Leukapheresis in the treatment of Sézary syndrome

Five patients received leukapheresis therapy for Sézary syndrome. All patients had erythroderma, lymphocytic band infiltration of the skin, and a normal white blood cell count with an absolute Sézary cell count of more than 1,000/mm3. Improvement in 3 to 6 months occurred, usually with the addition of a combined regimen of prednisone and low-dose chlorambucil therapy. One patient had sustained improvement with repeated leukapheresis for more than 2 years. The two patients who showed a major response were the youngest patients, who had normal karyotypes, normal delayed-hypersensitivity skin tests, and a quantitative response of the Sézary cells and the T and B cells to leukapheresis. These preliminary results suggest that there may be selected patients for whom leukapheresis is useful therapy and that it is possible to perform the procedure safely in patients with normal white blood cell counts.