Journal of Clinical Oncology, Vol 5, 1796-1803, Copyright © 1987 by American Society of Clinical Oncology
Mycosis fungoides: management with topical nitrogen mustard
RT Hoppe, EA Abel, DG Deneau and NM Price
Department of Therapeutic Radiology, Stanford University Medical Center, CA 94305.
The technique of treatment, response rate, freedom from relapse, survival,
and complications of therapy in 123 patients treated with topical nitrogen
mustard (HN2) for cutaneous mycosis fungoides (MF) at Stanford University
Medical Center are reviewed. Patients were treated with HN2 in an aqueous
or ointment base with equal efficacy. Response rates depended on the extent
of skin involvement. In limited plaque (T1) disease, complete and overall
response rates were 51% and 88%, respectively, while in generalized plaque
(T2) disease they were 26% and 69%. No patients with tumorous involvement
(T3) achieved complete skin clearance and all 13 of these patients
developed progression of disease. Only two of nine patients with
erythrodema (T4) achieved a complete response (CR), and both later
relapsed. After achieving a CR, 40% of patients with T1 disease and 60%
with T2 disease later relapsed; however, subsequent therapies, including
repeat courses of topical HN2, often were successful in achieving later
skin clearance. Overall, 42% of T1 patients and 31% of T2 patients were
without evidence of MF at last follow-up. When death occurred, it was
usually unrelated to MF in the T1 group. However, half of the deaths of
patients with T2 disease were attributable to MF. Among the 22 patients
with T3 or T4 disease, 80% of deaths were attributable to MF. The most
common complication observed was a cutaneous hypersensitivity reaction,
which occurred much more commonly with the aqueous than the ointment
preparation. Fourteen patients (11%) developed subsequent cutaneous
malignancies.
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