RESUMEN
Recent studies suggest that cells elaborating type 1 cytokines are important mediators of anti-tumor cell-mediated immunity in cutaneous T cell lymphoma. Type 1 cell-mediated immune responsiveness was assessed in 276 patients with cutaneous T cell lymphoma (mycosis fungoides and Sézary syndrome) using 2,4-dinitrochlorobenzene (DNCB) skin testing as part of the initial evaluation. The overall rate of sensitization after one and two DNCB challenges was 32% and 67%, respectively, which is much decreased compared with the expected rate of more than 95% for normal individuals. Moreover, the frequency of DNCB sensitization and allergic contact dermatitis to topically applied mechlorethamine decreased with advancing stage of disease. In addition to the expected strong correlation with stage, we observed that patients who were DNCB test positive were significantly less likely to experience disease progression and had a better overall prognosis compared with DNCB-negative patients. These results support the concept that cell-mediated responses are important in cutaneous T cell lymphoma, and that augmentation of these responses would be therapeutically beneficial.
Asunto(s)
Dinitroclorobenceno/farmacología , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad Tardía/inducido químicamente , Irritantes/farmacología , Linfoma Cutáneo de Células T/tratamiento farmacológico , Mecloretamina/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Administración Tópica , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Dinitroclorobenceno/administración & dosificación , Dinitroclorobenceno/inmunología , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/inmunología , Femenino , Humanos , Hipersensibilidad Tardía/inmunología , Irritantes/administración & dosificación , Linfoma Cutáneo de Células T/inmunología , Masculino , Mecloretamina/administración & dosificación , Mecloretamina/inmunología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Índice de Severidad de la Enfermedad , Piel/efectos de los fármacos , Piel/inmunología , Neoplasias Cutáneas/inmunología , Pruebas Cutáneas , Análisis de SupervivenciaRESUMEN
Ninety-two courses of daily low-dose intravenous nitrogen mustard were administered to 46 patients with advanced cutaneous lymphomas (mycosis fungoides, Sezary syndrome and lymphoma cutis). Seventy-eight % of patients showed objective clinical remission, and 35% reached a clinically disease-free state following 1 or more courses. The response rate was greater in patients with the plaque-tumor type of mycosis fungoides than in those with erythrodermic variants. Therapy was free of significant side effects.