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Blood, Vol. 94 No. 4 (August 15), 1999:
pp. 1409-1417
Demonstration of Frequent Occurrence of Clonal T Cells in the
Peripheral Blood But Not in the Skin of Patients With Small Plaque
Parapsoriasis
J. Marcus Muche,
Ansgar Lukowsky,
Jürgen Heim,
Markus Friedrich,
Heike Audring, and
Wolfram Sterry
From the Department of Dermatology, University Hospital
Charité, Humboldt University of Berlin, Germany.
Clinical, immunohistological, and molecular biological data suggest
the chronic dermatosis small plaque parapsoriasis (SPP) to be a
precursor of mycosis fungoides (MF). However, most data are
contradictory and confusing due to inexact definition of SPP. Recently,
clonal T cells were detected in skin and blood samples of early MF.
Because demonstration of identical T-cell clones in skin and blood of
SPP patients would indicate a close relationship of SPP to MF, we
investigated the clonality of skin and blood specimens from 14 well-defined SPP patients. By a polymerase chain reaction (PCR)
amplifying T-cell receptor  rearrangements and subsequent
high-resolution electrophoresis, clonal T cells were detected in 9 of
14 initial and 32 of 49 follow-up blood samples, but in 0 of 14 initial
skin specimens. Even a clone-specific PCR showing the persistence of
the initial blood T-cell clone in 20 of 20 follow-up samples, failed to
detect the T-cell clone in the skin. In 2 patients, the clonal T cells
were shown to be CD4+. For the first time, the majority
of SPP patients was shown to carry a T-cell clone in the peripheral
blood. Although a relation between circulating clonal T cells and SPP
cannot directly be proven by the applied techniques, our results
indicate blood T-cell clonality to be a characteristic feature of SPP
and CTCL because analysis of multiple controls and clinical workup of
our SPP patients excluded other factors simulating or causing a clonal
T-cell proliferation. A sufficient cutaneous antitumor response but
also an extracutaneous origin of the T-cell clones might explain the
failure to detect skin infiltrating clonal T cells.
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