33870 Mechlorethamine gel as a maintenance treatment regimen in patients with mycosis fungoides

Abstract

Background: Cutaneous T-cell lymphomas (CTCLs) are malignant proliferations in the skin that can invade blood, lymph nodes, or viscera. Mycosis fungoides (MF), the most common CTCL, is treated with topical agents, such as mechlorethamine gel 0.016%, in skin-limited stages. Currently, no data exist on maintenance therapy for patients in remission. Thomas Jefferson University has developed a unique protocol to use mechlorethamine as a maintenance regimen after total skin electron beam therapy. Purpose: To determine progression-free survival and efficacy of mechlorethamine as maintenance and active treatment regimens for MF. Methods: A retrospective review of MF patients seen at Thomas Jefferson University from 2012 to 2020 was conducted. Patients of all stages treated with mechlorethamine as maintenance or active treatment with 2 consecutive mSWATs (modified Severity Weighted Assessment Tool) documented were included. Treatment outcomes were assessed by change in mSWAT and progression-free survival. Dermatology Life Quality Index surveys before and after treatment were analyzed. Results: Of 186 MF patients, 44 met inclusion criteria. Patients on maintenance therapy had a 65.22% progression-free survival rate with median time to progression of 29.45 months. By-time analysis for responders on active and maintenance treatment showed an increased response over time. Peak responses were seen at last mSWAT recorded. Both cohorts experienced improved quality-of-life scores from initiation to discontinuation of mechlorethamine. Conclusions: Patients on maintenance and active mechlorethamine treatment regimens demonstrated improvement in mSWAT and quality-of-life. Mechlorethamine treatment showed progression-free survival for a median of 29.45 months, indicating this therapy may be an effective maintenance regimen.