Oncology Frontier:  In this era of biological agents， what is the role of chemotherapy for these tumors?

　　《肿瘤瞭望》： CTCL化疗有效吗？

　　Dr Prince: Chemotherapy has been used for years for skin lymphoma and all of us have known that we have not been getting the responses we would get with B-cell lymphoma or even peripheral T-cell lymphoma. We know that the durability is short and can be measured in months. So in general terms， for early stage disease， where it is difficult to control with skin-directed therapies， we go for the biological agents first. For patients with Sézary Syndrome that are not responding to ECP or interferon， we go for more biological agents. Chemotherapy is really reserved as a last step option and we have to decide whether we use a single agent regimen such as gemcitabine with lower toxicity or multi-agent regimens. We haven’t been able to define a regimen that is superior. For patients who have tumor disease or patients with transformed disease or for patients with very aggressive disease， then chemotherapy may have a role for quick control， but we are really trying to tease that area out. I don’t think we have discarded chemotherapy， but we have become very selective as to when we use it.

　　Prince博士：众所周知，CTCL化疗效果不如B细胞淋巴瘤化疗效果好，甚至不如外周T细胞淋巴瘤化疗效果好。而且CTCL化疗后疾病缓解持续时间仅有数月。因此，早期CTCL若皮肤定向治疗效果不好，则首先考虑生物制剂。若ECP或干扰素治疗塞扎综合征无缓解，则考虑多种生物制剂治疗。化疗是CTCL治疗最后的选择，需要权衡是采用毒性较低的单药（如吉西他滨）化疗方案还是多药化疗方案，目前尚不知晓哪种方案更好。对于皮肤淋巴肿瘤、转化型淋巴瘤或侵袭性肿瘤，采用化疗可快速控制病情。目前并非完全弃用化疗，只是CTCL的治疗选择更多。