Outcomes of extracorporeal photopheresis in a diverse cohort of patients with cutaneous T-cell lymphoma: a retrospective study at a tertiary care hospital

Figures & data

Table 1. Demographic characteristics and response to extracorporeal photopheresis, stratified by race (n = 42).

	Black (n = 20)	White (n = 22)	P value
Age at start of ECP, years, Median (range)	55.0 (24.9–86.9)	62.0 (39.0–84.5)	p = 0.14
Sex, n (%)			p = 0.13
Male	6 (30.0)	12 (54.5)
Female	14 (70.0)	10 (45.5)
BMI, Median (range)	26.9 (17.6–41.7)	27.3 (20.6–43.8)	p = 0.98
Previous single/multi-agent chemotherapy, n (%)			p = 1.00
No	18 (90.0)	22 (95.5)
Yes	2 (10.0)	1 (4.5)
Previous immunotherapy, n (%)			p = 1.00
No	17 (77.3)	19 (86.3)
Yes	3 (15.0)	3 (13.6)
Overall stage at diagnosis, n (%)			p = 0.22
Early-stage CTCL (IA-IIA)	12 (60.0)	8 (36.0)
Advanced-stage CTCL (IIB-IVB)	8 (40.0)	14 (64.0)
Overall stage at ECP start, n (%)			p = 0.45
Early-stage CTCL (IA-IIA)	3 (15.0)	6 (27.0)
Advanced-stage CTCL (IIB-IVB)	17 (85.0)	15 (68.0)
Unknown	–	1 (5.0)
Overall stage at start of ECP, n (%)			p = 0.13
IA	1 (5.0)	–
IB	1 (5.0)	5 (22.7)
IIA	1 (5.0)	1 (4.5)
IIB	2 (10.0)	–
IIIA	3 (15.0)	1 (4.5)
IIIB	2 (10.0)	–
IVA1	9 (45.0)	12 (55.5)
IVA2	1 (5.0)	2 (9.0)
Unknown	–	1 (4.5)
Progression from early (IA-IIA) to late (IIB-IVB) stage prior to ECP, n (%)			p = 0.27
Yes	6 (30.0)	3 (13.6)
No	14 (70.0)	19 (86.4)
B stage at ECP start, n (%)			p = 0.45
B0	6 (30.0)	3 (13.6)
B1	4 (20.0)	4 (18.2)
B2	10 (50.0)	14 (63.6)
Unknown	–	1 (5.0)
Months to start ECP from diagnosis, Median (range)	16.5 (0–185)	2.8 (0–140)	p = 0.16
ECP usage, n (%)			p = 0.52
1st line treatment	12 (60.0)	16 (72.7)
2nd line treatment or later	8 (40.0)	6 (27.7)
Concomitant systemic medications, n (%)
Interferon	11 (55.0)	11 (50.0)	p = 0.77
Methotrexate	0 (0.0)	2 (9.1)	p = 0.49
Oral bexarotene	12 (60.0)	11 (50.0)	p = 0.55
HDAC inhibitor	1 (5.0)	4 (18.2)	p = 0.35
Doxorubicin	0 (0.0)	1 (4.5)	p = 1.00
ECP response, n (%)			p = 0.20
Partial response	7 (35.0)	9 (40.1)
Complete response	0 (0.0)	2 (9.1)
Stable disease	8 (40.0)	10 (45.4)
Progressive disease	5 (25.0)	1 (4.5)
Duration of response, months, Median (range)	17.0 (2–79)	24.0 (4–112)	p = 0.18
Labs at ECP start, Median (range)
LDH (reference range: 118 – 273 U/L)	310 (147–644)	244 (165–403)	p = 0.11
WBCs (reference range: 3.4 − 10.8 x 10^3/uL)	6.0 (2.5–26.1)	9.0 (5.1–35.0)	p = 0.10
Absolute eosinophil count (reference range: 0 − 0.4 x 10^3/uL)	0.3 (0.02–6.4)	0.14 (0–0.6)	p = 0.09
CD4 + CD7- (% of total lymphocytes)
CD4 + CD26- (% of total lymphocytes)	27 (1–92)	25 (3.4–88)	p = 1.00
	34 (8–98)	75 (7–94)	p = 0.60

Abbreviations: ECP = extracorporeal photopheresis, CTCL = cutaneous T-cell lymphoma, BMI = body mass index.

Table 2. Nonresponders with progression on ECP (n = 6).

Patient characteristics (see legend)	Lab values at ECP start (see legend):	Treatment Course (see legend)	Possible Factors Related to Progression on ECP	Outcome
a. 1/40s/F/Black/3rd line/HIV	a. 213	1. PR (PUVA, bexarotene, & NM) for 5 years; PD (when PUVA stopped due to burn)	HIV	Death (CTCL-related)
b. fMF/IB/IIIA	b. 5.95, 0.17	2. PR (doxorubicin)	Folliculotropic MF
	c. 1%, 8%	3. PD (ECP, bexarotene)	Progression prior to ECP
	d. 45%, 51%	4. PD (brentuximab)
a. 2/20s/F/Black/2nd line	a. 318	1. PR (IFNa, NM) for 3 years; PD when lost to follow-up for 2 years	Loss to follow-up prior to ECP	Lost to follow-up.
b. cMF/IB/IB	b. 7.59, 0.16	2. PD (ECP and vorinostat)
	c., d. unknown	3. PR (doxorubicin); planned allo-HSCT
a. 3/30s/M/Black/3rd line	a. 456	1. PR (bexarotene, PUVA, NM); 2 years	Loss to follow-up prior to ECP	Death (CTCL-related)
b. fMF/IIA/IIIA	b. 2.48, 0.02	2. IFNa and PUVA (response unknown)	Folliculotropic MF
	c. 53%, 56%	3. PD (lost to follow-up for 3 years but saw external dermatologist & oncologist)	Progression prior to ECP
	d. 62%, 33%	4. PD (ECP and interferon-alpha)
		5. Mogamulizumab and brentuximab (response unknown)
		6. Care transferred to another institution
a. 4/20s/F/Black/8th line	a. 302	1. PD (PUVA)	Delayed start of ECP	Death (CTCL-related)
b. cMF/IB/IIIB	b. 12.27, 1.67	2. PR (bexarotene/PUVA)	Progression prior to ECP
	c. 53%, 56%	3. SD (HDACi)
	d. 69%, 27%	4. PD (Gemcitabine, PUVA)
		5. PD (brentuximab)
		6. DA-EPOCH (best response unknown)
		7. Pentostatin (best response unknown)
		8. PD (IFNa, bexarotene, ECP, NM)
		9. Lost to follow-up (1 year)
		10. PD (nivolumab, lirilumab)
a. 5/40s/F/Black/2nd line	a. 644	1. PD (PUVA)	Delayed start of ECP	Death (CTCL related)
b. cMF/IA/IVA1	b. 21.6, 6.37	2. PD (ECP, bexarotene, and IFNa)	Progression prior to ECP
	c. 92%, 9%	3. PR (CHOP)
	d. 97%, 2.7%	4. PR (EPOCH)
		5. SD (HDACi)
		6. PR (EPOCH)
		7. PD (HDACi)
		8. PD (Doxil)
a. 6/60s/F/White/1st line	a. 349	1. PD (IFNa, bexarotene, and ECP)	Loss to follow-up during ECP	Stable disease
b. SS/IVA1/IVA1	b. 34.96, unknown	2. Lost follow-up for a year	Advanced blood involvement
	c. 26%, 94%	3. SD (RCHOP)
	d. 96%, 2%

Patient characteristics: (a) Patient/age (years) at diagnosis/sex/race/line of ECP/relevant comorbidities, (b) Diagnosis/stage on diagnosis/stage on ECP start.

Lab values (all at time of ECP start): (a) LDH, (b) white blood cell count, absolute eosinophil count, (c) % CD4+/CD7-, % CD4+/CD26-, (d) % CD4+, % CD8+.

Treatment course: Best response (therapeutic regimen).

Abbreviations: PR = partial response, SD = stable disease, PD = progressive disease, PUVA = psoralen and UVA, NM = nitrogen mustard, ECP = extracorporeal photopheresis, IFNa = interferon-alpha, nbUVB = narrowband UVB. HDACi = histone deacetylase inhibitor; RCHOP = rituximab, cyclophosphamide, doxorubicin, vincristine, & prednisone; DA-EPOCH = dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, & doxorubicin.

Data availability statement

The data that support the findings of this study are available from the corresponding author, SR, upon reasonable request.