Extracorporeal photochemotherapy--the Columbia Presbyterian experience

Cutaneous T Cell Lymphoma (CTCL) is a lymphoma of skin homing usually CD4 + lymphocytes. There are numerous treatments available both for the early as well as the more advanced stages of the disease. Extracorporeal photochemotherapy is a well-accepted form of treating CTCL. The purpose of our study was to review the experience of treating 20 CTCL patients with extracorporeal photochemotherapy (ECP) at Columbia Presbyterian Medical Center over a seven-year period.

The study was conducted as a retrospective chart review of these 20 patients. Summarized demographic characteristics included age at diagnosis, gender, and race. We analyzed the overall response by categorizing patients as having complete response, partial response, stable disease, and progressive disease. We also analysed the predictive value for three factors: peripheral blood CD4 : CD8 (< 10, > 10), LDH level (normal, elevated), and erythrodermic status (erythrodermic or nonerythrodermic). The potential prognostic variables were evaluated for linear association with response using Mantel-Haenszel chi-square tests. All statistical tests were two-sided with alpha = 0.05. The tests were considered to be exploratory and no adjustments for multiple testing were made.

There was a significant linear association between response and CD4 : CD8. Patients with a ratio < 10 were more likely to respond than patients with a ratio > 10. There was a marginally significant linear association between response and LDH level. Patients whose LDH was not elevated at the start of treatment, tended to have a better response to ECP compared to patients with an elevated LDH. There was a suggestion of an association between erythroderma and response although this was not statistically significant. The majority of patients with erythroderma were responders compared to the majority of non-erythrodermic patients who were non-responders. The treatment was well tolerated with minimal side-effects.

Apparent predictors of good response to ECP include erythroderma, a relatively low (closer to normal) peripheral CD4 : CD8, and a normal LDH. This report confirms reports from other institutions indicating that CTCL patients who are erythrodermic with a relatively intact immune system are optimal candidates for ECP.