Bexarotene therapy in folliculotropic cutaneous T-cell lymphoma

Background. Folliculotropic lymphoma is a variant of fungoid mycosis distinguished by its clinical features, histology, poor prognosis and poor response to the standard treatments for cutaneous T-cell lymphomas. The purpose of our study was to evaluate the efficacy and safety of bexarotene, an RXR receptor-selective retinoid, in the treatment of folliculotropic lymphoma after 3 months and 6 months of therapy. Patients and methods. This retrospective, prospective, descriptive study was conducted between October 2004 and November 2005. It was carried out using all available dossiers for patients with folliculotropic lymphoma treated with bexarotene. Patients were included where diagnosis of folliculotropic lymphoma was based on histological evidence, provided they had received at least one prior treatment (PUVA therapy, Retinol/PUVA therapy, Caryolysine (R), Bicnu (R), methotrexate), and the affected body surface area could be calculated from initial whole-body photographs using the rule of 9. Results. Eight patients were included, all males. Partial remission was seen after 3 months and 6 months of treatment in 75% of patients. According to the Physical Global Assessment Scale (7-item evaluation scale), 75% of patients presented global improvement after 3 months of treatment compared with 87.5% after 6 months. Five of the 8 patients experienced sexual dysfunction while on treatment with bexarotene, which resolved one month after discontinuation of therapy in four cases. Onset or worsening of dyslipidaemia was seen in all patients, with five developing central hypothyroidism. Discussion. These global response levels confirm the place of bexarotene in the treatment of folliculotropic lymphoma. Combined therapy appears to be warranted due to the difficulty in maintaining optimal dosages of the drug because of the frequency of adverse effects. Preventive therapy for the hypothyroidism seen in practically all cases should prevent adverse effects of the drug on sexual function.