皮肤淋巴瘤诊断和治疗进展课件.ppt

* * ERBT, Electron Beam Radiotherapy; NBUVB, narrow-band ultraviolet B radiation; PUVA, PUVA, psoralens and ultraviolet A radiation Several skin-directed therapies are used to treat CTCL, including topical steroids (particularly high-potency topical steroids), topical nitrogen mustard (also known as mechlorethamine), and topical bexarotene gel (a retinoid). Carmustine, an alkalating agent similar to nitrogen mustard, is also used for early-stage disease. Phototherapy will be discussed in greater detail in a moment, including how narrow-band UVB therapy and PUVA phototherapy are used to treat this disease. One of the earliest skin-directed therapies was radiotherapy. X-ray radiation was developed more than 100 years ago. Because of the thick plaques and tumors associated with mycosis fungoides, it became 1 of the first diseases to be treated successfully with radiation therapy. Now either total skin or localized electron beam radiation therapy, which will be discussed later, is used. * Several systemic therapies are also available for CTCL, including isotretinoin capsules, bexarotene capsules, and acitretin capsules, all of which are retinoids. Methotrexate can be used in some stages, particularly the erythrodermic stage. Prednisone and chlorambucil are 2 agents that are often combined in a palliative fashion to treat patients with more advanced disease, where controlling symptoms is more important than trying to induce remission. Subcutaneous interferon has been used successfully, as has extracorporeal photochemotherapy. Other biologic modifiers and cytokines have been used in experimental studies. Denileukin diftitox, a US Food and Drug Administration (FDA)–approved therapy for cutaneous T-cell lymphoma, is 1 that will be discussed. Overall, combination chemotherapy has been disappointing as an approach to treating CTCL. * The cutaneous T-cell lymphoma treatment algorithm published in Wintrobe’s textbook of Clinical Hematology is shown here. The grid illustrates