Association of change in clinical status and change in the percentage of the CD4+CD26- lymphocyte population in patients with Sézary syndrome.
BACKGROUND
Because there are currently many effective therapies available for Sézary syndrome, close monitoring of disease progression is required in order for a clinician to know when to institute or change an intervention. It has been our clinical experience that changes in patients' CD4+CD26- T-cell populations of peripheral blood lymphocytes herald changes in their clinical status.


OBJECTIVE
Our purpose was to evaluate whether a change in patients' CD4+CD26- population of T cells presages a change in their clinical status. We also sought to investigate the association between a change in T-cell populations that are CD4+CD7-, CD8+, CD56+, and the CD4+/CD8+ T-cell ratio and a change in the patient's clinical status.


METHODS
We conducted a retrospective chart review analysis of 21 patients with Sézary syndrome who had flow cytometry, usually including levels of CD4+CD26-, CD4+CD7-, CD8+, CD56+, and CD4+/CD8+ ratios measured at two time periods, 12 weeks apart.


RESULTS
We report two cases in which changes in patients' clinical status were preceded by several weeks by a change in their CD4+CD26- level. We report weak associations between a decreasing CD4+CD26- T-cell population, a decreasing CD4+CD7- population, an increasing CD56+ population, and an improving clinical status. We also report stronger associations between both a decreasing CD8+ population and an increasing CD4+/CD8+ ratio and a worsening clinical status.


CONCLUSIONS
The study was limited by the number of patients and the time period over which the study was conducted. In addition, varying configurations of CD4+CD26- T-cell populations were observed that may have limited the utility of this measurement.


CONCLUSIONS
Flow cytometry assays of patients' blood and, in particular, measurement of the CD4+CD26- population of lymphocytes over time may be a valuable tool for monitoring patients with Sézary syndrome. There exist varying configurations of CD26 T lymphocytes that may cause differences in standards for what is considered positive and negative between observers. Further prospective analysis involving larger groups of patients is recommended.
Introcaso
Camille E
CE
Department of Dermatology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Hess
Stephen D
SD
Kamoun
Malek
M
Ubriani
Ravi
R
Gelfand
Joel M
JM
Rook
Alain H
AH
D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018819:Dipeptidyl Peptidase 4 / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D012751:Sezary Syndrome / Q000175:diagnosis* / Q000276:immunology; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000276:immunology
D014408:Biomarkers, Tumor; D018819:Dipeptidyl Peptidase 4