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Blood, 1 November 2000, Vol. 96, No. 9, pp. 2987-2992
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Diagnostic value of dominant T-cell clones in peripheral blood in
363 patients presenting consecutively with a clinical suspicion of
cutaneous lymphoma
Marie-Hélène Delfau-Larue,
Liliane Laroche,
Janine Wechsler,
Eric Lepage,
Chantal Lahet,
Marianne Asso-Bonnet,
Martine Bagot, and
Jean-Pierre Farcet
From the Departments of Immunobiology, Pathology,
Biostatistics and Medical Informatics, and Dermatology, Hospital
Henri-Mondor, Assistance Publique-Hôpitaux de Paris, and
University Paris XII, Créteil, France, and the Department of
Dermatology, Center of Extracorporeal Photochemotherapy, Hospital
Avicennes, Assistance Publique-Hôpitaux de Paris, and University
Paris XIII, Bobigny, France.
It is now widely accepted that polymerase chain reaction (PCR)
analysis of cutaneous T-cell clonality is of diagnostic value in
cutaneous T-cell lymphomas (CTCLs) and most helpful in the diagnosis of
mycosis fungoides (MF). However, the diagnostic and prognostic value of
circulating clonal T cells remains unclear. We studied T-cell clonality
in the peripheral blood (PB) and the cutaneous lesion, sampled at the
same time, in 363 consecutively seen patients with a clinical suspicion
of cutaneous lymphoma. Using a PCR technique providing a specific
imprint of T-cell clones (PCR -denaturing gradient gel
electrophoresis), we found that detection of identical circulating and
cutaneous T-cell clones was associated with the diagnosis of CTCL
(P < .001). Detection of circulating tumor cells in
patients with MF was infrequent (12.5%), except in those with
erythrodermic MF (42%; P = .003). Moreover, among the 46 patients who had identical circulating and cutaneous T-cell clones, 25 (56%) had erythroderma. The finding of a dominant clone in the PB but
not in the skin was frequent, regardless of the clinicohistologic
classification; it occurred in 30% of patients with CTCL, 41% with
non-CTCL malignant infiltrates, and 34% with benign infiltrates. This
pattern was significantly more frequent in patients over 60 years of
age (P < .002), even in the CTCL group
(P < .01). In conclusion, dominant T-cell clones detected in the PB of patients with MF by using a routine PCR technique
are rarely tumoral and are more often related to age. A multicenter
prospective study is under way to establish the prognostic value of
circulating tumor cells.
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