Treatment outcomes in 113 patients with mycosis fungoides (MF) and Sézary syndrome (SS) were studied by Anadolu et al. [1]. In their study of 113 patients, 110 were diagnosed with MF while 3 were diagnosed with SS, 101 patients (89.4 %) were diagnosed at early phases of the disease (IA, IB, IIA), and 12 (10.6 %) were diagnosed at advanced phases (IIB, III, IVA, IVB). The age of diagnosis was between 12 and 81 years (mean 45.6 ± 15.8 years), and 55 patients (48.7 %) were male and 58 patients (51.3 %) were female. Skin lesion duration varied between 1.5 months and 32 years (average 6.1 years). Psoralen and ultraviolet A (PUVA) was the primary treatment used (91 %) at early phases of the disease with a complete remission (CR) rate of 80.4 %. Treatment with PUVA + interferon-alpha resulted in 57 % complete remission 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 phase) passed away, 21.4 % of advanced phase patients showed relative recovery, and 14.2 % had complete recovery. None of the patients in the early phase died; however, 2 patients (1.9 %) progressed to an advanced phase of the disease.

Photochemotherapy in the form of PUVA is the first-line, effective, and tolerable treatment for the early phases of MF. In patients with thin patches and plaques, narrow band ultraviolet B (NB-UVB) is preferred. PUVA is used in patients with thick plaques and those who relapsed after initial treatment with NB-UVB. To induce recovery, three sessions of PUVA treatment per week, or three sessions of NB-UVB per week, were recommended until full recovery of the patient was achieved. In recurrent cases, PUVA monotherapy and/or a combination of PUVA with adjuvants such as methotrexate and interferon were used. Patients in early MF phases showed a good clinical response to combination therapy, such as PUVA with methotrexate, bexarotene, or interferon-α(alpha)-2b. In advanced phases of MF, this combination therapy may be used as first-line therapy. Currently, however, there is no consensus on maintenance therapy using phototherapy in attaining CR [2].

Interferon-alpha-2a was studied as a treatment for T-cell lymphoma in a study conducted by Olsen et al. [3]. In their study, 22 patients with T-cell lymphoma at IA to IVA phases entered into an interferon-alpha-2a controlled study (Roferon-A). Patients received 3 million IU interferon-alpha-2a at first, or received 36 million IU doses as intramuscular injection daily for a period of 10-week induction. At the end of induction, 14 out of 22 patients (64 %) had objective response against tumor: 3 patients had full response, 10 patients had relative response (≥50 % clinical improvement), and 1 patient showed slight response. Responders include individuals who were at IA to IVA phases of T-cell lymphoma and there was at least 4–27.5 months until recovery. Through continued treatment, 3 progressed from partial response to complete response and overall complete response was 27 %. Side effects included acute influenza-like symptoms, which were generally mild and transient. Weakness/fatigue, depression, anorexia, and weight loss were common dose-dependent side effects and were also the most common reasons to decrease the dose. Dose-dependent leukopenia was the most common laboratory side effect seen.

One study performed a systematic review of combination therapy in MF [4]. The results of this study showed that a combination of PUVA with interferon-alpha and/or retinoids does not lead to increased general response. Adding methotrexate but not retinoids to interferon-alpha may increase general response. In MF, no combination therapy is superior to monotherapy [4]. In some cases, patients may benefit from a combination of PUVA with interferon-alpha and/or one retinoid and/or a combination of two latter therapies. In addition, patients at advanced phases of the disease may benefit from a combination of methotrexate and interferon-alpha and/or bexarotene. The combination of bexarotene with vorinostat or gemcitabine does not increase overall response and can in fact lead to more severe complications; thus, it is not a recommended regimen.