Diagnostic value of dominant T-cell clones in peripheral blood in 363 patients presenting consecutively with a clinical suspicion of cutaneous lymphoma

• Published in: Blood 2000-11, Vol.96 (9), p.2987-2992
• Main Authors: Delfau-Larue, Marie-Hélène, Laroche, Liliane, Wechsler, Janine, Lepage, Eric, Lahet, Chantal, Asso-Bonnet, Marianne, Bagot, Martine, Farcet, Jean-Pierre
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Biopsy; Clone Cells; Dermatology; Diagnosis, Differential; Gene Rearrangement, T-Lymphocyte; Hematologic and hematopoietic diseases; Humans; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoma, T-Cell, Cutaneous - blood; Lymphoma, T-Cell, Cutaneous - diagnosis; Lymphoma, T-Cell, Cutaneous - immunology; Lymphoma, T-Cell, Cutaneous - pathology; Medical sciences; Middle Aged; Mycosis Fungoides - diagnosis; Mycosis Fungoides - immunology; Mycosis Fungoides - pathology; Neoplasm Staging; Polymerase Chain Reaction; Prognosis; Reproducibility of Results; Sezary Syndrome - diagnosis; Sezary Syndrome - immunology; Sezary Syndrome - pathology; Skin - immunology; Skin - pathology; Skin Diseases - diagnosis; Skin Diseases - immunology; Skin Diseases - pathology; Skin Neoplasms - diagnosis; Skin Neoplasms - immunology; Skin Neoplasms - pathology; T-Lymphocytes - immunology; Tumors of the skin and soft tissue. Premalignant lesions
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V96.9.2987

It is now widely accepted that polymerase chain reaction (PCR) analysis of cutaneous T-cell clonality is of diagnostic value in cutaneous T-cell lymphomas (CTCLs) and most helpful in the diagnosis of mycosis fungoides (MF). However, the diagnostic and prognostic value of circulating clonal T cells remains unclear. We studied T-cell clonality in the peripheral blood (PB) and the cutaneous lesion, sampled at the same time, in 363 consecutively seen patients with a clinical suspicion of cutaneous lymphoma. Using a PCR technique providing a specific imprint of T-cell clones (PCRγ–denaturing gradient gel electrophoresis), we found that detection of identical circulating and cutaneous T-cell clones was associated with the diagnosis of CTCL (P < .001). Detection of circulating tumor cells in patients with MF was infrequent (12.5%), except in those with erythrodermic MF (42%; P = .003). Moreover, among the 46 patients who had identical circulating and cutaneous T-cell clones, 25 (56%) had erythroderma. The finding of a dominant clone in the PB but not in the skin was frequent, regardless of the clinicohistologic classification; it occurred in 30% of patients with CTCL, 41% with non-CTCL malignant infiltrates, and 34% with benign infiltrates. This pattern was significantly more frequent in patients over 60 years of age (P < .002), even in the CTCL group (P < .01). In conclusion, dominant T-cell clones detected in the PB of patients with MF by using a routine PCR technique are rarely tumoral and are more often related to age. A multicenter prospective study is under way to establish the prognostic value of circulating tumor cells.