Management of Mycosis Fungoides With Chlormethine Hydrochloride Gel in Combination With Systemic Therapies: A Case Series

Background: Mycosis fungoides (MF) is a subtype of T-cell lymphoma that is characterised by the infiltration of malignant T cells into the skin. Treatment approaches usually include skin-directed therapies for early-stage disease and, additionally, systemic therapies for advanced stages. Chlormethine hydrochloride gel is recommended as a first-line treatment option for adult patients with MF, with previous studies demonstrating its efficacy. Due to the rarity of this disease, available literature on the optimal treatment of MF with chlormethine gel is limited, creating challenges for making informed clinical decisions. Thus, we share our individual clinical experiences of selected patients on chlormethine combination treatments to increase the real-world evidence for chlormethine gel in patients with MF. Case Presentation: We present the cases of five male and two female Caucasian patients above the age of 48 with Stage I-IV MF, presenting with symptoms of skin plaques and lesions. All patients were treated with chlormethine hydrochloride gel in combination with other skin-directed and systemic therapies, including bexarotene, methotrexate, topical steroids, extracorporeal photopheresis, donor lymphocyte infusion and interferon-α (IFN-α) 2a. In most cases, chlormethine combination treatment resulted in disease control, e.g., plaque reduction, stable disease, and partial or complete response. The combination regimens were generally well tolerated, with associated adverse events being inflammation, pruritus and erythema. Conclusions: This case series reports on the efficacy and safety of chlormethine hydrochloride gel in combination with other topical and systemic therapies in reducing the skin lesion severity in patients with Stage I-IV MF in different real-world settings.