Detection of circulating T cells with CD4+CD7− immunophenotype in patients with benign and malignant lymphoproliferative dermatoses

Harmon, Christopher B.; Witzig, Thomas E.; Katzmann, Jerry A.; Pittelkow, Mark R.

doi:10.1016/s0190-9622(96)90605-2

Cited by 134 publications

(99 citation statements)

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“…This indicates that some flow cytometric surface aberrations are not necessarily indicative of T-cell malignancies. These findings agree with earlier observations that loss or dim expression of CD7 and CD26 can be found in patients with benign inflammatory dermatoses 17,34,35 and other reactive conditions, 14 and aberrant dim CD3 can be observed non-neoplastic T cells. 29 Similarly, T-cell receptor gene rearrangements have been detected in samples of patients without clinical or histologic evidence of lymphoma or evidence of T-cell clonality shown by other methods.…”

Section: Discussionsupporting

confidence: 93%

“…[11][12][13][14][15][16] However, it has been recognized that T-cell antigenic alterations are not entirely specific for mycosis fungoides or Sézary syndrome, and have been observed in some reactive conditions. 11,17,18 Assessment of T-cell clonality using molecular methods is therefore recommended by the International Society for Cutaneous Lymphomas, even in the presence of flow cytometric immunophenotypic aberrancies.…”

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confidence: 99%

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Flow cytometric detection of peripheral blood involvement by mycosis fungoides and Sézary syndrome using T-cell receptor Vβ chain antibodies and its application in blood staging

et al. 2010

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Peripheral blood involvement has been recognized as an adverse prognostic factor in patients with mycosis fungoides and Sé zary syndrome. However, accurate identification and enumeration of the neoplastic cells in these diseases can be challenging. We assessed the clinical utility of flow cytometric immunophenotypic analysis of T-cell receptor Vb expression in 82 mycosis fungoides and 6 Sé zary syndrome patients, with an atypical T-cell immunophenotype, or abnormal CD4:CD8 ratio, identified from peripheral blood specimens of 723 patients submitted for routine mycosis fungoides/Sé zary syndrome blood staging. To improve detection sensitivity, Vb expression was analyzed on gated CD3 þ CD4 þ T cells or T cells with an aberrant immunophenotype, if present. The flow cytometric results were compared with traditional morphologic assessment (n ¼ 88) and molecular methods to assess the T-cell receptor c or b genes (n ¼ 41 tested in parallel). Flow cytometric immunophenotyping yielded a clonal Vb pattern in 60/82 mycosis fungoides and 6/6 Sé zary syndrome patients. By contrast, flow cytometric Vb was negative in all 10 healthy donors and 18 control patients, showing a specificity of 100% and concordance with molecular testing of 86%. Using flow cytometric Vb results instead of morphologic assessment, 12 patients were upstaged from B1 to B2, and 20 patients from B0 to B1 (Po0.0001). The 12 upstaged B2 patients had no morphologic evidence of involvement, but had an aggressive clinical course similar to those staged by traditional morphologic assessment (median survival 27 vs 41 months, log-rank P ¼ 0.701). In 30/44 patients with a tumor-associated Vb expression, a single Vb tube was used to monitor treatment response. In conclusion, flow cytometric Vb analysis is rapid and convenient, can assess T-cell clonality and tumor quantity simultaneously, and is useful both in initial blood staging and monitoring tumor burden during therapy in patients with mycosis fungoides or Sé zary syndrome.

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Section: Discussionsupporting

confidence: 93%

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confidence: 99%

Flow cytometric detection of peripheral blood involvement by mycosis fungoides and Sézary syndrome using T-cell receptor Vβ chain antibodies and its application in blood staging

et al. 2010

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“…In SS, clonal T cells are generally CD3 1 CD4 1 and CD8 2 by multicolor flow cytometry [128][129][130]. As in MF, the aberrant loss of pan-T-cell antigens, including CD2, CD3, CD4, CD5, and CD7 is frequently observed [130][131][132]. Of these, the aberrant loss of CD7 expression is most common, being observed in approximately two-thirds of cases [131,133,134].…”

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Cutaneous T‐cell lymphoma: 2011 update on diagnosis, risk‐stratification, and management

Wilcox

2011

American J Hematol

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Disease overview: Cutaneous T‐cell lymphomas are a heterogenous group of T‐cell lymphoproliferative disorders involving the skin, the majority of which may be classified as Mycosis fungoides (MF) or Sézary syndrome (SS).Diagnosis: The diagnosis of MF or SS requires the integration of clinical and histopathologic data.Risk‐adapted therapy: Tumor, node, metastasis, and blood (TNMB) staging remains the most important prognostic factor in MF/SS and forms the basis for a “risk‐adapted,” multidisciplinary approach to treatment. For patients with disease limited to the skin, expectant management or skin‐directed therapies is preferred, as both disease‐specific and overall survival for these patients is favorable. In contrast, patients with advanced‐stage disease with significant nodal, visceral, or blood involvement are generally approached with biologic‐response modifiers, denileukin diftitox, and histone deacetylase inhibitors before escalating therapy to include systemic, single‐agent chemotherapy. Multiagent chemotherapy may be used for those patients with extensive visceral involvement requiring rapid disease control. In highly‐selected patients with disease refractory to standard treatments, allogeneic stem‐cell transplantation may be considered. Am. J. Hematol., 2011. © 2011 Wiley‐Liss, Inc.

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“…Moreover Sézary cells, atypical lymphocytes in peripheral blood and ratio of CD4/CD8 = 45 provide support for his rapid progression of diffuse erythroderma and Sézary syndrome. 8 Sych and Kalamkarian first reported the coexistence of Kaposi sarcoma and mycosis fungoides in 1968. 9 Similarly the coexistence of malignant lymphoma and Kaposi sarcoma has been documented and attributed to immune suppressive drugs.…”

Section: Discussionmentioning

confidence: 99%

Sézary syndrome, Kaposi sarcoma and generalized dermatophytosis 15 years after sulfur mustard gas exposure

Emadi¹,

Babamahmoodi²,

Poursaleh³

et al. 2012

J Dermatol Case Rep

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Background:The relationship between compromised immune system and the development of malignancy, generalized dermatitis, and infection after sulfur mustard gas exposure has been established. Main observation:We introduce a 58-year-old man with an abrupt, de novo and erythrodermic eruption in 2002 that was previously exposed to sulfur mustard during the Iran -Iraq war in 1987. Six weeks after the onset of diffuse eruption, he developed papules on the glans penis and generalized dermatophytosis. A biopsy of his eruption was consistent with cutaneous T-cell lymphoma/Sézary syndrome. A complete blood count demonstrated leukocytosis, eosinophilia and atypical lymphocytosis. Subsequently, Sézary syndrome was confirmed and T-cell count with increased CD4/CD8 in flow cytometry. The biopsy of his penile papules was consistent with Kaposi's sarcoma. Conclusion:These findings suggest a causative relationship between sulfur mustard gas exposure, cutaneous T cell lymphoma and immune compromised state with opportunistic infections. (J Dermatol Case Rep. 2012; 6(3): 86-89) Sézary syndrome, Kaposi sarcoma and generalized dermatophytosis 15 years after sulfur mustard gas exposure IntroductionCutaneous T-cell lymphoma (CTCL) comprises a group of clinicopathologic entities that are neoplastic proliferation of T lymphocytes that home to the skin. Eventually the T-cells may lose their dependence on an epidermal environment for growth, and spread to the dermis, lymph nodes, blood, and viscera. 1,2The cutaneous lesions evolve from patches to plaque and tumors (mycosis fungoides), and Sézary syndrome, where the neoplastic cells circulate in the peripheral blood. The patients present with generalized exfoliation erythroderma, intense pruritus, peripheral lymphadenophaty, and abnormal hyperchromatic mononuclear cells in the skin and peripheral blood. Decreased T-cell function may lead to subsequent immune compromised status and is followed by infection. 4 Kaposi sarcoma (KS) is a vascular tumor of intermediate malignancy, histologically characterized by proliferation of lymphatic and/or vascular endothelial cells caused by the Kaposi's sarcoma-associated herpesvirus (KSHV), human herpesvirus 8. KS is a systemic disease, which can present with cutaneous lesions with or without internal involvement. Four subtypes have been described: Classic KS, affecting middle aged men of Mediterranean descent, African endemic KS, KS in iatrogenically immunosuppressed patients, and AIDS-related KS. 5Sulfur mustard gas is a potent alkylating agent that has a long history of use as a chemical warfare agent, including recent use by Iraq against Iranian soldiers and civilians. The organs most commonly affected by sulfur mustard gas (SM) are skin, eyes, and airways. Skin lesions are seen in more than 90% of the patients exposed to SM. Although the acute DOI: http://dx.doi.org/10.3315/jdcr.2012.1109 86 systemic and cutaneous effects of SM are well known, few investigations have focused on reporting the long-term carcinogenic effects. 6,7Case Repor...

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Detection of circulating T cells with CD4+CD7− immunophenotype in patients with benign and malignant lymphoproliferative dermatoses

Cited by 134 publications

References 21 publications

Flow cytometric detection of peripheral blood involvement by mycosis fungoides and Sézary syndrome using T-cell receptor Vβ chain antibodies and its application in blood staging

Flow cytometric detection of peripheral blood involvement by mycosis fungoides and Sézary syndrome using T-cell receptor Vβ chain antibodies and its application in blood staging

Cutaneous T‐cell lymphoma: 2011 update on diagnosis, risk‐stratification, and management

Sézary syndrome, Kaposi sarcoma and generalized dermatophytosis 15 years after sulfur mustard gas exposure

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