PUVA And NB-UVB In The Treatment Of Early Stage Mycosis Fungoides: A Retrospective Study

AbstractObjectives Mycosis fungoides, the most common variant type of cutaneous T-cell lymphoma, often begins as limited patches and plaques with slow progression to systemic involvement. Narrowband UVB and PUVA therapies have been proven to be effective for MF. The purpose of this study was to compare the efficacy and safety of narrowband UVB and PUVA in 24 patients with early-stage MF (IA, IB,IIA stage).Materials and Methods A total of 24 patients were enrolled. The skin biopsy samples were fixed by 10% formalin, dehydrated, barred by paraffin, and the slides were stained with hematoxylin and eosin. PUVA and NB-UVB Phototherapy were carried out in Waldmann 7001 K and Waldmann 7001 rooms respectively. The entire patients were classified with TNM standard according to the clinical and histopathological manifestations.A retrospective study was carried out to analyze the sex, age of onset, TNM stage, treatment, and duration of treatment, T-cell receptor rearrangement, and times of treatment, duration of maintenance treatment, effective and recurrence. The data were analyzed with SPSS 17.0, statistical significance was set P<0.05. Results Of the 24 patients studied, there were 13 males (13/24,54.2%) and 11 females(11/24,45.8%), the ratio(male:female) was 1.18:1. There were 6 patients of T1N0M0 stage (25%),1 patient of T1NxMO stage (4.2%),15patients of T2N0M0 stage (62.5%),1 patient of T2N1M0 stage (4.2%), accordingly, there were 6 patients of I A stage (25%),15 patients of I B stage (62.5%),3 patients ofⅡA stage (12.5%). The average age of onset was 33.67 year-of-old[26.26-41.07]. The average time of treatment was 104.5 [75.71-133.29]. The average duration of treatment was 12.875 months[9.90-15.85]. The average maintenance treatment time was 11.083 months [2.13-20.04]. Thirteen patients were complete response (54.2%),8 patients were partial response (33.3%), Minimal responders were 3 patients (12.5%).There were no noresponders and aggravated patients. Eight patients experienced recurrences and 3 patients received radiotherapy (12.5%).There were 6 patient received test for T-cell receptor gene rearrangement,2 of them were positive (33.3%) and 4 negative (66.7%). There were 9 patients received only PUVA treatment (37.5%) and 6 patients received NB-UVB therapy, another 9 patients were treated with NB-UVB after they got responses treating with PUVA firstly. The effective rate (CR+PR) of PUVA treatment was 88.89%, recurrence rate was 11.11% (n=9). In the NB-UVB treatment group, the effective rate was 100%, and the recurrence rate was 33.33% (n=6). In the PUVA followed by NB-UVB (association therapy)treatment group, the effective rate was 77.78% and the recurrence rate was 55.56% (n=9). There were no significant differences between the three groups in terms of number of treatments (P=0.132), treatment duration (P=0.675), maintenance treatment duration (P=0.347), effective rate (P=0.473) and recurrence rate (P=0.147).Conclusion PUVA and NB-UVB were effective skin-directed therapies in the treatment of early stage MF. NB-UVB therapy is suitable for the slight infiltration and the earlier stage patients. The PUVA therapy is suitable for the deep infiltration and the server patients. The alliance therapy of PUVA followed by NB-UVB decrease the total UVA dose and the skin cancer risk. Key words:cutaneous T-cell lymphoma; mycosis fungoides; phototherapy; PUVA; NB-UVB AbstractObjectives Phototherapy has been considered one of the effective and safe treatments of early stage mycosis fungoides. However, the histopathological changes seen after phototherapy are not clearly studied. We studied the changes of histopathological features of 48 skin samples of 24 patients before and after phototherapy, and compared the features with previous literatures, to analyze the histopathological diagnosis criteria and changes after phototherapy, and to explore the evidence of diagnosis of early MF and help the clinics to treat MF with phototherapy.Materials and Methods Fourty-eight skin samples of 24 patients were collected before and after phototherapy. The skin biopsy samples were fixed by 10% formalin, dehydrated, barred by paraffin, and the slides were stained with hematoxylin and eosin.A study was carried out to analyze the features of histological changes of 24 early MF patients, consisted of epidermotropism, stratum corneum, epidermis, and pattern of inflammatory infiltrate, dilated vessels, fibrosis, and other dermal changes. The data were analyzed with SPSS 13.0, statistical significance was set P<0.05.Results There were significant differences between the Pagetoid infiltration (P<0.05), Pautrier microabscess (P<0.01), lichenoid inflammatory infiltration (P<0.05), fibrosis (P<0.01) and dilated vessels (P<0.01) in all the 48 skin samples of the 24 enrolled patients.Conclusion Phototherapy was effective treatment for early stage MF. Phototherapy changes the epidermotropism, dermal inflammatory infiltration, fibrosis and dilated vessels. The pathologist should describe the changes of epdermotropism, dermal inflammatory infiltration fibrosis and dilated vessels after the phototherapy. Objectives We studied the expressions of BCL-2, STAT3, CCL17 and CCL27 in the lesions of early stage mycosis fungoides before and post phototherapy, detected the apoptosis of MF cells and the changes of CC chemokine CCL17 and CCL27, and the activations of cell signal pathway, aiming to explore the possible mechanism of phototherapy in treating early stage MF.Materials and Methods A total of 48 skin samples from 24 early MF patients were enrolled. Immunohistochemstry were carried out with SP staining. The expressions of BCL-2, STAT3, CCL17 and CCL27 in the lesions of early stage MF before and post phototherapy were detected. The skin sample from a normal person was set as the negative control, and the results were analyzed with a microscope.A Pearson chi-square test was carried out to analyze the expressions of interesting proteins changes. The data were analyzed with SPSS 17.0, statistical significance was set P<0.05.Results After phototherapy, the expressions of BCL-2 in the tumor cells, CCL17, CCL27 and STAT3 in the stratum corneum were down-regulated significantly (X2=13.195, P<0.05; X2=8.703, P<0.05; X2=10.783, P<0.05; X2=8.171, P<0.05; respectively). The positive rate of expressions of STAT3 in the tumor cells was decreased(n=24, 29.17%,7/24; 12.5%,3/24), but there was no statistical significance(X2=2.421, P>0.05).Results The possible mechanism of phototherapy in the treatment early stage MF are increasing the apoptosis of tumor cells in the skin lesions by down-regulating the expressions of BCL-2, inhibiting the lymphocytes epidermotropism by decreasing the expressions of CC chemokines, and increasing the cells apoptosis by inhibiting the cell activation signal pathway. Phototherapy is a effectively palliative treatment to the early stage MF. AbstractObjecitve To detect the expressions of BCL-2/IgH fusion gene in early stage mycosis fungoides with SYBR Green I real-time quantitative polymerase chain reaction(RQ-PCR) and the relationships between the expressions level of BCL-2/IgH and the disease prognosis, and to explore the possible mechanism of ultraviolet phototherapy in MF.Materials and methods Purified DNA were extracted from the paraffin imbedding skin samples of early stage MF patients before and post ultraviolet phototherapies, standard control was set with positive patients in preliminary experiment, and negative control with normal person, blank control with distilled water.The expressions of BCL-2/IgH fusion gene copies were detected with SYBR Green I RQ-PCR. We analyzed the possible relationships between ultraviolet phototherapies and the prognosis, and the possible mechanism of phototherapies in treatment of early stage MF.Results There was no statistical significant between relative expressions (ACTs) of BCL-2/IgH fusion gene before and post treatment(P>0.05)。There were no statistical significant of the correlation between up or down regulation expressions of BCL-2/IgH fusion gene with reoccurrence and efficacies.Conclusions The possible mechanism of ultraviolet-induced decline expressions of BCL-2 protein in early stage MF cases may occur through pathways other than BCL-2/IgH fusion gene inhibition.