Durable loss of a malignant T-cell clone in a stage IV cutaneous T-cell lymphoma patient treated with high-dose interferon and photopheresis

Stage IV cutaneous T-cell lymphoma (CTCL) has a notoriously poor prognosis and many treatment options stage IV CTCL with combination photopheresis and exist. We describe the successful treatment of a case of stage high-dose interferon alfa (IFN alpha). The patient was treated with combination therapy of monthly photopheresis and daily doses of IFN alpha up to 36 MU. Response to therapy was followed by clinical observation and Southern blot analysis for the detection of a malignant clone. The findings of this case were compared with others using a computer-based literature review A complete clinical response lasting 64 months was achieved. Clinical relapse was preceded by an increase in the CD4/CD8 ratio and by reappearance of the T-cell receptor gene rearrangement. Combined photopheresis and high-dose IFN alpha led to a durable and sustained complete response in stage IV CTCL. CD4/CD8 ratios and T-cell gene rearrangements may be helpful in patient management.