Cutaneous T-cell lymphoma (CTCL): Current practices in blood assessment and the utility of T-cell receptor (TCR)-Vβ chain restriction

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• 作者：Juliet F. Gibson ; MD^a ; Jing Huang ; MD^c ; Kristina J. Liu ; MD^d ; Kacie R. Carlson ; PA-C^a ; Francine Foss ; MD^b ; Jaehyuk Choi ; MD ; PhD^a ; Richard Edelson ; MD^a ; Jerry W. Hussong ; MD^e ; Ramsey Mohl ; MT^e ; Sally Hill ; MT^e ; Michael Girardi ; MD^a ; ^{michael.girardi@yale.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：cutaneous T-cell lymphoma ; flow cytometry ; mycosis fungoides ; peripheral blood analysis ; Sé ; zary syndrome ; T-cell receptor-Vβ
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：74
• 期：5
• 页码：870-877
• 全文大小：636 K

文摘

Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T-cell lymphoma is important for early detection, prognosis, and monitoring disease burden.

Objective

We sought to determine the spectrum of current clinical practices; critically evaluate elements of current International Society for Cutaneous Lymphomas (ISCL) B₁ and B₂ staging criteria; and assess the potential role of T-cell receptor-Vβ analysis by flow cytometry.

Methods

We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, positive predictive value, and negative predictive value of parameters for ISCL B2 staging.

Results

There was heterogeneity in clinical practices among institutions. ISCL B₁ criteria did not capture 5 Yale cohort cases with immunophenotypic abnormalities that later progressed. T-cell receptor-Vβ testing was more specific than polymerase chain reaction and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden.

Limitations

Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit.

Conclusion

We propose further study of modified B₁ criteria: CD4/CD8 ratio 5 or greater, %CD4⁺ CD26⁻ 20% or greater, or %CD4⁺ CD7⁻ 20% or greater, with evidence of clonality. T-cell receptor-Vβ testing should be considered in future diagnostic and staging algorithms.