Case and Research Letters
The Effectiveness of a Twice-weekly Narrowband Ultraviolet B Phototherapy Schedule in Early-stage Mycosis Fungoides in a Cohort of 18 Argentinian Patients
Efectividad de la fototerapia ultravioleta B de banda estrecha con un esquema bisemanal en el tratamiento de la micosis fungoide estadio temprano en una cohorte de 18 pacientes argentinos
D.A. De Luca
, E.A. Zambrano, R.L. Galimberti, P.A. Enz
Corresponding author
Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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De Luca, E.A. Zambrano, R.L. Galimberti, P.A. Enz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D.A." "apellidos" => "De Luca" "email" => array:1 [ 0 => "daviddeluca@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E.A." "apellidos" => "Zambrano" ] 2 => array:2 [ "nombre" => "R.L." "apellidos" => "Galimberti" ] 3 => array:2 [ "nombre" => "P.A." "apellidos" => "Enz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectividad de la fototerapia ultravioleta B de banda estrecha con un esquema bisemanal en el tratamiento de la micosis fungoide estadio temprano en una cohorte de 18 pacientes argentinos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 938 "Ancho" => 1500 "Tamanyo" => 112520 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Female patient with plaque stage MF in both legs. Complete resolution of the skin lesions after 60 sessions of UVB-NB therapy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Mycosis fungoides (MF) is the most common type of primary cutaneous T-cell lymphoma (CTCL), affecting middle-aged and elderly population. The clinical manifestations are limited to the skin in early stages (eMF). Skin histopathology, immunohistochemistry and other complementary studies are required, in order to classify MF stages. The prognosis of eMF is favourable, with 98% five-year survival rate for limited patch or plaque disease.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most recommended treatments for eMF are topical therapies and phototherapy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Narrowband UVB phototherapy (NB-UVB) is considered to have a safer profile than PUVA and broadband UVB regarding side effects, tolerability and carcinogenesis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Up to the present, most MF and NB-UVB studies were performed on Caucasian and Asian populations with a schedule of three sessions per week.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aims of this study are to evaluate the response, relapse and side effects of a twice-weekly NB-UVB regimen in eMF. We compared the results with the classic three times a week schedule published in the literature. We also described for the first time the response to NB-UVB therapy in an Argentinean cohort, a mixture of Caucasian and Mestizo people (Amerindian and European ancestry).</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present a retrospective analysis of adult patients (> 18 years old) with confirmed eMF,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> who underwent NB-UVB in the Department of Dermatology at “Hospital Italiano de Buenos Aires” for 8 years. Patient data were obtained from the electronic medical records. No patients presented advanced-stage MF prior to the treatment. NB-UVB treatment scheme is depicted in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Clinical evaluation was performed every 10 sessions or in the presence of side effects.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical response was classified as complete (CR, >95% of skin lesions clearance), partial (PR, 50% to 95%), stable disease (<50%) and progressive disease. After achieving CR, NB-UVB frequency was reduced once-weekly for 5 weeks and then, discontinued. Remission and relapse were clinically assessed every 3 months and skin biopsies were performed, provided that the clinical picture was unclear. Late relapse was defined as the recurrence of MF more than 12 months after completion of NB-UVB.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We included a cohort of eighteen eMF patients. The study was completed by fifteen patients, while three were excluded as they developed a progressive disease. The eMF population and NB-UVB details are described in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. All twelve CR patients received maintenance and five did not relapse during the follow-up period up to 36 months. <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the response to NB-UVB in eMF patients.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">NB-UVB is an effective therapy to improve life quality and to induce a short-term CR in MF. Our cohort of patients was treated with a twice-weekly schedule, reaching a 80% CR in a mean time of 6.1 months. Hofer et al<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> reported 6 patients treated with NB-UVB 3-4 times-weekly for 5 to 10 weeks, with a mean cumulative dose (CuD) of 16.3<span class="elsevierStyleHsp" style=""></span>J/cm2. Although 83% of the patients achieved CR, all of them relapsed within 6 months. Gökdemir et al<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> published a prospective study with 23 early-stage MF patients, treated with a thrice-weekly schedule. A CR was achieved in 91.3% patients, the mean CuD was 90.3<span class="elsevierStyleHsp" style=""></span>J/cm2 with an average of 36 sessions. In the 3-year follow-up period, only one CR patient relapsed. Relapse rate appears to be related to the CuD, rather than to the number of sessions or the schedule applied. However, we also observed a late relapse in 2 patients, which it would suggest that the response variability is still insufficiently understood.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The establishment of a maintenance therapy should be mandatory as relapse is expected in most of the patients. Boztepe <span class="elsevierStyleItalic">et al</span> described a maintenance therapy based on 80-160 NB-UVB sessions (12-30 months) on a decreasing frequency schedule. During this period, no relapse was observed.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> In regard to avoiding unnecessary energy accumulation and longer therapy, we decided a short-term maintenance, with a close follow-up. Relapsed eMF patients restarted NB-UVB or began PUVA (data not shown).</p><p id="par0045" class="elsevierStylePara elsevierViewall">In order to lower side effects, we apply a common schedule to our cohort and no severe reactions were observed. Despite most publications show a shorter mean time treatment to reach CR (3-4 months), twice-weekly regimen reduces theoretically the risk of acute side effects, as well as the immunosuppressive response in the short term.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A twice-weekly NB-UVB schedule in eMF is as effective as the three-times-weekly regimen. Our CR and relapse rate can be compared to the classic scheme, which confirms that the total amount of energy delivered could be more important than the frequency of exposure or the initial dose. Although longer treatments could be required to reach CuD, we emphasize the low rate of side effects and an adequate treatment compliance. Based on our clinical study, we can recommend a twice-weekly schedule as an alternative to the classical schedule, if patients report intolerance to NB-UVB.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">Conflicts of Interest The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-28" "fechaAceptado" => "2017-11-21" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: De Luca DA, Zambrano EA, Galimberti RL, Enz PA. Efectividad de la fototerapia ultravioleta B de banda estrecha con un esquema bisemanal en el tratamiento de la micosis fungoide estadio temprano en una cohorte de 18 pacientes argentinos. Actas Dermosifiliogr. 2018;109:922–924.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 938 "Ancho" => 1500 "Tamanyo" => 112520 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Female patient with plaque stage MF in both legs. Complete resolution of the skin lesions after 60 sessions of UVB-NB therapy.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Population \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.75 females per male (11 female) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mean<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>60.8 years old<br>Range<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28 to 81 years old \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fitzpatrick classification scale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Skin type II<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8 patients<br>Skin type III<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8 patients<br>Skin type IV<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2 patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MF clinical stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Patch stage<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5 patients<br>Plaque stage<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13 patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TNMB staging system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IA<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2 patients<br>IB<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16 patients \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Concomitant treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Potent topical steroids (class I-II)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>18 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">One patient received PUVA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NB-UVB phototherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mean sessions<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>39<br>Range sessions<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20 to 65<br>Mean CuD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>28.7 J/cm2<br>Range CuD<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21 to 61.1 J/cm2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Study completion and response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15/18 patients<br>CR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12 (66%)<br>PR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3 (16.5%)<br>CR Mean time<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6.1 months<br>CR Median time<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.5 months<br>CR Range time<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3 to 13 months \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Side effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/18 patients<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>moderate erythema<br>4/18 patients<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>burning sensation<br>1/18 patients<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>SCC (previous photodamaged skin) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Relapse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/12 CR patients<br>Mean time<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>13.4 months<br>Median time<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3 months<br>Range time<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2 to 60 months<br>Histological confirmation<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2 patients \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1915244.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Early-stage mycosis fungoides population features.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NB-UVB Cabinet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Jorlan® Argentina; 44 fluorescent TL/01 Philips lamps 100W, peak emission at 311/312 nm \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NB-UVB frequency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Twice a week on nonconsecutive days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Initial dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 J/cm2 (regardless of the skin phototype) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Increasing dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 J/cm2 per session \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximal dose \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5 J/cm2 or maximal well-tolerated dose \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild side effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">If marked erythema or discomfort: 1 week pause and restart with 20% to 30% lower dose \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Persistent side effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Highest well-tolerated dose until the end of the treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1915243.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Narrowband UVB treatment scheme.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO-EORTC classification for cutaneous lymphomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 7 | 14 |
| 2024 October | 77 | 43 | 120 |
| 2024 September | 98 | 39 | 137 |
| 2024 August | 128 | 60 | 188 |
| 2024 July | 99 | 36 | 135 |
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| 2024 May | 101 | 44 | 145 |
| 2024 April | 95 | 40 | 135 |
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| 2024 February | 108 | 37 | 145 |
| 2024 January | 93 | 40 | 133 |
| 2023 December | 100 | 19 | 119 |
| 2023 November | 118 | 33 | 151 |
| 2023 October | 87 | 38 | 125 |
| 2023 September | 100 | 34 | 134 |
| 2023 August | 83 | 15 | 98 |
| 2023 July | 113 | 35 | 148 |
| 2023 June | 115 | 20 | 135 |
| 2023 May | 121 | 25 | 146 |
| 2023 April | 78 | 18 | 96 |
| 2023 March | 97 | 27 | 124 |
| 2023 February | 96 | 23 | 119 |
| 2023 January | 68 | 30 | 98 |
| 2022 December | 77 | 38 | 115 |
| 2022 November | 60 | 28 | 88 |
| 2022 October | 46 | 21 | 67 |
| 2022 September | 58 | 45 | 103 |
| 2022 August | 51 | 36 | 87 |
| 2022 July | 37 | 46 | 83 |
| 2022 June | 48 | 28 | 76 |
| 2022 May | 60 | 50 | 110 |
| 2022 April | 71 | 31 | 102 |
| 2022 March | 102 | 47 | 149 |
| 2022 February | 78 | 29 | 107 |
| 2022 January | 113 | 41 | 154 |
| 2021 December | 91 | 34 | 125 |
| 2021 November | 75 | 45 | 120 |
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| 2021 September | 54 | 42 | 96 |
| 2021 August | 100 | 34 | 134 |
| 2021 July | 64 | 37 | 101 |
| 2021 June | 34 | 27 | 61 |
| 2021 May | 38 | 50 | 88 |
| 2021 April | 87 | 71 | 158 |
| 2021 March | 42 | 30 | 72 |
| 2021 February | 41 | 28 | 69 |
| 2021 January | 33 | 26 | 59 |
| 2020 December | 31 | 25 | 56 |
| 2020 November | 32 | 24 | 56 |
| 2020 October | 16 | 14 | 30 |
| 2020 September | 26 | 25 | 51 |
| 2020 August | 29 | 22 | 51 |
| 2020 July | 14 | 18 | 32 |
| 2020 June | 31 | 28 | 59 |
| 2020 May | 14 | 20 | 34 |
| 2020 April | 8 | 10 | 18 |
| 2020 March | 20 | 7 | 27 |
| 2020 February | 1 | 0 | 1 |
| 2019 May | 1 | 0 | 1 |
| 2019 April | 1 | 0 | 1 |
| 2019 March | 5 | 0 | 5 |
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