Background: Phototherapy has been the mainstay of therapies for early mycosis fungoides (MF). The beneficial role of ultraviolet (UV) light on MF is suggested by the observation that lesions occur on non-sun-exposed areas. Therapeutic light sources that are available today are broadband UVB, psoralen and UVA, narrowband UVB, and long-wave UV (UVA1). Current literature provides increasing evidence on the use of UVA1 to treat MF. Aim: To investigate the treatment responses of early MF patients treated with fixed 30 J/cm2 doses of UVA1 phototherapy. Material and Methods: Nineteen patients with early MF, stage IA-IIA of the TNM staging system, received fixed 30 J/cm2 doses of UVA1, given 5 times weekly over 5 weeks. Therapeutic effectiveness was assessed by clinical examination and was confirmed by histological evaluation. Results: Of the 19 patients, complete responses were achieved in 12 (63%) and partial responses were achieved in 7 (37%) patients after UVA1 radiation exposures. During the study, UVA1 therapy was well tolerated. During the follow-up, 7 (58%) of the 12 patients with complete response relapsed within 3 months of the UVA1 therapy. Conclusion: The current study provides clinical and histological evidence for the effectiveness of UVA1 (30 J/cm2 5 times a week for 5 weeks) as a skin-directed therapy in the treatment of early MF; however, such a treatment failed to maintain a long and sustained response. Thus, studies to identify the optimal dosing protocol regarding the therapeutic efficacy, the factors affecting relapse time/rate, and the necessity of maintenance treatment are needed.

Keywords:
Mycosis fungoides, Treatment, Ultraviolet A1 phototherapy
1.
Whittaker SJ, Foss FM: Efficacy and tolerability of currently available therapies for the mycosis fungoides and Sezary syndrome variants of cutaneous T-cell lymphoma. Cancer Treat Rev 2007;33:46-160.
2.
Olsen EA, Whittaker S, Kim YH, Duvic M, Prince HM, Lessin SR, et al; International Society for Cutaneous Lymphomas; United States Cutaneous Lymphoma Consortium; Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer: Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer. J Clin Oncol 2011;29:2598-2607.
3.
Olsen EA, Hodak E, Anderson T, Carter JB, Henderson M, Cooper K, Lim HW: Guidelines for phototherapy of mycosis fungoides and Sézary syndrome: a consensus statement of the United States Cutaneous Lymphoma Consortium. J Am Acad Dermatol 2016;74:27-58.
4.
Zandi S, Kalia S, Lui H: UVA1 phototherapy: a concise and practical review. Skin Therapy Lett 2012;17:1-4.
5.
Dawe RS: Ultraviolet A1 phototherapy. Br J Dermatol 2003;148:626-637.
6.
Mang R, Krutmann J: UVA-1 Phototherapy. Photodermatol Photoimmunol Photomed 2005;21:103-108.
7.
York NR, Jacobe HT: UVA1 phototherapy: a review of mechanism and therapeutic application. Int J Dermatol 2010;49:623-630.
8.
Gambichler T, Terras S, Kreuter A: Treatment regimens, protocols, dosage, and indications for UVA1 phototherapy: facts and controversies. Clin Dermatol 2013;31:438-454.
9.
Kerr AC, Ferguson J, Attili SK, Beattie PE, Coleman AJ, Dawe RS, Eberlein B, Goulden V, Ibbotson SH, Menage Hdu P, Moseley H, Novakovic L, Walker SL,Woods JA, Young AR, Sarkany RP: Ultraviolet A1 phototherapy: a British Photodermatology Group workshop report. Clin Exp Dermatol 2012;37:219-226.
10.
Krutmann J, Schöpf E: High-dose-UVA1 phototherapy: a novel and highly effective approach for the treatment of acute exacerbation of atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1992;176:120-122.
11.
Godar DE: UVA1 radiation mediates singlet-oxygen and superoxide anion production rich trigger two different final apoptotic pathways: the S and P site of mitochondria. J Invest Dermatol 1999;112:3-12.
12.
Yamauchi R, Morita A, Yasuda Y, Grether-Beck S, Klotz LO, Tsuji T, Krutmann J: Different susceptibility of malignant versus nonmalignant human T cells toward ultraviolet A-1 radiation-induced apoptosis. J Invest Dermatol 2004;122:477-483.
13.
von Kobyletzki G, Heine O, Stephan H, Pieck C, Stücker M, Hoffmann K, Altmeyer P, Mannherz HG: UVA1 irradiation induces deoxyribonuclease dependent apoptosis in cutaneous T-cell lymphoma in vivo. Photodermatol Photoimmunol Photomed 2000;16:271-277.
14.
Plettenberg H, Stege H, Megahed M, Ruzicka T, Hosokawa Y, Tsuji T, Morita A, Krutmann J: Ultraviolet A1 (340-400 nm) phototherapy for cutaneous T-cell lymphoma. J Am Acad Dermatol 1999;41:47-50.
15.
Ständer H, Schwarz T: Ultraviolet A1 (340-400 nm) phototherapy for cutaneous T-cell lymphoma? J Am Acad Dermatol 2000;43:881.
16.
Zane C, Leali C, Airo P, De Panfilis G, Pinton PC: “High-dose” UVA1 therapy of widespread plaque-type, nodular and erythrodermic mycosis fungoides. J Am Acad Dermatol 2001;44:629-633.
17.
Plettenberg H, Stege H, Megahed M, et al: UVA1 photo-therapy versus PUVA photochemotherapy in treatment of patients with cutaneous T-cell lymphoma. Photodermatol Photoimmunol Photomed 2001;17:87.
18.
Roupe G: Hypopigmented mycosis fungoides in child successfully treated with UVA1-light. Pediatr Dermatol 2005;22:82.
19.
Rombold S, Lobisch K, Katzer T, et al: Efficacy of UVA1 phototherapy in 230 patients with various skin diseases. Photodermatol Photoimmunol Photomed 2008;24:19-23.
20.
Suh KS, kang JS, Baek JW, et al: Efficacy of ultraviolet A1 phototherapy in recalcitrant skin diseases. Ann Dermatol 2010;22:1-8.
21.
Olek-Hrab K, Silny W, Dańczak-Pazdrowska A, Osmola-Mańkowska A, Sadowska PA, Polańska A, Gniadecki R, Jenerowicz D: Ultraviolet A1 phototherapy for mycosis fungoides. Clin Exp Dermatol 2013;38:126-130.
22.
Jang MS, Kang DY, Jeon YS, Kim ST, Suh KS: Ultraviolet A1 phototherapy of mycosis fungoides. Ann Dermatol 2013;25:104-107.
23.
Harris M, Lezanski-Gujda A, Nguyen J: Disseminated cutaneous herpes simplex virus infection following UVA1 phototherapy in a patient with cutaneous T-cell lymphoma. J Am Acad Dermatol 2015;72:AB158. DOI: 10.1016/j.jaad.2015.02.649.
24.
Connolly KL, Griffith JL, McEvoy M, Lim HW: Ultraviolet A1 phototherapy beyond morphea: experience in 83 patients. Photodermatol Photoimmunol Photomed 2015;31:289-295.
25.
El Mofty M, Ramadan S, Fawzy MM, Hegazy RA, Sayed S: Broad band UVA: a possible reliable alternative to PUVA in the treatment of early-stage mycosis fungoides. Photodermatol Photoimmunol Photomed 2012;28:274-247.
26.
Aydogan K, Yazici S, Balaban Adim S, Tilki Gunay I, Budak F, Saricaoglu H, Tunali S, Bulbul Baskan E: Efficacy of low-dose ultraviolet A-1 phototherapy for parapsoriasis/early-stage mycosis fungoides. Photochem Photobiol 2014;90:873-877.
27.
Hodge L, Warin AP, Gange RW, Bleehen S, Vella Briffa D: Photochemotherapy in mycosis fungoides. Br Med J 1977;2:1257-1259.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.