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• Hematologic Malignancies Program

• Diagnosis and Treatment...
• Physicians and Staff
• Q&A with Dr. Maria Baer
• Patient Education...
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• Clinical Trials
• Information for Patients

Hematologic Malignancies Program

Patient and Family Education

Cutaneous T-Cell Lymphoma

Stages and Treatment

If a patient has cutaneous T-cell lymphoma, the doctor will do more tests to find out if cancer cells have spread from the lungs to other parts of the body. This process is called staging and it is used to help the doctor plan treatment. The following stages are used to describe cutaneous T-cell lymphoma:

Stage I: The cancer only affects parts of the skin, which has red, dry, scaly patches, but no tumors. The lymph nodes are not larger than normal. Treatment may be one of the following:

• Phototherapy (PUVA therapy) with or without biological therapy
• Total skin electron beam radiation therapy (TSEB radiation therapy)
• Topical chemotherapy
• Local electron beam or x-ray therapy to reduce the size of the tumor or to relieve symptoms
• Clinical trials of phototherapy
• Interferon alfa (biological therapy) alone or in combination with topical therapy

Stage II: Either of the following may be true:

• The patient's skin has red, dry, scaly patches, but no tumors. Lymph nodes are larger than normal, but they do not contain cancer cells.
• The patient has tumors on his or her skin. The lymph nodes are either normal or are larger than normal, but they do not contain cancer cells.

Treatment may be one of the following:

• Phototherapy (PUVA therapy) with or without biological therapy
• Total skin electron beam radiation therapy (TSEB radiation therapy)
• Topical chemotherapy
• Local electron beam or x-ray therapy
• Interferon alfa (biological therapy) alone or in combination with topical therapy

Stage III: Nearly all of the skin is red, dry, and scaly. The lymph nodes are either normal or larger than normal, but they do not contain cancer cells. Treatment may be one of the following:

• Phototherapy (PUVA therapy) with or without biological therapy
• Total skin electron beam radiation therapy (TSEB radiation therapy)
• Topical chemotherapy
• Local electron beam or x-ray therapy
• Systemic chemotherapy with or without therapy to the skin
• Chemotherapy for mycosis fungoides and Sezary syndrome
• Extracorporeal photochemotherapy
• Interferon alfa (biological therapy) alone or in combination with topical therapy
• Retinoids

Stage IV: The skin is involved, in addition to either of the following:

• Cancer cells are found in the lymph nodes.
• Cancer has spread to other organs, such as the liver or lungs.

Treatment may be one of the following:

• Systemic chemotherapy
• Topical chemotherapy
• Total skin electron beam radiation therapy (TSEB radiation therapy)
• Phototherapy (PUVA therapy) with or without biological therapy
• Local electron beam or x-ray therapy
• Chemotherapy for mycosis fungoides and Sezary syndrome
• Extracorporeal photochemotherapy
• Interferon alfa (biological therapy) alone or in combination with topical therapy
• Monoclonal antibody therapy
• Retinoids

Recurrent: Recurrent cancer is cancer that has come back after it has been treated. It may come back where it started or in another part of the body. Treatment may be one of the following:

• Local electron beam or x-ray therapy
• Total skin electron beam radiation therapy (TSEB radiation therapy)
• Phototherapy (PUVA therapy)
• Topical chemotherapy
• Systemic chemotherapy
• Extracorporeal photochemotherapy
• Clinical trials of biological therapy
• Clinical trials of bone marrow transplantation

About the Treatments

There are three primary treatment options for patients with cutaneous T-cell lymphoma: radiation therapy, chemotherapy, and phototherapy. Biological therapy and bone marrow transplants are being tested in clinical trials.

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. In cutaneous T-cell lymphoma, special rays of tiny particles called electrons are commonly used to treat all of the skin. This is called total skin electron beam (TSEB) radiation therapy.

Electron beam radiation may also be given to smaller areas of the skin. This kind of radiation only goes into the outer layers of the skin. Another type of radiation uses x-rays to kill cancer cells. The x-rays are usually directed to only certain areas of the body, but sometimes x-rays are directed at the whole body (total body irradiation).

The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles; a treatment period is followed by a recovery period, then another treatment period, and so on. However, in cutaneous T-cell lymphoma, chemotherapy drugs may be given in a cream or lotion put on the skin. This is called topical chemotherapy.

Chemotherapy drugs generally fight rapidly dividing cells in the body. Cells that divide rapidly include both the targeted cancer cells and healthy cells in the blood, digestive tract, and hair follicles. Depending on which anticancer drugs a patient receives, he or she may experience symptoms when healthy cells are damaged along with the cancer cells. If healthy blood cells are destroyed by chemotherapy, the patient may be more susceptible to infections, bruising or bleeding, and fatigue. When cells in the hair roots or digestive tract are affected by anticancer drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not all chemotherapy patients develop all of these side effects, and the symptoms usually go away during the recovery period or after the treatments are done. Doctors can prescribe medicines and other treatments to control most of the symptoms.

Phototherapy

Phototherapy uses light to kill cancer cells. A drug that makes cancer cells sensitive to light is given to the patient and then a special light is used to shine on the cancer cells to kill them. In one type of phototherapy, called PUVA therapy, a patient receives a drug called psoralen, and then ultraviolet light is shone on the skin. In another type of phototherapy, called extracorporeal photochemotherapy, the patient is given drugs. Then some blood cells are taken from the body, put under a special light, and put back into the body.

Biological Therapy

Biological therapy tries to get the body to fight cancer cells. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Bone Marrow Transplant

A bone marrow transplant is a treatment in which a patient's diseased bone marrow is replaced with healthy bone marrow. A bone marrow transplant using marrow from a relative or person not related to the patient is called an allogeneic bone marrow transplant:

• First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy.
• Healthy marrow is then taken from another person (a donor) whose tissue is the same or almost the same as that of the patient. The donor may be a twin (the best match), a brother or sister, or a person who is not related.
• The healthy marrow from the donor is then given to the patient through a needle in the vein, and the new marrow replaces the original marrow that was destroyed.

Another type of bone marrow transplant, called an autologous bone marrow transplant, is being studied in clinical trials:

• First, bone marrow is taken from the patient and treated with drugs to kill any cancer cells.
• The treated marrow taken from the patient is then frozen and saved.
• Next, high-dose chemotherapy is given to the patient with or without radiation therapy to destroy all of the remaining marrow.
• The frozen, treated marrow is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.

Another type of autologous transplant is called a peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns the blood to the patient. This procedure is called leukapheresis and usually takes three or four hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to the patient. This procedure may be done alone or with an autologous bone marrow transplant.

Patients have a greater chance of recovery if they are treated in a hospital that does more than five bone marrow transplants a year.

This page was last updated on: October 7, 2009.

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