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Blood, 1 November 2002, Vol. 100, No. 9, pp. 3369-3373
NEOPLASIA
Clonal heterogeneity in mycosis fungoides and its relationship to
clinical course
Francisco Vega,
Rajyalakshmi Luthra,
L. Jeffrey Medeiros,
Valerie Dunmire,
Sang-Joon Lee,
Madeleine Duvic, and
Dan Jones
From the Division of Pathology and Laboratory Medicine
and the Departments of Biostatistics and Dermatology, University of
Texas MD Anderson Cancer Center, Houston.
Mycosis fungoides (MF) is a cutaneous T-cell lymphoma characterized
by multifocal disease and protracted clinical course. The few studies
that have assessed T-cell receptor (TCR) gene rearrangements (GRs)
present at different anatomic sites in MF have generally reported a
common clone. We used a previously validated 4-color polymerase chain
reaction (PCR) assay to assess the size and V-family usage of TCR-
GRs in 102 concurrent and/or sequential morphologically involved biopsy
specimens (91 skin and 11 lymph nodes) from 39 MF patients. This assay
detected TCR- clonal GRs in 89 samples (87%) from 36 patients
(92%). In 24 patients (77%), an identical clonal GR was present in at
least 2 skin samples. However, in one third of these patients,
additional different clonal GRs were also noted. Four patients (13%)
had clonal GRs that were distinct in different skin samples. In 3 patients (10%), no GR was detected in any sample. In a comparison of
lymph node and skin samples, 8 patients had the identical clonal GRs at
both sites, 2 patients had different clonal GRs, and 1 patient had no
GR identified at either site. Independent of clinical stage, patients
who had the same GR detected in multiple concurrent biopsy specimens at
the time of diagnosis were more likely to have progressive disease than
those who had different GRs (P = .04). Four-color TCR-
PCR analysis can uncover multiple distinct clonal GRs in different
samples consistent with multiclonal or oligoclonal disease in a
significant proportion of MF patients. Demonstration of identical clonal GRs in multiple biopsy specimens at the time of diagnosis may
provide prognostic information related to disease progression.
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