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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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Submitted June 14, 2004
Accepted August 27, 2004
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
Department of Dermatology, Charite - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
Institute of Pathology, Charite - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
Institute of Medical Informatics, Biometrics and Clinical Epidemiology, Charite - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
* Corresponding author; email: chalid.assaf{at}charite.de.
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 two independent PCR assays, namely a recently developed TCR- PCR technique as well as a established TCR- PCR. T-cell clonality was found in 22/22 lymph nodes with histological detectable CTCL involvement as well as in 7/14 histologically non-involved 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 7/14 dermatopathic lymph nodes of CTCL patients was associated with limited survival (74 months, 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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