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December 1992

Frequency and Prognostic Significance of Clonal T-Cell Receptor ß-Gene Rearrangements in the Peripheral Blood of Patients With Mycosis Fungoides

Author Affiliations

From the Departments of Dermatology (Drs Bakels, Van Oostveen, and Willemze, and Mr Gordijn) and Pathology, Molecular Pathology Unit (Messr van Oostveen and Gordijn and Drs Walboomers, Meijer, and Willemze), Free University Hospital, Amsterdam, the Netherlands.

Arch Dermatol. 1992;128(12):1602-1607. doi:10.1001/archderm.1992.04530010040005

• Background.  —Previous studies have shown that peripheral blood involvement is a poor prognostic sign in patients with cutaneous T-cell lymphoma. However, evaluation of the results of these studies is difficult. In this study peripheral blood mononuclear cells from 45 patients with various stages of mycosis fungoides (MF) were investigated for the presence of clonal T-cell populations by T-cell receptor β (TCRβ)-gene rearrangement analysis.

Results.  —Clonal TCRβ-gene rearrangements were found in five (11%) of 45 patients with MF, including one (3%) of 31 patients without MF and four (27%) of 15 patients with histologically confirmed lymph node involvement. With respect to skin stage, clonal T-cell populations were detected in one (4%) of 23 patients with plaque stage disease, two (10%) of 19 patients with tumor stage disease, and two (50%) of four patients with erythrodermic MF. In the group of patients with lymph node involvement the median survival of patients with detectable clonal T-cell rearrangements in the periphera blood was much shorter (3 months) than that of patients without clonal rearrangements (16 months).

Conclusions.  —The results of this study indicate that clonal TCRβ-gene rearrangements, as detected by Southem blot analysis, are uncommon in the peripheral blood of [ill] tients with MF, in particular in patients without histologically documented lymph node involvement. The presence [ill] clonal T-cell populations in the peripheral blood of [ill] patients with lymph node involvement is usually [ill] with rapidly fatal disease.