Cutaneous T-cell lymphoma (CTCL): Current practices in blood assessment and the utility of T-cell receptor (TCR)-V? chain restriction - 14/04/16
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.
Le texte complet de cet article est disponible en PDF.Key words : cutaneous T-cell lymphoma, flow cytometry, mycosis fungoides, peripheral blood analysis, Sézary syndrome, T-cell receptor-Vβ
Abbreviations used : CTCL, EORTC, ISCL, PCR, TCR
Plan
Supported by Yale SPORE in Skin Cancer (grant #1P50CA121974 from National Institutes of Health/National Cancer Institute). |
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Conflicts of interest: None declared. |
Vol 74 - N° 5
P. 870-877 - mai 2016 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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