Maintenance phase in PUVA phototherapy of early stage mycosis fungoides. A critically appraised topic

Summary

A 65-years-old patient affected by mycosis fungoides stage IB achieved complete remission after a cycle of PUVA phototherapy. As suggested by USCLC guidelines¹, the patient should be kept in maintenance phase, defined as "period of gradual decrease of frequency of UVL while in clinical remission before discontinuation of phototherapy" by slowly tapering the number of PUVA applications over time up to clinical relapse. USCLC also suggest a standardized schedule for maintenance phase (table 1). Alternatively, the patient could end PUVA therapy and go straight to follow up. The aim of this Critically Appraised Topic (CAT) is to determine if a maintenance phase gives a significant benefit in terms of Relapse Rate (RR) and Relapse Free Interval (RFI) in patients affected by early stages of mycosis fungoides who had achieved Complete Remission under PUVA phototherapy. Embase, Pubmed and TRIP databases were searched for ("mycosis fungoides") AND ((("photochemotherapy") OR "puva") OR "psoralen") in June 2016. Three articles matched our inclusion criteria and have been discussed in this CAT. In this field of research literature is poor and the reported level of evidence is low. Only one of the studies was conducted prospectively, and none were randomised. No significant difference in terms of reduction of relapses or increase in RFI in patients who underwent PUVA maintenance phase emerged when compared to those who went simple follow up. Further Randomized Clinical Trials (RCTs) are required in order to evaluate maintenance phase versus no treatment before it can be favoured as a standard protocol of treatment in early stage mycosis fungoides. At the time of writing this paper, we report an ongoing Austrian multicentre RCT (Clinical Trial. gov identifier: NCT01686594) that will hopefully give useful results in this topic.

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