First-line treatment in lymphomatoid papulosis: a retrospective multicentre study.
Por:
Fernández-de-Misa R, Hernández-Machín B, Servitje O, Valentí-Medina F, Maroñas-Jiménez L, Ortiz-Romero PL, Sánchez Schmidt J, Pujol RM, Gallardo F, Pau-Charles I, García Muret MP, Pérez Gala S, Román C, Cañueto J, Blanch Rius L, Izu R, Ortiz-Brugués A, Martí RM, Blanes M, Morillo M, Sánchez P, Peñate Y, Bastida J, Pérez Gil A, Lopez-Lerma I, Muniesa C and Estrach T
Publicada:
1 mar 2018
Ahead of Print:
10 oct 2017
Categoría:
Dermatology
Resumen:
BACKGROUND: Data regarding response to treatment in lymphomatoid papulosis (LyP) are scarce. AIM: To assess the daily clinical practice approach to LyP and the response to first-line treatments. METHODS: This was a retrospective study enrolling 252 patients with LyP. RESULTS: Topical steroids, methotrexate and phototherapy were the most common first-line treatments, prescribed for 35%, 20% and 14% of the patients, respectively. Complete response (CR) was achieved in 48% of treated patients. Eczematous lesions significantly increased relative risk (RR) of not achieving CR (RR = 1.76; 95% CI 1.16-2.11). Overall median time to CR was 10 months (95% CI 6-13 months), and 78% of complete responders showed cutaneous relapse; both results were similar for all treatment groups (P > 0.05). Overall estimated median disease-free survival (DFS) was 11 months (95% CI 9-13 months) but DFS for patients treated with phototherapy was 23 months (95% CI 10-36 months; P < 0.03). Having the Type A LyP variant (RR = 2.04; 95% CI 0.96-4.30) and receiving a first-line treatment other than phototherapy (RR = 5.33; 95% CI 0.84-33.89) were significantly associated with cutaneous early relapse. Of the 252 patients, 31 (13%) had associated mycosis fungoides unrelated to therapeutic approach, type of LyP or T-cell receptor clonality. CONCLUSIONS: Current epidemiological, clinical and pathological data support previous results. Topical steroids, phototherapy and methotrexate are the most frequently prescribed first-line treatments. Although CR and cutaneous relapse rates do not differ between them, phototherapy achieves a longer DFS. Presence of Type A LyP and use of topical steroid or methotrexate were associated with an increased risk of early relapse.
Filiaciones:
Fernández-de-Misa R:
Department of Dermatology and Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
Hernández-Machín B:
Department of Dermatology, Clínica Buenaderma, Las Palmas de Gran Canaria, Spain
Servitje O:
Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
Valentí-Medina F:
Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
Maroñas-Jiménez L:
Department of Dermatology, Hospital Universitario 12 de Octubre, i+12 Research Institute, Universidad Complutense Madrid, Madrid, Spain
Ortiz-Romero PL:
Department of Dermatology, Hospital Universitario 12 de Octubre, i+12 Research Institute, Universidad Complutense Madrid, Madrid, Spain
Sánchez Schmidt J:
Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
Pujol RM:
Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
Gallardo F:
Department of Dermatology, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, Spain
Pau-Charles I:
Department of Dermatology, Hospital Clínico, University of Barcelona, IDIBAPS, Barcelona, Spain
García Muret MP:
Department of Dermatology, Hospital Santa Creu i Sant Pau, UAB, Barcelona, Spain
Pérez Gala S:
Department of Dermatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
Román C:
Department of Dermatology, Hospital Universitario de Salamanca, Salamanca, Spain
Cañueto J:
Department of Dermatology, Hospital Universitario de Salamanca, Salamanca, Spain
Blanch Rius L:
Department of Dermatology, Hospital de Basurto, Bilbao, Spain
Izu R:
Department of Dermatology, Hospital de Basurto, Bilbao, Spain
Ortiz-Brugués A:
Department of Dermatology, IRBLleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
Martí RM:
Department of Dermatology, IRBLleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
:
Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain
Morillo M:
Department of Dermatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Sánchez P:
Department of Dermatology, Hospital de León, León, Spain
Peñate Y:
Department of Dermatology, Complejo Hospitalario Universitario Insular Materno-Infantil, Gran Canaria, Las Palmas de Gran Canaria, Spain
Bastida J:
Department of Dermatology, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
Pérez Gil A:
Department of Dermatology, Hospital Virgen de Valme, Sevilla, Spain
Lopez-Lerma I:
Department of Dermatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Muniesa C:
Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
Estrach T:
Department of Dermatology, Hospital Clínico, University of Barcelona, IDIBAPS, Barcelona, Spain
Green Accepted
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