Is PUVA maintenance therapy necessary in patients with early-stage mycosis fungoides? Evaluation of a treatment guideline over a 28-month follow-up.

BACKGROUND: Cutaneous T-cell lymphoma is a rare condition that represents 2% of all lymphomas and 75-80% of primary cutaneous lymphomas. The objective of the present study is to evaluate a clinical practice guideline.
METHODS: This paper reports a prospective cohort study with a five-year follow-up. This is the second report to describe the analysis of data obtained during follow-up of 28 months. To date, 40 patients diagnosed with early-stage mycosis fungoides (stage IA, n = 20; stage IB, n = 20) have been enrolled. All patients have been treated with a minimum of 58 sessions of psoralen and long-wave ultraviolet radiation, with complete clinical and histological clearance of lesions. Variables considered include disease duration, treatment time, treatment dose, and history of relapse. Complete physical examinations and diverse complementary examinations were performed. A tumor-node-metastasis-blood staging system was applied. The population was divided into two groups according to results consisting, respectively, of those who relapsed during follow-up (n = 12) and those who did not (n = 28).
RESULTS: History of relapse was the variable most strongly associated with future relapse (relative risk = 10.38, 95% confidence interval 2.64-40.72). No statistically significant difference between the groups according to receipt of maintenance therapy was found (P = 0.161).
CONCLUSIONS: Our results strongly suggest that maintenance therapy does not prevent future relapse. However, history of relapse is a strong predictor for future relapse.