TREATMENT OF CUTANEOUS T-CELL LYMPHOMA BY EXTRACORPOREAL PHOTOCHEMOTHERAPY - PRELIMINARY-RESULTS
TREATMENT OF CUTANEOUS T-CELL LYMPHOMA BY EXTRACORPOREAL PHOTOCHEMOTHERAPY - PRELIMINARY-RESULTS
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DOI：
10.1056/nejm198702053160603
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发表时间：
1987-02-05
影响因子：
158.5
通讯作者：
LAROCHE, L
中科院分区：
文献类型：
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作者：
EDELSON, R;BERGER, C;LAROCHE, L
全身播散性皮肤T细胞淋巴瘤通常对化疗和放疗有抵抗力。我们测试了一种治疗方法，该治疗方法涉及通过紫外线A能量将生物惰性甲氧沙林（8-methoxypropylene）体外光活化成共价交联DNA的形式。口服甲氧沙林后，将富含淋巴细胞的血液部分暴露于紫外线A（每平方厘米1至2 J），然后返回患者体内。紫外线A和甲氧沙林的组合引起88 . 5%的目标淋巴细胞的活力损失，而单独的药物是无活性的。37例其他方面耐药的皮肤T细胞淋巴瘤患者中有27例对治疗有反应，在22 ± 24小时后，皮肤受累平均减少64%。10周（平均值±. SD）。反应组包括10例淋巴结受累患者中的8例，29例剥脱性红皮病患者中的24例，以及28例对标准化疗耐药的患者中的20例。标准化疗经常出现的副作用，如骨髓抑制，胃肠道糜烂和脱发，没有发生。虽然这种有益作用的机制还不确定，但对输注的受损细胞的免疫反应可能限制了异常T细胞的活性。这项初步研究表明，体外光化学疗法是一种有前途的治疗广泛的皮肤T细胞淋巴瘤。
Systemically disseminated cutaneus T-cell lymphoma is generally resistant to chemotherapy and radiotherapy. We tested a treatment involving the extracorporeal photoactivation of biologically inert methoxsalen (8-methoxypsoralen) by ultraviolet A energy to a form that covalently cross-links DNA. After oral administration of methoxsalen, a lymphocyte-enriched blood fraction was exposed to ultraviolet A (1 to 2 J per square centimeter) and then returned to the patient. The combination of ultraviolet A and methoxsalen caused an 88 .+-. 5 percent loss of viability of target lymphocytes, whereas the drug alone was inactive. Twenty-seven of 37 patients with otherwise resistant cutaneous T-cell lymphoma responded to the treatment with an average 64 percent decrease in cutaneous involvement after 22 .+-. 10 weeks (mean .+-. SD). The responding group included 8 of 10 patients with lymph-node involvement, 24 of 29 with exfoliative erythroderma, and 20 of 28 whose disease was resistant to standard chemotherapy. Side effects that often occur with standard chemotherapy, such as bone marrow suppression, gastrointestinal erosions, and hair loss, did not occur. Although the mechanism of the beneficial effect is uncertain, an immune raction to the infused damaged cells may have restricted the activity of the abnormal T cells. This preliminary study suggests that extracorporeal photochemotherapy is a promising treatment for widespread cutaneous T-cell lymphoma.