-band UVB in the treatment of early stage mycosis fungoides: report of 16 patients. Clin Exp Dermatol 2005;30:376-8.
• Querfeld C, Rosen ST, Kuzel TM et al. Long-term follow-up of pa- tients with early stage cutaneous T-cell lymphoma who achieved complete remission with psoralen plus UV-A monotherapy. Arch Dermatol 2005;141:305-11.
• Boztepe G, Sahin S, Ayhan M, et al. Narrowband ultraviolet B pho- totherapy to clear and maintain clearance in patients with mycosis fungoides. J Am Acad Dermatol 2005;53:242-6.
• Gathers RC, Scherschun L, Malick F, Fivenson DP, Lim HW. Nar- rowband UBV phototherapy for early-stage mycosisfungoides. J Am Acad Dermatol 2002;47:191-7.
• Xiao T, Xia LX, Yang ZH, He CD, Gao XH, Chen HD. Nar- row-band ultraviolet B phototherapy for early stage mycosis fun- goides. Eur J Dermatol 2008;18:660-2.
• Adısen E, Gurer MA. Kutanoz T hücreli lenfomada foto(kemo) terapi. Turkderm 2010;44:105-11.
• Aykol C, Mevlitoğlu İ, Ozdemir M, Unal M. Evaluation of clini- cal and sociodemograpic features of patients with psoriasis in the Konya region. Turk J Dermatol 2011;5:71-4.