Active Ingredients: Ciprofloxacin
With time, the patient became refractory to multiple treatments, including PUVA with interferon alfa, 6 cycles of CHOP cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone and 2 cycles of 9-aminocamptothecin.
The posttransplantation course was complicated by GVHD of the gastrointestinal tract and liver grade 2, which resolved with prednisone treatment.
The patient was in complete remission for 9 months when new small papules and plaques on the chest and right thigh were noted. The skin biopsy specimen confirmed the recurrence of MF large cell type, and the T-cell clone was again detected by PCR and Southern blot analysis.
Because there was no evidence of GVHD, prophylactic immunosuppression with cyclosporine was discontinued.
Within 1 month, the MF plaques resolved and were replaced by lichenoid scaly patches Figure 5. Subsequently, a new onset of small plaques and papules improved with the reinfusion of donor lymphocytes.
Resolution of one of the lesions was also corroborated by a negative skin biopsy result. Five years after the allogeneic HSCT, the patient continues to develop occasional small papules and small patches of MF, which respond to topical treatments with mechlorethamine hydrochloride ointment, imiquimod gel, or spot electron beam radiation Figure 6.
Surveillance visits with routine computed tomographic scans and blood examination have been negative. Figure 4. Figure 5.
Patient 3 is shown with a large patch of chronic graft-vs-host disease, lichenoid type, involving the thigh. Figure 6. Patient 3 is shown with few recurrent papules arrows of mycosis fungoides involving both hands and the right thigh.
The lesions resolved with topical treatments.
Despite the encouraging results obtained with use of immune-modulating agents and targeted chemotherapy, most patients with advanced CTCL eventually become refractory to treatment and die of complications of the disease, such as infection, as a consequence of the relentless deterioration of the immune status.
Bone marrow transplantation after ablative chemotherapy and irradiation has proved to be an effective curative therapy in various lymphoproliferative and myeloproliferative disorders. Autologous bone marrow transplantation has the advantage of being a safe procedure with low treatment-related morbidity and mortality rates, but the results in CTCL have been disappointing.