Treatments and Therapies for Cutaneous Lymphoma

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Fred Hutch Cancer Center is one of few centers in the U.S. with extensive experience treating cutaneous lymphoma and specializes in providing novel therapies and clinical trials for this rare disease. Patients are referred here for collaborative work between research and clinical trials for peripheral (systemic) and cutaneous T-cell lymphomas, including specific subtypes.

Fred Hutch’s Cutaneous Lymphoma Specialty Clinic brings together specialists from dermatology, hematology oncology and pathology to comprehensively evaluate and treat cutaneous lymphoma. Treatment options depend on the type of lymphoma, where it is in the body and the stage, as well as other factors such as your overall health.

Cutaneous Lymphoma Care Tailored to You

You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.

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How We Treat Cutaneous Lymphoma at Fred Hutch

Several types of treatment can be used for skin lymphoma, generally divided into treatments directed at the skin and whole body (systemic) treatments. Sometimes these are used together, and because cutaneous lymphoma is often a chronic disease, many people are treated with multiple therapies over their lifetime. Fred Hutch offers all standard therapies for cutaneous lymphoma.

Patients with early stage or indolent cutaneous lymphomas are often evaluated and treated primarily by a Fred Hutch dermatologist. A dermatologist prescribes and manages skin-directed therapies including topical treatments, phototherapy and skin radiation, as well as oral therapies. If patients have more advanced disease or require infusion (intravenous) treatments such as chemotherapy, they are seen by our hematologist-oncologists. 

Many patients live normal lives while being treated for cutaneous lymphoma, and some people are able to remain in remission for long periods. It is important to discuss all of your treatment options and possible side effects with your physician to help make the decisions that best fit your needs.

Recurrent (Relapsed) Cutaneous Lymphoma

Some lymphomas may not respond well to treatment, or they may return after a period of time. This is called recurrent or relapsed disease. In general, cutaneous lymphomas come back in the skin, and additional treatments may be tried and may be effective for a time.

Treatments for mycosis fungoides and Sézary syndrome may help patients, sometimes for years, but they are rarely cured. Patients with recurrent disease that is no longer responding to treatment may want to consider entering a clinical trial.

Whole‑Body (Systemic) Treatments

Systemic treatments enter the bloodstream and travel throughout the body, and they are most useful for more advanced or aggressive disease.

Photoimmune Therapy (Photopheresis)

Photopheresis may be used for T‑cell lymphomas, especially Sézary syndrome. Blood is passed through a machine that separates and treats lymphocytes with a drug and ultraviolet (UV) light, which may destroy some lymphoma cells and boost the immune system to destroy others.

This treatment is typically well tolerated, with sensitivity to sunlight for about one day as the main side effect.

Interferons

Interferons are substances produced by the immune system to help fight infections and various cancers, given by injection (often into the abdomen or thigh) and sometimes combined with other therapies such as photopheresis and retinoids.

Potential side effects include flu‑like symptoms, low blood counts and autoimmune conditions, such as thyroid problems.

Chemotherapy

Chemotherapy is not often used for cutaneous lymphoma but may be given when disease is advanced, when other treatments are no longer working, or when lymphoma has spread to lymph nodes or other organs and tissues. It may be used alone or in combination with other chemotherapy or targeted drugs. Examples include:

  • CHOP (combination regimen of cyclophosphamide, adriamycin, vincristine and prednisone).
  • Cyclophosphamide
  • Fludarabine
  • Gemcitabine 
  • Liposomal doxorubicin
  • Methotrexate (at high dose)
  • Pentostatin

Chemotherapy side effects vary from person to person and depend on the drug type and dose, how it is given, and how long it is taken. Some people have few side effects, and physicians may give medicines to help protect normal cells and lessen or prevent side effects. The time it takes to recover and regain energy depends on many factors, including overall health and the specific drugs received.

Targeted Therapies

These newer drugs are designed to target specific parts of cancer cells or to boost the immune system to attack them. Targeted therapies used in cutaneous lymphoma include:

  • Alemtuzumab
  • Bortezomib
  • Denileukin diftitox
  • Rituximab
  • Romidepsin
  • Vorinostat

Side effects are typically different, and often milder, than standard chemotherapy.

Retinoids

Retinoids, used to treat a variety of skin diseases, may be given as topical treatments or as pills for more extensive lymphomas.

Potential side effects include elevated blood sugar or fat levels, mood changes, thyroid problems and eye problems. Retinoids may cause serious birth defects and should never be used by a woman who is pregnant or may become pregnant.

Skin‑Directed Treatments

In many cases, initial treatment of skin lymphoma involves treating the skin tumors directly while trying to avoid harmful side effects on the rest of the body.

Surgery

Surgery may be used to obtain a tissue sample for biopsy or, when there are few lesions, to completely remove them. Surgery is usually combined with other therapies.

Radiation Therapy

Radiation therapy uses high‑energy rays to kill cancer cells. Electron beam radiation is used most often for cutaneous lymphomas because the electrons penetrate only the skin, minimizing side effects to other organs and tissues. Possible side effects include skin irritation (sunburn‑like symptoms, itching, dry skin) and fatigue.

Phototherapy

Phototherapy uses ultraviolet (UV) light to kill cancer cells in the skin and may be combined with psoralen, a drug that increases the activity of UV light, in a treatment called PUVA given about three times per week. Potential side effects include nausea, sensitivity to sunlight and sunburn‑like symptoms.

Topical Medicines

Topical medicines, including steroids, chemotherapies, retinoids and immune therapies, are applied directly to the skin so effects are concentrated where they are used, limiting side effects elsewhere in the body. Side effects depend on the specific medicine and may include thinning of the skin, local irritation (rash, itching), easy bruising and dilated blood vessels.

Blood and Marrow Transplant

On rare occasions, blood and marrow transplant (BMT) may be used to treat cutaneous lymphoma, typically when other treatments are no longer working. This therapy uses high doses of chemotherapy and/or radiation to destroy both healthy and cancerous blood cells in the bone marrow, followed by an infusion of stem cells that travel to the marrow and begin making new blood cells.

A blood and marrow transplant is a complex treatment with a number of potential complications and side effects. Your care team will talk with you in detail about risks and benefits.

Why Choose Fred Hutch for Cutaneous Lymphoma Treatment

At Fred Hutch, we understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need.  

Team-Based Care from Specialists

Fred Hutch has hematologist-oncologists, dermatologists and pathologists who specialize in cutaneous lymphoma, as well as transplant oncologists if you need them. We offer the most advanced diagnostic, treatment and recovery programs. Along with treating your cancer, we also offer a range of services to support you and your caregiver. This is part of how we take care of you — not just your disease. From registered dietitians to Spiritual Health clinicians to social workers, our experts know how to care for people with cutaneous lymphoma.

Treatment Tailored to You

We view treatment as a collaborative effort. Your Fred Hutch physicians will explain all your options. We’ll recommend a treatment plan to get you the best results based on the subtype and stage of your cancer, the treatment’s potential side effects, as well as your age and overall health. We provide all standard therapies. Our experts are national leaders in cutaneous lymphoma research.

Clinical Trials to Improve Outcomes

Many of our patients receive promising therapies by taking part in cutaneous lymphoma clinical trials. These research studies are done by physician-scientists from Fred Hutch and UW Medicine. They test new treatments or new ways to use current treatments. Every advance in cancer treatment in recent years has come out of clinical trials. Through the Fred Hutch/University of Washington/Seattle Children's Cancer Consortium, we typically have more than 750 active clinical trials, which means more treatment options for people like you.