Algorithm for the Care of Patients with Mycosis Fungoides or Sezary Syndrome - Flowchart
Algorithm for the Care of Patients with Mycosis Fungoides or Sezary Syndrome - Flowchart Mycosis Fungoides Mycosis Fungoides
«Flowchart»

History/exam consistent with MF/SS and biopsy confirmation

History/exam consistent with MF/SS and biopsy confirmation

History/exam consistent with MF/SS and biopsy confirmation

History/exam consistent with MF/SS and biopsy confirmation

Stage IA

Stage IA

Stage IA

Stage IA

Stage IB-IIB

Stage IB-IIB

Stage IB-IIB

Stage IB-IIB

Stage III/Sézary

Stage III/Sézary

Stage III/Sézary

Stage III/Sézary

Stage IV A/B

Stage IV A/B

Stage IV A/B

Stage IV A/B

Photopheresis alone, photopheresis and interferon or topical therapy + interferon, interferon alone or bexarotene alone or clinical trial

Photopheresis alone, photopheresis and interferon or topical therapy + interferon, interferon alone or bexarotene alone or clinical trial

Photopheresis alone, photopheresis and interferon or topical therapy + interferon, interferon alone or bexarotene alone or clinical trial

Photopheresis alone, photopheresis and interferon or topical therapy + interferon, interferon alone or bexarotene alone or clinical trial

Rotate topical therapy alone or topical therapy with interferon or bexarotene or clinical trial

Rotate topical therapy alone or topical therapy with interferon or bexarotene or clinical trial

Rotate topical therapy alone or topical therapy with interferon or bexarotene or clinical trial

Rotate topical therapy alone or topical therapy with interferon or bexarotene or clinical trial

Topical therapy/rotate as necessary for clinical benefit or clinical trial

Topical therapy/rotate as necessary for clinical benefit or clinical trial

Topical therapy/rotate as necessary for clinical benefit or clinical trial

Topical therapy/rotate as necessary for clinical benefit or clinical trial

Interferon alone or topical therapy + interferon or bexarotene or clinical trial

Interferon alone or topical therapy + interferon or bexarotene or clinical trial

Interferon alone or topical therapy + interferon or bexarotene or clinical trial

Interferon alone or topical therapy + interferon or bexarotene or clinical trial

Progression

Progression

Progression

Progression

Interferon or bexarotene (whichever is not used previously) or investigational approach

Interferon or bexarotene (whichever is not used previously) or investigational approach

Interferon or bexarotene (whichever is not used previously) or investigational approach

Interferon or bexarotene (whichever is not used previously) or investigational approach

Progression

Progression

Progression

Progression

Single-agent cytotoxic agents


Methotrexate
Nitrosourea
Histone deacetylases
Liposomal doxorubicin
Gemcitabine
Denileukin diftitox (fusion protein)

Combination chemotherapy


CVP
CHOP
EPOCH

Investigational approaches


Novel retinoids
Allogeneic stem cell transplant
Novel cytokines
Monoclonal antibodies
Combinations of single modalities
Alemtuzumab

Symptom control


Steroids
Radiation therapy
Topical approaches as necessary

Single-agent cytotoxic agents


Methotrexate
Nitrosourea
Histone deacetylases
Liposomal doxorubicin
Gemcitabine
Denileukin diftitox (fusion protein)

Combination chemotherapy


CVP
CHOP
EPOCH

Investigational approaches


Novel retinoids
Allogeneic stem cell transplant
Novel cytokines
Monoclonal antibodies
Combinations of single modalities
Alemtuzumab

Symptom control


Steroids
Radiation therapy
Topical approaches as necessary

Single-agent cytotoxic agents


Methotrexate
Nitrosourea
Histone deacetylases
Liposomal doxorubicin
Gemcitabine
Denileukin diftitox (fusion protein)

Combination chemotherapy


CVP
CHOP
EPOCH

Investigational approaches


Novel retinoids
Allogeneic stem cell transplant
Novel cytokines
Monoclonal antibodies
Combinations of single modalities
Alemtuzumab

Symptom control


Steroids
Radiation therapy
Topical approaches as necessary

Single-agent cytotoxic agents

Single-agent cytotoxic agents


Methotrexate
Nitrosourea
Histone deacetylases
Liposomal doxorubicin
Gemcitabine
Denileukin diftitox (fusion protein)


Methotrexate
Nitrosourea
Histone deacetylases
Liposomal doxorubicin
Gemcitabine
Denileukin diftitox (fusion protein)

Combination chemotherapy

Combination chemotherapy


CVP
CHOP
EPOCH


CVP
CHOP
EPOCH

Investigational approaches

Investigational approaches


Novel retinoids
Allogeneic stem cell transplant
Novel cytokines
Monoclonal antibodies
Combinations of single modalities
Alemtuzumab


Novel retinoids
Allogeneic stem cell transplant
Novel cytokines
Monoclonal antibodies
Combinations of single modalities
Alemtuzumab

Symptom control

Symptom control


Steroids
Radiation therapy
Topical approaches as necessary


Steroids
Radiation therapy
Topical approaches as necessary

End

End

End

End

Bexarotene (if interferon failed)

Bexarotene (if interferon failed)

Bexarotene (if interferon failed)

Bexarotene (if interferon failed)

Progression

Progression

Progression

Progression

Slow progression

Slow progression

Slow progression

Slow progression

Rapid progression

Rapid progression

Rapid progression

Rapid progression