Low dose interferon-alpha2b combined with PUVA is an effective treatment of early stage mycosis fungoides: results of a multicenter study. Cutaneous-T Cell Lymphoma Multicenter Study Group

BACKGROUND AND OBJECTIVE

The early stages of mycosis fungoides (MF) can be treated but not cured by photochemotherapy (PUVA) alone; some recent studies of the effect of a combination of human interferon-alpha (IFN(alpha)) and PUVA reported a high degree of response. The aim of our study was to evaluate the activity of a low dose of IFN-alpha2b combined with PUVA.

DESIGN AND METHODS

Twenty-five patients were included: 16 men and 9 women aged between 23-80 years; 19 patients ahd stage I and 6 stage II disease. In the induction phase, the dose of IFNalpha was gradually raised over 6-8 weeks to the target dose of 18 MU/week; in the maintenance phase, the combination with PUVA allowed IFNalpha to be reduced to a maximum dose of 6 MU/week; in this way the cumulative administration of IFNalpha and PUVA was considerably lower than in similar combination protocols. Treatment success was analyzed in terms of freedom from treatment failure (FFTF).

RESULTS

After the induction phase 9/25 patients (36%) achieved complete remission (CR) and 15/25 (56%) achieved partial remission (PR). One to five months from the beginning of the maintenance phase, a CR was recorded in 19/25 patients (76%) and a PR in 5/25 patients (20%) accounting for an overall response rate of 96%. The median of FFTF was not reached; probability of FFTF was 82% at 12 months and 62% at 24 months. Disease free survival projected to 48 months was 75%.

INTERPRETATION AND CONCLUSIONS

Even with low doses of IFNalpha plus PUVA it is possible to achieve excellent clinical responses,many of which are long-lasting, in patients with early MF.

[Alclometasone dipropionate (Legederm) for the treatment of steroid-sensitive dermatoses in the elderly]

This is a randomized single blind parallel comparison of alclometasone dipropionate cream 0.1% vs hydrocortisone butyrrate in 39 geriatric patients (greater than 60 years old) with steroid sensible skin diseases. The regimen consisted of dosing patients with two applications of the two drugs every day for 4 weeks. Follow-up evaluations have been done weekly, and subjective and objective clinical symptoms, adherence to the study protocol, evolution of the disease, onset of adverse reactions including atrophy have been recorded. Furthermore possible side-effects on hypophysis-adrenal axis have been monitored in baseline conditions, after 7 days and at the end of therapy. In most patients bioptic skin patterns for histomorphometric examination have been drawn before and after therapy to be evaluated by a blind examinator. Alclometasone has reduced initial skin lesions by 82.2%, the extent as hydrocortisone butyrrate. In five patients the complete clearance of the disease has been obtained. Study drugs have been tolerated well by all patients, nor clinical signs of atrophy have been observed. Fluctuations of blood cortisol levels ranged between the normal values. In patients treated with alclometasone histomorphometry revealed a better skin trophism than in patients treated with hydrocortisone butyrrate.

Complement cleavage products in the phototoxic reaction of porphyria cutanea tarda

We have measured C3, C4, CH50 and complement cleavage products C3a and C5a in in sera and plasma from PCT patients and normal controls 10 min and 1, 4 and 24 h after UVA irradiation. We found elevated C3a concentrations in PCT patients immediately after UVA irradiation and 24 h later. The same was true for CH50, whereas C3, C4 and C5a did not change significantly. No such changes occurred in normal controls. Our data suggest that activation of the complement cleavage product C3a by porphyrin and UV light triggers a series of events that cause tissue damage.

Proposed Secondary Wavelength Standards and Line Classifications in Thorium Spectra Between 0.9 and 3 μ m

The spectrum of thorium as emitted by an electrodeless lamp has been recorded by Connes and collaborators by means of Fourier Transform Spectroscopy in the region 0.9 to 3 μm. Of the 3100 lines observed, about 1900 are classified as transitions in the energy level system of Th i and 412 in Th ii. Since the average deviation between the observed and calculated wave numbers is less than 0.002 cm-1, the observed wavelengths are suitable for use as standard wavelengths.