Clinical Characteristics and Long-term Outcome of Patients With Generalized Patch and/or Plaque (T2) Mycosis Fungoides

Objectives To study the long-term results of treatment of patients with generalized patch and/or plaque mycosis fungoides and to identify clinical characteristics predictive of survival and response to treatment. Design A single-center, 35.5-year retrospective cohort analysis. Setting Private referral medical center. Patients One hundred seventy-six patients with generalized patch and/or plaque (T2) mycosis fungoides. Main Outcome Measures Long-term actuarial survival and freedom-from-relapse results as calculated by the Kaplan-Meier method. Results The long-term (35.5-year) survival of patients with T2 mycosis fungoides is worse than the expected survival of a race-, age-, and sex-matched control population ( P P P P Conclusions A significant proportion (24%) of patients with generalized patch and/or plaque (T2) mycosis fungoides experience disease progression to a more advanced clinical stage, and nearly 20% eventually die of the disease. Younger patients have a more favorable disease-specific long-term outcome than patients who are older. Presence of lymphadenopathy (stage IIA) at diagnosis does not predict worse long-term survival outcome. Clinical features predictive of disease progression include initial lymphadenopathy (stage IIA) and lack of complete response to initial treatment. Despite superior complete response rate to a 30-Gy or higher dose of total skin electron beam therapy, topical mechlorethamine proves to be a cost-effective initial treatment for patients with T2 disease. The concept of an adjuvant therapy after irradiation is appealing, although it may not lead to improved long-term survival.