Cutaneous T-Cell Lymphoma: Treatment Options

This page is for people with cutaneous T-cell lymphoma, and their families, who are getting ready to talk through treatment choices. It walks through the main options, from skin creams to whole-body drugs, and the symptoms that need a call right away.

Cutaneous T-cell lymphoma is a lymphoma that affects your skin. Mycosis fungoides and Sézary syndrome are its two main forms. In Sézary syndrome, cancerous cells are also found circulating in your blood, not just your skin. Treatment ranges from skin-directed therapies for early disease to systemic drugs for more advanced or widespread disease. Systemic drugs work throughout the body, not just on the skin. Your team will match the intensity of treatment to how much of your body is affected.

This lymphoma typically moves through stages on the skin. It can start as flat patches. It can progress to raised plaques. In some cases, it develops into tumors. In Sézary syndrome, skin all over the body is red, itchy, peeling and painful. Cancer cells are also found in the blood. Knowing which stage and pattern you have shapes almost every treatment decision that follows.

For early or limited disease, treatment often starts on the skin itself. Corticosteroid creams calm inflammation. A retinoid medicine called bexarotene can slow the growth of certain cancer cells. It may be put on the skin or taken by mouth.

PUVA therapy combines a light-sensitizing drug called psoralen with ultraviolet A light exposure. Another approach, called extracorporeal photopheresis, removes some of your blood cells. It exposes them to UV light outside your body, then returns them to you. This can be used alone. It can also be combined with radiation therapy aimed at your entire skin surface.

Total skin electron beam therapy delivers radiation across your entire skin surface. It is useful when disease is widespread on the skin. In some cases, radiation is aimed at single skin lesions to ease symptoms. Ask your team which approach fits the extent of your disease.

Systemic options come into play when disease is more advanced. They are also used when disease has not responded to skin-directed treatments. These include chemotherapy drugs and interferon, a treatment that adjusts the immune system. HDAC inhibitors like vorinostat and romidepsin are options too. They cause a chemical change that stops tumor cells from dividing. Mogamulizumab is a monoclonal antibody, a lab-made immune protein. It attaches to a protein called CCR4 on some lymphoma cells. NCI lists it for disease that came back or did not get better after treatment.

Immune checkpoint inhibitors, including pembrolizumab, are being tested in clinical trials for cutaneous T-cell lymphoma. Ask your team whether a clinical trial might be a reasonable option for your specific situation.

Skin-directed treatments commonly cause irritation, redness, or dryness at the treated area. Systemic drugs bring a wider range of possible side effects. These include fatigue and effects on blood counts. They vary by which specific drug you receive. Ask your team what to expect from your particular treatment plan. This disease's treatments vary more than most.

Some symptoms during treatment need a call right away, not a wait for your next visit.

Fever. A fever of 100.4°F (38°C) or higher is the threshold CDC gives for infection during cancer treatment. Ring your care team as soon as you record it, at any hour, rather than waiting for office hours. If you are on chemotherapy or another systemic drug that pushes your blood counts down, treat that reading as a medical emergency. CDC says it may be the only sign of an infection, and infection during chemotherapy can be life-threatening. Should you not get through to the team quickly, head for an emergency department. Say on arrival that you are being treated for lymphoma. Ask your team which group your own treatment puts you in.

Skin problems. Also call for widespread skin breakdown, or signs of skin infection such as increasing warmth, redness, or drainage. Sudden worsening of your rash needs a call right away too. These need prompt evaluation, not a wait for your next scheduled visit.

• What stage and pattern of cutaneous T-cell lymphoma do I have?
• Would skin-directed treatment, light therapy, radiation, or a systemic drug fit my situation best?
• What side effects should I expect from my specific treatment, and which need a same-day call?
• Is a clinical trial a reasonable option for me?

• NCI PDQ — Mycosis Fungoides (Including Sézary Syndrome) Treatment (Patient Version)
• CDC — Fever and Cancer Treatment
• NCI — Infection and Neutropenia during Cancer Treatment