Evidence that an identical T cell clone in skin and peripheral blood lymphocytes is an independent prognostic factor in primary cutaneous T cell lymphomas.
The monoclonality of the T cell receptor gamma-chain gene was analyzed by polymerase chain reaction in skin and blood specimens of 85 patients with cutaneous T cell lymphomas including 67 mycosis fungoides, seven Sézary syndromes, and 11 CD30- nonepidermotropic cutaneous T cell lymphomas. A cutaneous T cell clone was detected in 69% of mycosis fungoides and 100% of Sézary syndromes. This frequency varied according to the clinical stage: 57% in early stages (Ia-IIa) to 96% in advanced stages (IIb-IV, Sézary syndrome). A peripheral blood T cell clone was detected in 42% of early stages and in 74% of late stages but was identical to the cutaneous one in 15% and in 63%, respectively. A significant association between initial clinical stage and T cell monoclonality was observed. In nonepidermotropic cutaneous T cell lymphomas, T cell monoclonality was detected in 55% of skin and 36% of blood samples. Univariate and multivariate analyses showed that, besides the initial clinical stage, an identical cutaneous and blood T cell clone was an independent prognostic factor for disease progression of mycosis fungoides/Sézary syndrome (hazard ratio 3.4, 95% confidence interval 1.4-9.9). Parallel polymerase chain reaction study of skin and blood specimens may therefore provide an initial prognostic marker that could help to monitor therapeutic strategies. A fully prospective study, with simultaneous therapeutic trials, needs to be done to confirm our findings and to include treatment variables in the statistical analysis.
Beylot-Barry
M
M
Equipe Histologie et Pathologie Moléculaire 12406, Université Victor Segalen Bordeaux 2, France. marie.beylot-barry@histo.u-bordeaux2.fr
Sibaud
V
V
Thiebaut
R
R
Vergier
B
B
Beylot
C
C
Delaunay
M
M
Chene
G
G
Dubus
P
P
Merlio
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001773:Blood Cells / Q000473:pathology*; D002999:Clone Cells; D005260:Female; D006801:Humans; D016399:Lymphoma, T-Cell / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000473:pathology*; D013601:T-Lymphocytes / Q000473:pathology*