Diagnostic value of dominant T-cell clones in peripheral blood in 363 patients presenting consecutively with a clinical suspicion of cutaneous lymphoma.
It is now widely accepted that polymerase chain reaction (PCR) analysis of cutaneous T-cell clonality is of diagnostic value in cutaneous T-cell lymphomas (CTCLs) and most helpful in the diagnosis of mycosis fungoides (MF). However, the diagnostic and prognostic value of circulating clonal T cells remains unclear. We studied T-cell clonality in the peripheral blood (PB) and the cutaneous lesion, sampled at the same time, in 363 consecutively seen patients with a clinical suspicion of cutaneous lymphoma. Using a PCR technique providing a specific imprint of T-cell clones (PCRgamma-denaturing gradient gel electrophoresis), we found that detection of identical circulating and cutaneous T-cell clones was associated with the diagnosis of CTCL (P <.001). Detection of circulating tumor cells in patients with MF was infrequent (12.5%), except in those with erythrodermic MF (42%; P =.003). Moreover, among the 46 patients who had identical circulating and cutaneous T-cell clones, 25 (56%) had erythroderma. The finding of a dominant clone in the PB but not in the skin was frequent, regardless of the clinicohistologic classification; it occurred in 30% of patients with CTCL, 41% with non-CTCL malignant infiltrates, and 34% with benign infiltrates. This pattern was significantly more frequent in patients over 60 years of age (P <.002), even in the CTCL group (P <. 01). In conclusion, dominant T-cell clones detected in the PB of patients with MF by using a routine PCR technique are rarely tumoral and are more often related to age. A multicenter prospective study is under way to establish the prognostic value of circulating tumor cells.
Delfau-Larue
M H
MH
Departments of Immunobiology, Pathology, Biostatistics and Medical Informatics, and Dermatology, Hospital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France. marie-helene.delfau@ap-hop-paris.fr
Laroche
L
L
Wechsler
J
J
Lepage
E
E
Lahet
C
C
Asso-Bonnet
M
M
Bagot
M
M
Farcet
J P
JP
D000328:Adult; D000368:Aged; D001706:Biopsy; D002999:Clone Cells; D003937:Diagnosis, Differential; D015329:Gene Rearrangement, T-Lymphocyte; D006801:Humans; D016410:Lymphoma, T-Cell, Cutaneous / Q000097:blood / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction; D011379:Prognosis; D015203:Reproducibility of Results; D012751:Sezary Syndrome / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000276:immunology / Q000473:pathology*; D012871:Skin Diseases / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000473:pathology; D013601:T-Lymphocytes / Q000276:immunology*