Cutaneous lymphoma

Treatment

Seattle Cancer Care Alliance (SCCA) is one of few centers in the United States that has experience treating cutaneous lymphoma and specializes in providing novel therapies and clinical studies for this rare disease. Patients are referred to SCCA for our collaborative efforts between research and clinical studies for peripheral (systemic) and cutaneous T-cell lymphomas in general, as well as specific subtypes, bringing focus to this challenging disease.

SCCA's Cutaneous Lymphoma Specialty Clinic is a multidisciplinary clinic that brings together a team of specialists from dermatology, pathology, oncology, and radiation oncology to comprehensively evaluate and treat cutaneous lymphoma. Treatment options depend on the kind of lymphoma, including its location and stage, as well as other factors, such as overall health.

Dr. Ajay Gopal discusses treatment options for cutaneous lymphoma.

Treatment types

Several types of treatment can be used against skin lymphoma. These are generally divided into treatments directed at the skin and treatments that can affect the whole body (systemic treatments). Sometimes these two types of treatments are used together. In addition, because it is a chronic disease, many patients are treated with multiple therapies in their lifetime.

Many patients live normal lives while being treated for cutaneous lymphoma and some are able to remain in remission for long periods of time. It is important to discuss all of your treatment options as well as their possible side effects with your doctors to help make the decision that best fits your needs.

Recurrent (or relapsed) cutaneous lymphoma

Some lymphomas may not respond well to treatment. When a cancer returns after treatment it is called recurrent or relapsed. In general, cutaneous lymphomas come back in the skin. Additional treatments may be tried and may be effective for a time.

Treatments for mycosis fungoides and Sezary syndrome may help patients, sometimes for years, but they are rarely cured.

Patients with recurrent disease that is no longer responding to treatment may want to consider entering a clinical study.

Recurrent (or relapsed) cutaneous lymphoma

Some lymphomas may not respond well to treatment. When a cancer returns after treatment it is called recurrent or relapsed. In general, cutaneous lymphomas come back in the skin. Additional treatments may be tried and may be effective for a time.

Whole-body treatments

Systemic treatments, which enter the bloodstream and go throughout the body, are most useful for more advanced or aggressive disease. Systemic treatments include:

Photoimmune therapy (photopheresis)

Phtopheresis may be used for T cell lymphomas, especially Sezary syndrome. In this procedure your blood is pushed through a machine that separates and treats your lymphocytes with a drug and UV light. This method may kill some lymphoma cells and boost your immune system to kill other lymphoma cells. Photopheresis is typically well tolerated with relatively few side effects. The main side effect is sensitivity to sunlight for about one day after your treatment.

Inteferons

Interferons are substances that are produced by the immune system to help fight infections and a variety of cancers. They are administered by injection, typically into the abdomen or thigh, and can be combined with other therapies including photopheresis and retinoids. Potential side effects include flu-like symptoms, low blood counts, and auto-immune conditions, like thyroid problems.

Targeted therapies

These newer drugs that are designed to target specific parts of cancer cells or to boost your immune system to attack cancer cells. Targeted therapies used in treating cutaneous lymphomas include: vorinostat (Zolinza), romidepsin (Istodax), bortezomib (Velcade), denileukin diftitox (Ontak), rituximab (Rituxan), alemtuzumab (Campath). The side effects of these drugs are typically different, and often milder, than chemotherapy.

Retinoids

Used to treat a variety of skin diseases, retinoids may be given as a topical treatment or as a pill for more extensive lymphomas. Potential side effects depend on the type and dose of treatment and may include elevated blood sugar and/or fat levels, mood changes, thyroid problems, and eye problems. Retinoids may cause serious birth defects and should never be used by a woman who is pregnant or may become pregnant.

Chemotherapy

Not often used for cutaneous lymphoma, chemotherapy may be used when the disease is advanced or when other treatments are no longer working. It may also be useful when the disease has spread to the lymph nodes or other organs and tissues. It may be given alone or in combination with other chemotherapy or targeted drugs. Chemotherapies that may be used include: high dose methotrexate, pentostatin (Nipent), fludarabine (Fludara), liposomal doxorubicin (Doxil), gemcitabine (Gemzar), cyclophosphamide (Cytoxan), and a combination chemotherapy regimen known as CHOP (cyclophosphamide, adriamycin, vincristine, and prednisone).

There are a number of side effects associated with chemotherapy. The side effects vary greatly from person to person and depend on the type and dose of drug(s) given, how they are given, and the length of time they are taken. Some people experience few, if any, side effects. Your doctor may give you medicines to help protect your body’s normal cells and lessen the severity of side effects or prevent them before they happen. The time it takes to get over some side effects and regain energy depends on many factors, including your overall health and the drugs you were given. 

Whole-body treatments

Systemic treatments, which enter the bloodstream and go throughout the body, are most useful for more advanced or aggressive disease. 

High-dose chemotherapy with bone marrow transplant (BMT)

BMT may be used to treat cutaneous lymphoma on rare occasions. It is typically used only when other treatments are no longer working. This therapy uses high doses of chemotherapy and/or radiation to destroy both the healthy and cancerous blood cells in the bone marrow. Stem cells are then transplanted to travel to the marrow and begin making new blood cells. A bone marrow transplant is a complex treatment, with a number of potential complications and side effects.

High-dose chemotherapy with bone marrow transplant (BMT)

BMT may be used to treat cutaneous lymphoma on rare occasions. It is typically used only when other treatments are no longer working. 

Skin directed treatments

In many cases, initial treatment of skin lymphoma involves treating the skin tumors directly, while trying to avoid harmful side effects on the rest of the body. Skin-directed treatments include:

Surgery

Surgery may be used to obtain a biopsy sample or, when there are few lesions, to completely remove the lesion(s). It is usually combined with other therapies.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Electron beam radiation is used most often for cutaneous lymphomas. The electrons only penetrate the skin, minimizing side effects to other organs and tissues. The possible side effects include skin irritation (sunburn-like symptoms, itching, dry skin) and fatigue.

Phototherapy

Phototherapy uses ultraviolet (UV) light to kill cancer cells in the skin. It may be combined with a drug, psoralen, that increases the activity of the UV light. This treatment, called PUVA, is given about three times per week. Potential side effects include nausea (from psoralen), sensitivity to sunlight, and sunburn-like symptoms.

Topical Medicines

Topical medicines, including steroids, chemotherapies, retinoids, and immune therapies, are applied directly to the skin. When applied topically to the skin, the effects are concentrated on the spot where applied minimizing side effects to other areas of the body. Possible side effects may occur in the area where the medicine is applied. The side effects depend on the type of topical therapy and may include thinning of the skin, skin irritations (rashes, itching), bruising easily, and dilated blood vessels.

Skin directed treatments

In many cases, initial treatment of skin lymphoma involves treating the skin tumors directly, while trying to avoid harmful side effects on the rest of the body.