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J Am Acad Dermatol. 2016 May;74(5):870-7. doi: 10.1016/j.jaad.2015.12.018. Epub 2016 Feb 10.

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

Author information

1
Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.
2
Department of Dermatology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
3
Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
4
Department of Hematology and Oncology, Yale School of Medicine, New Haven, Connecticut.
5
Department of Pathology/ARUP Laboratories, University of Utah, Salt Lake City, Utah.
6
Department of Dermatology, Yale School of Medicine, New Haven, Connecticut. Electronic address: michael.girardi@yale.edu.

Abstract

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) 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.

KEYWORDS:

Sézary syndrome; T-cell receptor-Vβ; cutaneous T-cell lymphoma; flow cytometry; mycosis fungoides; peripheral blood analysis

PMID:
26874819
PMCID:
PMC4835257
DOI:
10.1016/j.jaad.2015.12.018
[Indexed for MEDLINE]
Free PMC Article

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