皮肤淋巴瘤诊断和治疗进展.pptVIP

* Topical nitrogen mustard, a DNA alkylating agent, has been used to treat mycosis fungoides since approximately the 1940s. However, some authorities believe that nitrogen mustard’s induction of a hypersensitivity reaction may also aid in the clearing of mycosis fungoides lesions. Nitrogen mustard is often used in an ointment base, however, some clinicians still use an aqueous formulation applied to the skin once daily. In general, nitrogen mustard is continued for only 2-3 months after a complete response. If patients only achieve a partial response, they may continue on nitrogen mustard for several years, or until they fail treatment for other reasons. The efficacy of nitrogen mustard used to treat patch and plaque stage disease depends on the skin stage. However, in a combined analysis of patients at Stanford University, Youn Kim showed that patients with T1 stage disease have an overall response rate of 93%, with a complete response rate of 65%. The 5-year relapse-free rate was 52%. Patients with T2 disease, on the other hand, had an overall response rate of 72% and a complete response rate of 34%. Also, the 5-year relapse-free response rate was 19%, much less than in T1 stage disease. * The adverse effect profile for topical nitrogen mustard includes an irritant dermatitis in a minority of patients, and an allergic contact dermatitis. For reasons that are unclear, the allergic contact dermatitis is seen most often with the aqueous formulation rather than the ointment formulation. There are no studies regarding systemic absorption of nitrogen mustard when it is applied to the skin, even to the entire integument. There may be a role for patients to use nitrogen mustard on only a region of their skin rather than their entire integument. In addition, some studies indicate an increase in nonmelanoma skin cancers in patients that use nitrogen mustard. However, the review of the Stanford experience by Youn Kim did not show a significant increase in nonmelanoma skin ca