Long-term follow-up and survival of cutaneous T-cell lymphoma patients treated with extracorporeal photopheresis

Purpose: Extracorporeal photopheresis (ECP) is effective for treating cutaneous T-cell lymphoma. In 1987, a pivotal trial showed 81% overall response rate (ORR) using outdated criteria. No long-term follow-up was available for assessing survival. This study applies modern criteria to the 1987 trial to assess the impact of ECP on skin responses and also updates overall survival of the cohort. Methods: Generalized erythroderma (GE, stage T4, n=31) or extensive patch-plaque (EPP, stage T2, n=8) patients received ECP (mean 3.9 years' duration). Patients achieving ≥50% partial skin response, ≥90% near-complete skin response, treatments required, and duration of response (DOR) were determined. Overall survival (OS) from diagnosis and first ECP treatment was determined for all patients and the GE cohort. Results: Patients showed 74% skin ORR using modern criteria; 33% of patients achieved ≥50% partial skin response (after median 7.1 months, mean 23 ECP treatments); 41% achieved ≥90% improvement (after median 19.6 months, mean 40 ECP treatments). Mean DOR was 14 months for ≥50% improvement and 8.9 months for ≥90% improvement. Response rates were comparable for GE and EPP cohorts. Median OS was 9.2 years from diagnosis and 6.6 years from ECP initiation (71.6 months follow-up). Conclusion: Analysis of long-term follow-up confirmed durable responses and prolonged survival of patients treated with ECP.