title: Complete molecular remission during biologic response modifier therapy for Sézary syndrome is associated with enhanced helper T type 1 cytokine production and natural killer cell activity.
abstract: BACKGROUND
  Cutaneous T-cell lymphoma (CTCL) is a clonally derived, skin-invasive malignancy of CD4(+) T lymphocytes with the phenotype of mature helper T cells. Advancing stages of CTCL are associated with depressed cell-mediated immunity, increased production of T helper type 2 cytokines and decreased levels of T helper type 1 cytokines.
  
  
  OBJECTIVE
  Our purpose was to evaluate the cytokine secretion pattern and cell-mediated cytotoxicity in peripheral blood mononuclear cells of patients with Sézary syndrome in relation to the presence of the malignant clone.
  
  
  METHODS
  Serial polymerase chain reaction for the T-cell receptor-beta or T-cell receptor-gamma gene rearrangement was used to determine the presence of the malignant clone. Enzyme-linked immunosorbent assays were used to determine the levels of interleukin 4 and interferon gamma produced by the peripheral blood mononuclear cells from the patients with Sézary syndrome.
  
  
  RESULTS
  We demonstrate 3 cases of Sézary syndrome with typically suppressed cell-mediated cytotoxicity, elevated production of interleukin 4, and depressed production of interferon gamma by their peripheral blood mononuclear cells before institution of therapy with biologic response modifier therapy. In all 3 cases after clinical and molecular remission, we observed striking immunologic changes, including an increase in levels of natural killer cell activity and interferon gamma production and decreased production of interleukin 4.
  
  
  CONCLUSIONS
  The observation that the cytokine secretion pattern by peripheral blood mononuclear cells from 3 patients with Sézary syndrome normalized with the disappearance of the malignant clone from the peripheral blood suggests that the malignant T cells account for the aberrant cytokine production. Moreover, the aberrant cytokine production may be the cause for suppression of cell-mediated immunity seen in advancing stages of CTCL.
authors.affiliation: Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Yoo
authors.forename: M
authors.initials: M
authors.lastname: Cassin
authors.forename: S R
authors.initials: SR
authors.lastname: Lessin
authors.forename: A H
authors.initials: AH
authors.lastname: Rook
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003602:Cytotoxicity, Immunologic; D015329:Gene Rearrangement, T-Lymphocyte; D019674:Genes, T-Cell Receptor beta / Q000235:genetics; D019675:Genes, T-Cell Receptor gamma / Q000235:genetics; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D007371:Interferon-gamma / Q000096:biosynthesis*; D015847:Interleukin-4 / Q000096:biosynthesis*; D007694:Killer Cells, Natural / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D016133:Polymerase Chain Reaction; D011994:Recombinant Proteins; D012751:Sezary Syndrome / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D016176:T-Lymphocyte Subsets; D018417:Th1 Cells / Q000276:immunology* / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D007155:Immunologic Factors; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D015847:Interleukin-4; D007371:Interferon-gamma