Treatment of mycosis fungoides (MF) depends on its TNM (tumor, node, metastasis ) clinical staging for which psoralen and ultraviolet A (PUVA) has been the accepted standard treatment for early phases of the disease, with reported complete remission (CR) of up to 71.4 % [1]. Researchers have been aiming to find a combination of therapies that will not only work synergistically to result in more patients reaching complete remission but also result in fewer adverse effects, in order to improve quality of life. There are few studies in the literature that compare PUVA with other therapies or combination treatments (see Chap. 9). With that being said, one of the promising treatment combinations reported in the literature has been PUVA plus interferon (IFN)-α(alpha)-2a as it has been shown to require fewer doses of both treatments to reach high overall and complete response rates. For instance, a recent study on the efficacy of PUVA + IFN-α(alpha) reported overall response and complete response of 98 % and 84 %, respectively [2]. In another study done on 89 patients suffering from IA and IIA stages of MF, in which patients were treated for 14 months with a low-dose interferon-alpha-2b (6–18 MU/week) in combination with PUVA, CR was achieved in 84 % of the patients, with an overall response of 98 % [3].

In our own study, there was a significant difference in response to treatment based on the phase of the disease (both in overall and in each individual treatment group). The main purpose of our study was to determine and compare the efficacy of two treatment methods, one being psoralen and ultraviolet A (PUVA) monotherapy and the other being PUVA combined with interferon-alpha-2a in mycosis fungoides patients referred to the Razi Dermatology Hospital in Tehran, Iran. Our efforts focused on the comparison of these two treatment regimens with respect to complete remission, partial remission, different phases of MF, and effect of gender. Of 24 patients in early phase of the disease who were under treatment with PUVA alone, 16 patients (67 %) achieved complete remission, while 8 patients (33 %) did not achieve a complete remission. Among eight patients with early phase of the disease who were under treatment with PUVA + IFN, six patients (75 %) achieved complete remission and two patients (25 %) did not achieve a complete remission. Of four patients who were in advanced phase of the disease and were under treatment with PUVA alone, one patient (25 %) achieved complete remission, and three patients (75 %) did not achieve complete remission. Of 14 patients who were in advanced phases of the disease and were under treatment with PUVA + IFN, 3 patients (22 %) achieved complete remission, and 11 patients (78 %) did not achieve complete remission. Therefore, in examining the response to treatment in terms of complete remission between the two groups separately in subgroups of early phase and advanced phase, a significant statistical difference was not observed.

Of 24 patients in our study who were in early phase of the disease and treated with PUVA alone, 22 patients (92 %) achieved overall response and 2 patients (8 %) did not respond to the treatment. Of eight patients who were in the early phase of the disease and were under treatment with PUVA + IFN, all of the patients (100 %) achieved overall recovery and responded to treatment. Of four patients who were in advanced phase of the disease and were treated with PUVA alone, two patients (50 %) achieved overall response and two patients (50 %) did not respond to treatment. Of 14 patients who were in advanced phase of the disease and were treated with PUVA + IFN, seven patients (50 %) achieved overall response and seven patients (50 %) did not respond to treatment.

After we examined the response to treatment in terms of general remission (complete + partial), there was no statistically significant difference between the two groups in two separate patient subgroups of early phase and advanced phase. Patients in the early phases of the disease responded well to PUVA alone and PUVA + IFN treatment (92 % and 100 %, respectively). In other words, the results of the study showed that PUVA alone and PUVA + IFN are more effective treatments in the early phases of MF. Complete remission and overall response (complete + partial) had no significant difference based on the type of treatment received, using the Kaplan–Meier method and log rank test.

Type and treatment outcome in 113 patients with MF and SS has been investigated by Anadolu et al. [4]. Of 113 patients in the study, 110 patients were diagnosed with MF, and 3 people were diagnosed with SS; 101 patients (89.4 %) were in early phases of the disease (IA, IB, IIA), and 12 patients (10.6 %) were diagnosed with advanced phases (IIB, III, IVA, IVB). Age of diagnosis was between 12 and 81 years (average 45.6 ± 15.8 years). Fifty-five patients (48.7 %) were male and 58 patients (51.3 %) were female. The duration of skin lesion was between 1.5 months and 32 years (average 6.1 years). Psoralen along with UVA (PUVA) was used mostly in early treatment (91 %) phases of the disease and was associated with complete remission (CR) of 80.4 %. Treatment with PUVA + IFN results in a CR of 57 % in early phases and 33.3 % in advanced phases. Of 113 patients with MF, 8 patients (7 % of all patients and 57.1 % of advanced stage cases) died, 21.4 % of patients with advanced stages showed partial remission, and 14.2 % had complete remission. One of the advanced stage patients died, and two patients (1.9 %) progressed to advanced phase of the disease.

In our own study, most patients were in early phases of diseases, with complete remission (CR) measured to be 52 %, and partial remission (PR) 26 %. In our study, CR was observed in 78.6 % of patients in phase IA, 57.1 % in phase IB, and 75 % in phase IIA. PR was achieved in 21.4 % in IA phase, 28.6 % in IB phase, and 25 % in IIA phase.