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Review
. 2021 Mar 11:3:26-41.
doi: 10.1016/j.jdin.2021.01.002. eCollection 2021 Jun.

Topical treatments for early-stage mycosis fungoides using Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria: A systematic review

Ebba Wennberg  1 , Phillip Q Richards  2 , Paul A Bain  3 , Victor Huang  4 , Sydney D Sullivan  4 , Emanual M Maverakis  4 , Gabriel E Molina  5 , Peggy A Wu  4
Affiliations
Review

Topical treatments for early-stage mycosis fungoides using Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria: A systematic review

Ebba Wennberg et al. JAAD Int. .

Abstract

Background: Mycosis fungoides (MF) is a cutaneous lymphoma; most patients present with early, skin-limited disease and are managed by dermatologists.

Objective: The purpose of this study was to systematically review and assess the evidence on topical treatments for early-stage (IA, IB, IIA) MF.

Methods: We performed a literature search via MEDLINE, Embase, Web of Science, and Cochrane databases. Grading Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to assess the certainty of the data.

Results: Two searches yielded 1252 references; 26 met the inclusion criteria and included literature on nitrogen mustard, retinoids, corticosteroids, carmustine, fluorouracil, methotrexate-laurocapram, hexadecylphosphocholine, peldesine, ingenol mebutate, topical methotrexate with oxygen flow-assisted LP3 carrier, and resiquimod. Most studies were single intervention, observational series. Nitrogen mustard, with the most published reports, was effective with 12%-82% early-stage MF patients (total n > 1000) achieving complete remission (CR) (low certainty evidence). Clinical CR was achieved among 10%-60% treated with topical retinoids (low certainty evidence). Two moderate-sized retrospective case series on topical steroids had 18%-63% CR (low certainty evidence). Only single studies were available for the other therapies.

Conclusions: For most outcomes of interest, the GRADE certainty for topical therapies for early-stage MF was low. Further randomized controlled trials and inclusion of quality of life indicators are needed.

Keywords: 5FU, topical fluorouracil; BAD, British Association of Dermatologists; CR, complete remission; GRADE; GRADE, Grading Recommendations Assessment, Development and Evaluation; MF, mycosis fungoides; NCCN, National Comprehensive Cancer Network; OFA-LP3, oxygen flow-assisted LP3 carrier; PR, partial remission; RCT, randomized, controlled, blinded trial; UK, United Kingdom; WHO-EORTC, World Health Organization-European Organisation for Research and Treatment of Cancer; corticosteroids; mycosis fungoides; nitrogen mustard; retinoids; topical treatments.

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Conflict of interest statement

None disclosed.

Figures

Fig 1
Fig 1
PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) diagram of topical treatments for early-stage mycosis fungoides.
See this image and copyright information in PMC

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References

    1. Olsen E., Vonderheid E., Pimpinelli N. Revisions to the staging and classification of mycosis fungoides and Sezary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC) Blood. 2007;110(6):1713–1722. - PubMed
    1. Kim Y., Liu H., Mraz-Gernhard S. Long-term outcome of 525 patients with mycosis fungoides and Sezary syndrome: clinical prognostic factors and risk for disease progression. Arch Dermatol. 2003;139(7):857–866. - PubMed
    1. Quaglino P., Pimpinelli N., Berti E. Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides: a multicenter, retrospective follow-up study from the Italian Group of Cutaneous Lymphomas. Cancer. 2012;118(23):5830–5839. - PubMed
    1. Xia F., Ferket B., Huang V. Local radiation and phototherapy are the most cost-effective treatments for stage IA mycosis fungoides: a comparative decision analysis model in the United States. J Am Acad Dermatol. 2019;80(2):485–492. - PubMed
    1. Gilson D., Whittaker S.J., Child F.J. British Association of Dermatologists and U.K. Cutaneous Lymphoma Group guidelines for the management of primary cutaneous lymphomas 2018. Br J Dermatol. 2019;180(3):496–526. - PubMed