Management of Mycosis Fungoides with Topical Chlormethine/Mechlorethamine Gel: A Columbia University Cutaneous Lymphoma Center Experience
DOI:
https://doi.org/10.2340/00015555-3911Keywords:
cutaneous T-cell lymphoma, mycosis fungoides, chlormethine, mechlorethamine, prescription drug management, chemotherapeuticsAbstract
Mycosis fungoides is a type of cutaneous T-cell lymphoma, which accounts for the majority of cases of cutaneous T-cell lymphoma. Mycosis fungoides can be classified as early-stage (IA–IIA) or late-stage (IIB or greater) disease. In early-stage mycosis fungoides, skin-directed therapies are commonly used to manage the disease. Chlormethine, or mechlorethamine, is a topical chemotherapeutic, which has been in use for over 60 years. In 2013, the US Food and Drug Administration approved chlormethine/mechlorethamine gel (Valchlor®) for treatment of stage IA and IB mycosis fungoides. Chlormethine/mechlorethamine gel is an effective therapy; however, its use may be limited by the development of adverse cutaneous reactions. Off-label dosing modifications, as well as co-administration of topical steroids and an aggressive moisturization regimen, can be used to reduce these side-effects. We report here 4 cases of mycosis fungoides treated with chlormethine/mechlorethamine gel at the Comprehensive Skin Cancer Center at Columbia University Irving Medical Center, which provide insights into the use of this therapy in clinical practice.
Downloads
References
Denis D, Beneton N, Laribi K, Maillard H. Management of mycosis fungoides-type cutaneous T-cell lymphoma (MF): focus on chlormethine gel. Cancer Manag Res 2019; 11: 2241–2251.
Esteve E, Bagot M, Joly P, Souteyrand P, Beylot-Barry M, Vaillant L, et al. A prospective study of cutaneous intolerance to topical mechlorethamine therapy in patients with cutaneous T-cell lymphomas. French Study Group of Cutaneous Lymphomas. Arch Dermatol 1999; 135: 1349–1353.
Ramsay DL, Halperin PS, Zeleniuch-Jacquotte A. Topical mechlorethamine therapy for early stage mycosis fungoides. J Am Acad Dermatol 1988; 19: 684–691.
Vonderheid EC, Tan ET, Kantor AF, Shrager L, Micaily B, Van Scott EJ, et al. Long-term efficacy, curative potential, and carcinogenicity of topical mechlorethamine chemotherapy in cutaneous T cell lymphoma. J Am Acad Dermatol 1989; 20: 416–428.
Kim YH, Martinez G, Varghese A, Hoppe RT. Topical nitrogen mustard in the management of mycosis fungoides: update of the Stanford experience. Arch Dermatol 2003; 139: 165–173.
Tang L, Cao L, Bernardo O, Chen Y, Sundberg JP, Lui H, et al. Topical mechlorethamine restores autoimmune-arrested follicular activity in mice with an alopecia areata-like disease by targeting infiltrated lymphocytes. J Invest Dermatol 2003; 120: 400–406.
Lessin SR, Duvic M, Guitart J, Pandya AG, Strober BE, Olsen EA, et al. Topical chemotherapy in cutaneous T-cell lymphoma: positive results of a randomized, controlled, multi-center trial testing the efficacy and safety of a novel mechlorethamine, 0.02%, gel in mycosis fungoides. JAMA Dermatol 2013; 149: 25–32.
Trautinger F, Knobler R, Willemze R, Peris K, Stadler R, Laroche L, et al. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome. Eur J Cancer 2006; 42: 1014–1030.
Talpur R, Venkatarajan S, Duvic M. Mechlorethamine gel for the topical treatment of stage IA and IB mycosis fungoides-type cutaneous T-cell lymphoma. Expert Rev Clin Pharmacol 2014; 7: 591–S97.
Gilmore ES, Alexander-Savino CV, Chung CG, Poligone B. Evaluation and management of patients with early-stage mycosis fungoides who interrupt or discontinue topical mechlorethamine gel because of dermatitis. JAAD Case Rep 2020; 6: 878–881.
Kim EJ, Geskin L, Guitart J, Querfeld C, Girardi M, Musiek A, et al. Real-world experience with mechlorethamine gel in patients with mycosis fungoides-cutaneous lymphoma: preliminary findings from a prospective observational study. J Am Acad Dermatol 2020; 83: 928–930.
Geskin LJ, Kim EJ, Angello JT, Kim YH. Evaluating the treatment patterns of chlormethine/mechlorethamine gel in patients with Stage I-IIA mycosis fungoides: by-time reanalysis of a randomized controlled phase 2 study. Clin Lymphoma Myeloma Leuk 2021; 21: 119–124.
Duffy R, Jennings T, Sahu J. Mechlorethamine gel usage in patients with mycosis fungoides in a lymphoma clinic. Indian J Dermatol 2020; 65: 237–239.
Gutman AB, Kligman AM, Sciacca J, James WD. Soak and smear: a standard technique revisited. Arch Dermatol 2005; 141: 1556–1159.
Nagoba BS, Suryawanshi NM, Wadher B, Selkar S. Acidic environment and wound healing: a review. Wounds 2015; 27: 5–11.
de Quatrebarbes J, Esteve E, Bagot M, Bernard P, Beylot-Barry M, Delaunay M, et al. Treatment of early-stage mycosis fungoides with twice-weekly applications of mechlorethamine and topical corticosteroids: a prospective study. Arch Dermatol 2005; 141: 1117–1120.
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2021 Tiffany J. Garcia-Saleem, Connor J. Stonesifer, Alexandra E. Khaleel, Larisa J. Geskin
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
