Mycosis Fungoides: Therapy

General measures

Nicotine restriction (refraining from tobacco use).
Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).

PUVA therapy – This term stands for the combined use of UVA light (UV-A phototherapy) and psoralen. Psoralen are substances that have a photosensitizing effect on the skin, so that the effectiveness of UVA light is increased. In Germany, the substance 8-methoxypsoralen (8-MOP) is used. This substance can be applied via oral therapy (oral PUVA therapy/oral puva), although bath PUVA treatment and cream PUVA treatment are also available today. This procedure is also called photochemotherapy.Long-term remission can be achieved in 25% of cases by this therapy!In a comparison of methods, patients with early mycosis fungoides were treated with PUVA or narrow-band UV-B irradiation (NBUVB). More complete responses were seen with PUVA: 73.8% of patients had a complete response with PUVA and 62.2% with NBUVB. This resulted in a 68% higher ratio of complete to incomplete response in favor of PUVA (odds ratio [OR] 1.68; confidence interval 1.02-2.76).
Extracorporeal photopheresis (ECP) – “blood washing”; psoralen administration combined with irradiation (UVA light) of leukocytes (white blood cells) outside the body (extracorporeal); advantage: the actual treatment takes place outside the body, in an ECP machine

The following vaccinations are advised before starting therapy:

Influenza vaccination (seasonal quadrivalent inactivated vaccine ).
Pneumococcal vaccination: immunocompromised individuals should be vaccinated sequentially with the 13-valent conjugate vaccine PCV13 and six to twelve months later with the 23-valent polysaccharide vaccine PPSV23 against pneumococcus.
Meningococcal vaccination (ACWY and B).
Herpes zoster vaccination (only with inactivated vaccine.
If necessary, booster vaccination against diphtheria, Haemophilus influenzae capsule type b (Hib), pertussis and tetanus.

Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
- Consume only limited energy-rich foods.
- Moderate total fat intake
- Little red meat (pork, beef, lamb, veal) and sausages.
- Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grains, vegetables).
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
- Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
- Refrain from polluted foods such as offal and wild mushrooms.
- Do not eat moldy food
Observe the following special dietary recommendations:
- Diet rich in:
  - Vitamins (A, C, D, E, folic acid).
  - Minerals
  - Trace elements (selenium, zinc)
  - Omega-3 fatty acids
  - Secondary plant compounds (e.g. carotenoids, polyphenols).
Selection of appropriate food based on the nutritional analysis
See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
Detailed information on nutritional medicine you will receive from us.

Endurance training (cardio training) and strength training (muscle training).
- In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training. This means that load phases lasting 1 to 3 minutes alternate with rest phases also lasting 1 to 3 minutes.Exercise should be performed at about 80% of maximum heart rate for a total of 30 minutes.
- During and after treatment, the patient should be active in sports (Recommendation grade. B).
Preparation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
Detailed information on sports medicine you will receive from us.

Psychosocial care
Detailed information on psychosomatic care (including stress management) is available from us.