Early TCR-beta and TCR-gamma PCR detection of T-cell clonality indicates minimal tumor disease in lymph nodes of cutaneous T-cell lymphoma: diagnostic and prognostic implications.
The lymph nodes are generally the first extracutaneous manifestation in patients with cutaneous T-cell lymphoma (CTCL); however, their early involvement is difficult to assess. The aim of our study was to define the diagnostic and prognostic value of T-cell clonality analysis for a more precise assessment of lymph node involvement in CTCL. T-cell clonality was determined by 2 independent polymerase chain reaction (PCR) assays, namely a recently developed T-cell receptor-beta (TCR-beta) PCR technique as well as an established TCR-gamma PCR. T-cell clonality was found in 22 of 22 lymph nodes with histologically detectable CTCL involvement as well as in 7 of 14 histologically noninvolved dermatopathic lymph nodes. The clonal T-cell populations in the lymph nodes were in all cases identical to those detected in the corresponding skin lesions, identifying them as the tumor cell population. T-cell clonality was not found in any of the 12 dermatopathic lymph nodes from 12 patients with inflammatory skin diseases. Clonal T-cell detection in 7 of 14 dermatopathic lymph nodes of patients with CTCL was associated with limited survival (74 months; confidence interval [CI], 66-82 months) as in patients with histologically confirmed lymph node involvement (41 months; CI, 35-47 months), whereas all patients without T-cell clonality in the lymph nodes (7 patients) were alive at the last follow-up. Thus, T-cell clonality analysis is an important adjunct in differentiating benign dermatopathic lymphadenitis from early CTCL involvement.
Department of Dermatology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany. chalid.assaf@charite.de
Chalid
C
Assaf
Michael
M
Hummel
Matthias
M
Steinhoff
Christoph C
CC
Geilen
Helmut
H
Orawa
Harald
H
Stein
Constantin E
CE
Orfanos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002999:Clone Cells; D005260:Female; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D019674:Genes, T-Cell Receptor beta; D019675:Genes, T-Cell Receptor gamma; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D016410:Lymphoma, T-Cell, Cutaneous / Q000235:genetics* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012878:Skin Neoplasms / Q000235:genetics* / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate; D013601:T-Lymphocytes / Q000473:pathology / Q000502:physiology