Extracorporeal photopheresis in varying mycosis fungoides and Sézary syndrome stages: race-based differences in treatment utilization and response

Background: Black patients can face a higher incidence and poorer prognosis from cutaneous T-cell lymphoma (CTCL) compared to their white counterparts yet race is not a known factor in the treatment of CTCL. The significance of race, particularly in the treatment of early-stage CTCL using extracorporeal photopheresis (ECP), is not well understood. Objective: To characterize race-based and stage- based differences in ECP utilization and response among adults with mycosis fungoides and Sezary syndrome. Methods: A 10-year retrospective chart review was performed at a single tertiary referral center institution. Results: Among total 42 qualifying CTCL patients that received, 57.1% were female, 47.6% identified as black, and 54.7% presented with early-stage CTCL (Stage IA–IIA). There were no race-based differences in the number of systemic therapies trialed before ECP (p=0.8), use of ECP as 1st-line treatment (p=0.5), number of ECP treatments (p=0.4965), or use of concomitant medications (e.g. interferon, oral retinoids). White patients began ECP sooner than black patients following CTCL diagnosis (median 16 vs 4 months; p=0.08). Black patients were significantly more likely to face progressive disease following ECP (p=0.04) and had a shorter duration of response (16.1 vs 36.5 months; p=0.0455). Limitations: This was a retrospective study. Conclusion: There are race-based differences in ECP use and disease progression among adults with CTCL. Future research may investigate the source of these disparities, be they attributable to biologic differences in disease or differential treatment prescription.