Prognostic Clinicopathologic Factors in Cutaneous T-cell Lymphoma

Abstract

Influence of clinicopathologic data on survival was analyzed in 43 patients with cutaneous T-cell lymphoma. The median age was 66 years; 35 were male and eight female. The extent of the disease, established according to a modification of the TNM system, was as follows: T1, three patients; T2, 15; T3, 14; T4, 11; N0, 15; N1, 28; M0, 38; M1, 5; B0, 37; and B1, six. The first treatment applied after staging was skin-limited therapy in seven patients and different regimens of systemic chemotherapy in 29. Seven patients received no treatment or only topical corticosteroids and tars. Median follow-up was 26 months. Nineteen patients died, with a median survival of 36.3 months. The prognostic value of age, sex, delay of diagnosis and staging, pruritus, number of sites of clinically enlarged lymph nodes, results of staging and TNM classification, erythrocyte sedimentation rate, peripheral blood cell count, liver function tests, serum lactate dehydrogenase levels, protein electrophoresis, presence of epidermotropism, thickness of cutaneous infiltrate, blastic cell percentage, mitotic index, cellular density, cutaneous eosinophilia, and follicular mucinosis was studied. Multivariate analysis (proportional hazard model with covariates) indicated that the major prognostic factors in patients with cutaneous T-cell lymphoma are as follows: (1) in a clinical model, the T category of TNM classification and the serum lactate dehydrogenase value; and (2) in a clinicopathologic model, the T category of TNM classification and the thickness of cutaneous infiltrate (measured in 10(-1) mm from the granular layer to the lower limit of the infiltrate) of the clinically thickest lesion.

Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC)

“…The ISCL/EORTC have attempted to add some clarity to the situation by suggesting definitions for the skin lesions (Table 4). Because in patch/plaque disease, histology has been shown to offer an objective means of defining each subtype, 27,28 be a validated surrogate for the clinical classification of MF lesions, 29 and have prognostic implications, 30 there is a provision in the classification system for characterizing exclusively patch-stage disease with the subscript of "a" (T 1a and T 2a ) versus combined patch/plaque disease with the subscript of "b" (T 1b and T 2b ) in order to gather additional longitudinal data on this distinction (Table 4). However, the derivation of all T stages remains a clinical determination.…”

IL-22, but Not IL-17, Dominant Environment in Cutaneous T-cell Lymphoma

“…Laboratory findings can also be similar in CTCL and AD, such as eosinophilia, high serum levels of lactate dehydrogenase (LDH), immunoglobulin E (IgE), and soluble interleukin-2 receptor (sIL-2R; refs. [3][4][5]. Histologic appearance is the key to distinguish between these 2 diseases.…”

Prognostic Value of Blood Eosinophilia in Primary Cutaneous T-Cell Lymphomas

“…3,[13][14][15][16][17][18] In this context, eosinophilia has been related to the predominant secretion of T helper cell type 2 (T H 2) eosinophilopoietic or eosinophilotactic cytokines (interleukin [IL] 3, IL-5, and sargramostim) by neoplastic cells. [19][20][21][22][23][24][25][26] Since T H 1 cells are likely to play a key role in the initiation and the persistence of an antitumoral response, while a predominant T H 2 differentiation has been associated with a relative defect of the antitumoral and anti-infectious response, 27 the hypothesis that eosinophilia might be an indicator of poor prognosis was raised.…”