Narrowband-UVB in Early Stage Cutaneous T-Cell Lymphoma

ISRN Dermatology
Volume 2014, Article ID 951821, 4 pages
http://dx.doi.org/10.1155/2014/951821

Efficacy and Side Effects of Narrowband-UVB in Early Stage Cutaneous T-Cell Lymphoma in Jordanian Patients

Salah A. AbdallatAyman S. AlqaqaaNidal A. Obaidat, and Rameh F. Alnueimi

Department of Dermatology, King Hussein Medical Center, Amman 11941, Jordan

Received 1 November 2013; Accepted 31 December 2013; Published 19 February 2014

Academic Editors: B. Amichai, F. M. Camacho, L. Dourmishev, A. Oakley, and W. Vanscheidt

Copyright © 2014 Salah A. Abdallat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Many studies, on light-skinned patients, suggested narrowband-UVB to be effective and safe for the treatment of early stage cutaneous T-cell lymphoma. Objectives. To evaluate the efficacy and side effects of narrowband-UVB in treatment of early stage cutaneous T-cell lymphoma in patients with skin phototypes III, IV, and V. Methods. A total of 27 patients with the diagnosis of early stage cutaneous T-cell lymphoma were involved in this prospective study. All patients received narrowband-UVB as monotherapy until clearance or a maximum of 42 sessions. Patients with complete clearance were followed for six months or relapse. Rate of clearance, number of sessions, and cumulative narrowband-UVB dose needed to achieve clearance, percentage of patients remaining in remission at 6 months, and side effects were analyzed. Results. Within 5–14 weeks (15–42 sessions), using cumulative narrowband-UVB dose ranging from 17.3 to 48.2 J/cm2, complete remission was achieved in 76.4% of patients. The rest of the patients achieved partial remission. Six months after discontinuation of the treatment, 42.8% of patients with complete remission remained in remission. Transient erythema in 11.1% of patients and mild hyperpigmentation in 14.8% of patients were the only side effects encountered during this study. Conclusion. We conclude that narrowband-UVB phototherapy is safe and effective for the treatment of early stage cutaneous T-cell lymphoma in darker-skinned patients.

1. Introduction

Cutaneous T-cell lymphoma (CTCL) is a group of lymphoproliferative disorders with clonal expansion of T helper cells, or rarely T suppressor/killer cells or NK cells, with localization to the skin. This group is characterized by an increased CD4+ cells: CD4/CD8 > 10, and/or an expansion of T cells with a loss of 1 or more of the normal T-cell antigens (CD2, CD3, and CD5) [1].

Cutaneous T-cell lymphomas are very rare, with a prevalence of 5/1000000 per year [12]. They are classified into a group with indolent clinical behavior, which includes mycosis fungoides (MF) and its variants (62%), and primary cutaneous CD30+ lymphoproliferative disorders (26%) and a group with aggressive clinical behavior (12%) like Sézary syndrome and adult T-cell leukemia/lymphoma [2].

MF, the commonest form of CTCL, presents as patches and plaques over trunk and proximal extremities, without internal involvement. It has a predilection for older adults and male gender [35]. MF is classified into early (stage IA, IB, and IIA) and advanced (stage IIB, III and IV) stages [23].

In early stages, the clinical and pathological presentation are similar to other inflammatory dermatoses, for example, Atopic eczema. Repeated skin biopsies are usually needed to establish the diagnosis [45]. Treatment of early stage MF includes topical agents (corticosteroid, nitrogen mustards, carmustine, and bexarotene) [6], electron beam therapy, and phototherapy including ultraviolet light, excimer laser, and photodynamic therapy [79].

Many studies involving Western populations showed that NB-UVB is effective for early stage MF [78], but there is lack of studies on NB-UVB in early MF in darker-skinned patients. In this study, we analyzed the efficacy and safety of NB-UVB in patients with skin phototypes III, IV, and V having early stage MF.

Hugh O’Connor and Hodgkin’s Lymphoma

Hugh O’Connor was born in Rome, Italy. When he was six days old, he was adopted by Carroll O’Connor and his wife Nancy. Carroll was in Rome filming Cleopatra. He was named after Carroll O’Connor’s brother, who died in a motorcycle accident in 1961.

When he was 16, Hugh was diagnosed with Hodgkin’s lymphoma. He survived the cancer with chemotherapy and two surgeries but became addicted to drugs. He had been taking prescription drugs for the pain and marijuana for nausea but later became dependent on harder drugs. Despite numerous stays at rehabilitation clinics, he never conquered his addiction and remained in recovery.


Hodgkin’s lymphoma (HL) is a type of lymphoma in which cancer originates from a specific type of white blood cells called lymphocytes. Symptoms may include fever, night sweats, and weight loss. Often there will be non-painful enlarged lymph nodes in the neck, under the arm, or in the groin.[ Those affected may feel tired or be itchy.

About half of cases of Hodgkin’s lymphoma are due to Epstein–Barr virus (EBV). Other risk factors include a family history of the condition and having HIV/AIDS.[ There are two major types of Hodgkin lymphoma: classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma.[ Diagnosis is by finding Hodgkin’s cells such as multinucleated Reed–Sternberg cells (RS cells) in lymph nodes.[ The virus-positive cases are classified as a form of the Epstein-Barr virus-associated lymphoproliferative diseases.