title: CD4+ CD56+ neoplasia: clinical and biological features with emphasis on cytotoxic drug-induced apoptosis and expression of sialyl Lewis X.
abstract: CD4+ CD56+ neoplasia is a rare malignancy of unclarified origin. So far only 57 cases have been reported. We characterized in detail a case of CD4+ CD56+ malignancy with special emphasis on apoptosis induced by cytotoxic drugs and expression of sialyl Lewis X (CD15s). The disease was diagnosed in a 73-year-old female presenting with skin involvement, generalized lymphadenopathy and bone marrow infiltration. Treatment with cladribine/mitoxantrone induced a short-lasting partial response and the patient died 6 months after diagnosis. The neoplastic cells expressed CD4, CD56, HLA-DR, and CD15s. PCR for the T-cell receptor gamma chain revealed a polyclonal amplification product. In situ hybridization for Epstein-Barr Virus (EBV) was negative. Cytotoxic granule-associated proteins were not detected, consistent with the observation that the cells did not mediate cytotoxic activity against several target cells. Apoptosis of the tumor cells was inducible by anthracyclines and cladribine but not with gemcitabine. Combinations of cladribine or gemcitabine with anthracyclines however, resulted in synergistic effects on apoptosis. Expression of CD15s on the CD56+ cells was three times higher than on CD56+ cells from healthy controls. The results demonstrate that the features of the present case is in accordance with the diagnosis of CD4+ CD56+ malignancy. This is the first report demonstrating increased CD15s expression on a CD4+ CD56+ neoplasia, possibly explaining the frequent occurrence of the disease in the skin.
authors.affiliation: Department of Medicine III, Hematology/Oncology, University Hospital, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Franfurt/M, Germany.
authors.forename: Soo-Zin
authors.initials: SZ
authors.lastname: Kim
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Zollner
authors.forename: Daniela K
authors.initials: DK
authors.lastname: Schui
authors.forename: Kai U
authors.initials: KU
authors.lastname: Chow
authors.forename: Wolfram
authors.initials: W
authors.lastname: Sterry
authors.forename: Susanne
authors.initials: S
authors.lastname: Kriener
authors.forename: Dieter
authors.initials: D
authors.lastname: Hoelzer
authors.forename: Paris S
authors.initials: PS
authors.lastname: Mitrou
authors.forename: Eckhart
authors.initials: E
authors.lastname: Weidmann
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000494:pharmacology; D000970:Antineoplastic Agents / Q000494:pharmacology; D017209:Apoptosis / Q000187:drug effects; D015704:CD4 Antigens; D019002:CD56 Antigen; D017338:Cladribine / Q000494:pharmacology; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D004357:Drug Synergism; D005260:Female; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology*; D006801:Humans; D016130:Immunophenotyping; D016256:Lewis X Antigen / Q000032:analysis; D009844:Oligosaccharides / Q000032:analysis; D000080506:Sialyl Lewis X Antigen; D000093542:Gemcitabine
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D015704:CD4 Antigens; D019002:CD56 Antigen; D016256:Lewis X Antigen; D009844:Oligosaccharides; D000080506:Sialyl Lewis X Antigen; D003841:Deoxycytidine; D017338:Cladribine; D000093542:Gemcitabine