This RCT is one of very few in CTCL and it shows that combined PUVA and interferon alfa is more effective than interferon alfa or acitretin in early stage I/II disease. Weaknesses of this study are the lack of a validated scoring system to assess tumour burden and lack of evidence that outcome was assessed blind to allocation status. In addition, data regarding the duration of response and DFS/OS are urgently required. The trial comparing PUVA alone with PUVA plus acitretin31 suggests a reduction in mean cumulative dose of PUVA to CR, which would be helpful; disappointingly, however, there is no evidence for increased overall efficacy in the retinoid-PUVA group. The combination of alfa interferon and PUVA appears to be highly effective in all stages of CTCL. An RCT comparing PUVA alone with PUVA plus alfa interferon has recently closed (2001) and the results are awaited.
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