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

被引:30
作者
Gibson, Juliet F. [1 ]
Huang, Jing [3 ]
Liu, Kristina J. [4 ]
Carlson, Kacie R. [1 ]
Foss, Francine [2 ]
Choi, Jaehyuk [1 ]
Edelson, Richard [1 ]
Hussong, Jerry W. [5 ]
Mohl, Ramsey [5 ]
Hill, Sally [5 ]
Girardi, Michael [1 ]
机构
[1] Yale Univ, Sch Med, Dept Dermatol, 333 Cedar St,POB 208059, New Haven, CT 06520 USA
[2] Yale Univ, Sch Med, Dept Hematol & Oncol, New Haven, CT 06520 USA
[3] New York Presbyterian Hosp, Dept Dermatol, Weill Cornell Med Ctr, New York, NY USA
[4] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Dept Dermatol, Cambridge, MA 02138 USA
[5] Univ Utah, ARUP Labs, Dept Pathol, Salt Lake City, UT 84112 USA
基金
美国国家卫生研究院;
关键词
cutaneous T-cell lymphoma; flow cytometry; mycosis fungoides; peripheral blood analysis; Sezary syndrome; T-cell receptor-V beta; V-BETA ANTIBODIES; PERIPHERAL-BLOOD; SEZARY-SYNDROME; MYCOSIS-FUNGOIDES; FLOW-CYTOMETRY; INVOLVEMENT; EXPRESSION; RELEVANCE; DIAGNOSIS;
D O I
10.1016/j.jaad.2015.12.018
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background: 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) B-1 and B-2 staging criteria; and assess the potential role of T-cell receptor-V beta 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-V beta 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 B-1 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-V beta testing should be considered in future diagnostic and staging algorithms.
引用
收藏
页码:870 / 877
页数:8
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