title: The prognostic significance of delayed hypersensitivity to dinitrochlorobenzene and mechlorethamine hydrochloride in cutaneous T cell lymphoma.
abstract: Recent studies suggest that cells elaborating type 1 cytokines are important mediators of anti-tumor cell-mediated immunity in cutaneous T cell lymphoma. Type 1 cell-mediated immune responsiveness was assessed in 276 patients with cutaneous T cell lymphoma (mycosis fungoides and Sézary syndrome) using 2,4-dinitrochlorobenzene (DNCB) skin testing as part of the initial evaluation. The overall rate of sensitization after one and two DNCB challenges was 32% and 67%, respectively, which is much decreased compared with the expected rate of more than 95% for normal individuals. Moreover, the frequency of DNCB sensitization and allergic contact dermatitis to topically applied mechlorethamine decreased with advancing stage of disease. In addition to the expected strong correlation with stage, we observed that patients who were DNCB test positive were significantly less likely to experience disease progression and had a better overall prognosis compared with DNCB-negative patients. These results support the concept that cell-mediated responses are important in cutaneous T cell lymphoma, and that augmentation of these responses would be therapeutically beneficial.
authors.affiliation: Department of Dermatology, Allegheny University of the Health Sciences, Philadelphia, Pennsylvania, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Vonderheid
authors.forename: S K
authors.initials: SK
authors.lastname: Ekbote
authors.forename: K
authors.initials: K
authors.lastname: Kerrigan
authors.forename: J D
authors.initials: JD
authors.lastname: Kalmanson
authors.forename: E J
authors.initials: EJ
authors.lastname: Van Scott
authors.forename: A H
authors.initials: AH
authors.lastname: Rook
authors.forename: J T
authors.initials: JT
authors.lastname: Abrams
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004137:Dinitrochlorobenzene / Q000008:administration & dosage / Q000276:immunology / Q000494:pharmacology*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced* / Q000276:immunology; D007509:Irritants / Q000008:administration & dosage / Q000494:pharmacology*; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000276:immunology; D012882:Skin Tests; D016019:Survival Analysis
chemical_list: D004137:Dinitrochlorobenzene; D007509:Irritants; D008466:Mechlorethamine