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Diagnostic and prognostic significance of Sezary cells in peripheral blood
smears from patients with cutaneous T cell lymphoma
EC Vonderheid, EL Sobel, PC Nowell, JB Finan, MK Helfrich and DS Whipple
Blood smears stained with Wright-Giemsa were obtained from 124 patients
with pathologically confirmed cutaneous T cell lymphoma (CTCL), 70 patients
with various other cutaneous disorders, and ten healthy adult volunteers.
These were examined in a blinded fashion for atypical lymphocytes with
cerebriform nuclei (CLs), which were characterized further according to
cell diameter. CLs, comprising up to 15% of lymphocytes in smears, were
observed in 20% of the patients with benign dermatitis. CLs, comprising up
to 89% of lymphocytes in smears, were found in 22%, 30%, 50%, and 96% of
patients with patch, plaque, tumor, and erythrodermic CTCL, respectively.
Large-diameter CLs (15 to 20 micron) were observed only in smears from
patients with CTCL. Total CL counts above 15 per 100 lymphocytes and/or the
presence of large CLs occurred in 33 of 49 (67%) patients with
erythrodermic disease and in only two patients with other skin
manifestations. Blood smears obtained at the time of cytogenetic studies
indicated that a total CL count above 15% was the smear criterion that
correlated best with the demonstration of a chromosomally abnormal
malignant clone in the blood. The presence of large CLs per se, although
also predictive of a malignant clone, was less useful. Multivariate
survival analysis showed that the duration of disease before the blood
smear and the proportion of large CLs within the total CL population were
the covariates that correlated most significantly with survival. We
speculate that the reduced survival of patients with increased proportions
of large CLs in smears reflects the presence of polyploid malignant
lymphocytes in the blood.
Volume 66,
Issue 2,
pp. 358-366,
08/01/1985
Copyright © 1985 by The American Society of Hematology
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