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Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3376-3380
Prognostic Significance of a Polymerase Chain Reaction-Detectable
Dominant T-Lymphocyte Clone in Cutaneous Lesions of Patients With
Mycosis Fungoides
Marie-Hélène Delfau-Larue,
Sophie Dalac,
Eric Lepage,
Tony Petrella,
Janine Wechsler,
Jean-Pierre Farcet, and
Martine Bagot
From the Service d'Immunologie Biologique, Unité
d'Information Médicale, Département de Pathologie, Service
de dermatologie du Pr Revuz, Hôpital Henri-Mondor, Créteil,
France; the Service de Dermatologie du Pr Lambert, Hôpital du
Bocage; and the Département de Pathologie, CHU de
Dijon, Dijon, France.
Although mycosis fungoides (MF) is considered to be an indolent
lymphoma, survival is highly influenced by TNM stage. At diagnosis, most MF patients present with early stage disease and a high
probability of long-term survival. Treatment is generally directed
towards skin lesions, and achievement and duration of complete
responses are variable. A dominant T-cell clone is detectable in the
cutaneous lesions of 60% of patients. The aim of this study was to
determine whether the presence of a T-cell clonal population influences the clinical course of the disease after topical therapy. Cutaneous biopsies from 68 patients were histologically diagnosed as MF and
T-cell clonality was analyzed by in vitro amplification of TCR-
chain gene rearrangements (polymerase chain reaction [PCR]). After a median follow-up of 48 months,
response to treatment was clinically assessed. Age, sex, duration of
symptoms before diagnosis, type of cutaneous lesions (T stage), TNM
stage, and PCR were evaluated as predictive factors of response to
treatment in univariate and multivariate analyses. Univariate analysis
demonstrated that T1 cutaneous lesions (P = .05) and PCR
negativity (P = .007) were associated with a higher complete
remission rate. Using multivariate analysis, T stage
(relative risk, 3.13; P = .06) and PCR (relative risk,
4.4; P = .01) remained independent significant predictive parameters of response. In conclusion, T stage and cutaneous PCR at
diagnosis are the two predictive parameters of treatment response for
MF. Therefore, the cutaneous PCR findings should be considered in
the analysis of future therapeutic trials.
© 1998 by The American Society of Hematology.
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