Naive/memory T-cell phenotypes in leukemic cutaneous T-cell lymphoma: Putative cell of origin overlaps disease classification

BackgroundMycosis fungoides (MF) and Sezary Syndrome (SS) are clinically distinct cutaneous T-cell lymphomas with strikingly similar morphologic and phenotypic features. Prior studies have suggested phenotypic differences based on markers of antigen experience, suggesting a different cell of origin. MethodsSeventy-nine involved peripheral blood or bone marrow samples from 33 patients with SS and 19 patients with MF were studied by 10-color flow cytometry, including CD62L, CD45RA, CCR4, and PD-1. Gated tumor events were classified as naive (T-N), central memory (T-CM), effector memory (T-EM), or effector memory with reacquired CD45RA (T-EMRA); based on CD62L(+)/CD45RA(+), CD62L(+)/CD45RA(-), CD62L(-)/CD45RA(-), or CD62L(-)/CD45RA(+) phenotype, respectively. Sequential specimens were compared to assess for phenotypic stability. ResultsThe naive/memory phenotype of the neoplastic T-cells was markedly heterogeneous, with a dominant T-N, T-CM, T-EM, or T-EMRA subset on 11 (14%), 32 (41%), 30 (38%), and 6 (8%) cases, respectively. There was no correlation between the diagnosis of MF or SS and putative cell of origin (P = 0.4). Overexpression of CCR4 and PD1 was observed in most cases, with higher intensity in SS compared to MF. The naive/memory phenotype remained the same for 10 patients up to 273 days after the initial analysis; while on six patients, the naive/memory phenotype was different from the original phenotype. ConclusionsBoth SS and MF can have phenotypic features of any of the major naive/memory T-cell subsets, which questions the current principle of cell-of-origin distinction between SS and MF. Phenotypic shifts within these subsets are common, suggesting a functional state rather than a cell-of-origin surrogate. (c) 2018 International Clinical Cytometry Society