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Blood, 1 March 2002, Vol. 99, No. 5, pp. 1556-1563

CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

Clinical and biologic features of CD4+CD56+ malignancies

Jean Feuillard, Marie-Christine Jacob, Françoise Valensi, Marc Maynadié, Rémy Gressin, Laurence Chaperot, Christine Arnoulet, Françoise Brignole-Baudouin, Bernard Drénou, Eliane Duchayne, Annie Falkenrodt, Richard Garand, Emanuelle Homolle, Bernard Husson, Emilienne Kuhlein, Geneviève Le Calvez, Danielle Sainty, Marie-France Sotto, Franck Trimoreau, and Marie-Christine Béné

From the Service d'Hématologie Biologique, Hôpital Avicenne, Université Paris 13 Bobigny, France; Laboratoire d'Immunologie Cellulaire, EFS Rhône-Alpes Grenoble, La Tronche, France; Laboratoire Central d'Hématologie, Hôpital Necker, Paris, France; Service d'Hématologie Biologique, CHU Bocage, Dijon, France; Service d'Hématologie Clinique, CHU Michallon, Grenoble, France; Laboratoire R et D, EFS Rhône-Alpes Grenoble, La Tronche, France; Département de Biologie, Unité d'Hématologie, Institut Paoli-Calmettes, Marseille, France; Laboratoire d'Immuno-Hématologie, Hôpital Ambroise Paré, Boulogne, France; Laboratoire d'Hémato-Immunologie, Hôpital Pontchaillou, Rennes, France; Laboratoire d'Hématologie et Laboratoire d'Immunologie Cellulaire, Hôpital Purpan, Toulouse, France; Service de Séro-Hématologie, Hôpital de Hautepierre, Strasbourg, France; Laboratoire d'Hématologie, Institut de Biologie des Hôpitaux, Nantes, France; Laboratoire d'Hématologie, Hôpital Debrousse, Lyon, France; Laboratoire de Biologie Clinique, Hôpital de Jolimont, Haine St Paul, Belgique; Laboratoire d'Hématologie, CHU de Brest, Brest, France; Laboratoire d'Hématologie, CHU Michallon, Grenoble, France; Laboratoire d'Hématologie, CHU Dupuytren, Limoges, France; and Laboratoire d'Immunologie, Faculté de Médecine and CHU de Nancy, Vandoeuvre les Nancy, France.

CD4+CD56+ malignancies are rare hematologic neoplasms, which were recently shown to correspond to the so-called type 2 dendritic cell (DC2) or plasmacytoid dendritic cells. This study presents the biologic and clinical features of a series of 23 such cases, selected on the minimal immunophenotypic criteria defining the DC2 leukemic counterpart, that is, coexpression of CD4 and CD56 in the absence of B, T, and myeloid lineage markers. Clinical presentation typically corresponded to cutaneous nodules associated with lymphadenopathy or spleen enlargement or both. Cytopenia was frequent. Circulating malignant cells were often detected. Massive bone marrow infiltration was seen in 20 of 23 (87%) patients. Most tumor cells exhibited nuclei with a lacy chromatin, a blastic aspect, large cytoplasm-containing vacuoles or microvacuoles beside the plasma membrane, and cytoplasmic expansions resembling pseudopodia. Other immunophenotypic characteristics included both negative (CD16, CD57, CD116, and CD117) and positive (CD36, CD38, CD45 at low levels, CD45RA, CD68, CD123, and HLA DR) markers. The prognosis was rapidly fatal in the absence of chemotherapy. Complete remission was obtained in 18 of 23 (78%) patients after polychemotherapy. Most patients had a relapse in less than 2 years, mainly in the bone marrow, skin, or central nervous system. Considering these clinical and biologic features, the conclusion is made that CD4+CD56+ malignancies constitute a genuine homogeneous entity. Furthermore, some therapeutic options were clearly identified. Finally, relationships between the pure cutaneous indolent form of the disease and acute leukemia as well as with the lymphoid/myeloid origin of the CD4+CD56+ malignant cell are discussed.

© 2002 by The American Society of Hematology.
 

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