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Controlled trials are urgently required to compare ECP with standard single-agent chemotherapy regimens in erythrodermic disease and specifically in Sezary syndrome. Some previous studies have not clearly defined their diagnostic criteria for erythrodermic CTCL and others have included patients with non-erythrodermic disease. Combination therapy with ECP and alfa interferon is frequently used but the existing studies do not exclude a beneficial response to alfa interferon alone. An RCT to address this important issue is currently being considered by the European Organisation for the Research and Treatment of Cancer (EORTC). Studies suggest that ECP requires a minimum tumour burden within peripheral blood56 and the only RCT of ECP in non-erythrodermic, early-stage disease suggests that it is not effective.

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