High clinical response rate with multimodality immunomodulatory therapy for Sezary syndrome

Purpose: The goal of this study was to evaluate the clinical response rate of patients with Sezary syndrome (SS) to multimodality immunomodulatory therapy consisting of extracorporeal photopheresis in combination with >= 2 systemic biologic response modifiers (interferon-alpha, interferon-gamma, retinoids, and/or sargramostim) and psoralen plus UV-A. Patients and Methods: Twenty-eight patients who met established criteria for SS were treated with multimodality immunomodulatory therapy at the Hospital of the University of Pennsylvania between January 2000 and December 2002. All patients received > 6 cycles of extracorporeal photopheresis. Patients were categorized into groups based on their response to therapy. Results: An overall clinical response of 89% was achieved with multimodality immunomodulatory therapy. Twenty-nine percent of patients exhibited a complete response, characterized by no evidence of cutaneous disease and a Sezary count <= 5%. Sixty-one percent exhibited a partial response. Eleven percent were nonresponders. Conclusion: Based on our experience, multimodality immunomodulatory therapy is an exceptionally effective treatment for SS. The durability of response and impact on overall survival remains to be determined; however, this approach offers an appealing alternative to treatments associated with higher morbidity rates.