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Blood, 1 September 2001, Vol. 98, No. 5, pp. 1298-1301
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Extracorporeal photopheresis in Sézary syndrome:
hematologic parameters as predictors of response
Alun V. Evans,
Blair P. Wood,
Julia J. Scarisbrick,
Elizabeth A. Fraser-Andrews,
Sue Chinn,
Alan Dean,
Philip Watkins,
Sean J. Whittaker, and
Robin Russell-Jones
From the Skin Tumour Unit, St John's Institute of
Dermatology, St Thomas' Hospital; and the Department of Public Health
Sciences, Guy's, King's and St Thomas' School of Medicine, King's
College, London, United Kingdom.
Data were analyzed from 23 patients with Sézary syndrome
(defined by erythroderma, more than 10% circulating atypical
mononuclear cells, and peripheral blood T-cell clone) undergoing
monthly extracorporeal photopheresis as the sole therapy for up to 1 year. The cohort showed a significant reduction of skin scores during
treatment (P = .001). Thirteen patients (57%) achieved a
reduction in skin score greater than 25% from baseline at 3, 6, 9, or
12 months (responders). Reduction in skin score correlated with
reduction in the Sézary cell count as a percentage of total white
cell count (P = .03). Responders and nonresponders were
compared. None of the measured parameters was significantly different
between the 2 groups. It was assessed whether any of the baseline
parameters predicted outcome. A higher baseline lymphocyte count was
significantly associated with a decrease in skin score at 6 months
(P < .05). A higher baseline Sézary cell count as
a percentage of total white cell count predicted a subject was more
likely to be a responder after 6 months of treatment
(P = .021). No other parameters predicted responder
status. These data show that the modest falls in CD4, CD8, and
Sézary cell counts were seen in all patients and might have
resulted from lymphocyte apoptosis. This mechanism could explain the
more favorable response seen in patients with higher percentages
of Sézary cells in the peripheral blood. Alternatively, minimum
tumor burden might be required for the induction of a cytotoxic
response. Analysis of tumor-specific cytotoxic T cells is needed to
investigate these possibilities further.
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