Blood, 15 January 2005, Vol. 105, No. 2, pp. 503-510.
Prepublished online as a Blood First Edition Paper on September 30, 2004; DOI 10.1182/blood-2004-06-2220.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Early TCR- and TCR- PCR detection of T-cell clonality indicates minimal tumor disease in lymph nodes of cutaneous T-cell lymphoma: diagnostic and prognostic implications
Chalid Assaf,
Michael Hummel,
Matthias Steinhoff,
Christoph C. Geilen,
Helmut Orawa,
Harald Stein, and
Constantin E. Orfanos
From the Department of Dermatology, Charité–University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany; the Institute of Pathology, Charité–University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany; and the Institute of Medical Informatics, Biometrics and Clinical Epidemiology, Charité–University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
The lymph nodes are generally the first extracutaneous manifestation in patients with cutaneous T-cell lymphoma (CTCL); however, their early involvement is difficult to assess. The aim of our study was to define the diagnostic and prognostic value of T-cell clonality analysis for a more precise assessment of lymph node involvement in CTCL. T-cell clonality was determined by 2 independent polymerase chain reaction (PCR) assays, namely a recently developed T-cell receptor- (TCR-) PCR technique as well as an established TCR- PCR. T-cell clonality was found in 22 of 22 lymph nodes with histologically detectable CTCL involvement as well as in 7 of 14 histologically noninvolved dermatopathic lymph nodes. The clonal T-cell populations in the lymph nodes were in all cases identical to those detected in the corresponding skin lesions, identifying them as the tumor cell population. T-cell clonality was not found in any of the 12 dermatopathic lymph nodes from 12 patients with inflammatory skin diseases. Clonal T-cell detection in 7 of 14 dermatopathic lymph nodes of patients with CTCL was associated with limited survival (74 months; confidence interval [CI], 66-82 months) as in patients with histologically confirmed lymph node involvement (41 months; CI, 35-47 months), whereas all patients without T-cell clonality in the lymph nodes (7 patients) were alive at the last follow-up. Thus, T-cell clonality analysis is an important adjunct in differentiating benign dermatopathic lymphadenitis from early CTCL involvement.
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