A stable aberrant immunophenotype characterizes nearly all cases of cutaneous T-cell lymphoma in blood and can be used to monitor response to therapy - PubMed (original) (raw)

A stable aberrant immunophenotype characterizes nearly all cases of cutaneous T-cell lymphoma in blood and can be used to monitor response to therapy

LaBaron T Washington et al. BMC Clin Pathol. 2002.

Abstract

BACKGROUND: Abnormal variations in the expression level of some commonly expressed T-cell antigens are a feature of many T-cell malignancies. METHODS: We sought to assess the frequency of such abnormal antigen expression by flow cytometry in peripheral blood (PB) samples from patients with mycosis fungoides (MF) and Sézary syndrome (SS). We correlated presence of morphologically identifiable tumor cells on PB smear with the frequency of abnormalities in the level of expression of CD3, CD4, CD7, CD8 and CD26. We also examined the degree of stability of these abnormal findings in tumor cells over the course of disease. The flow cytometric findings in 100 PB samples from 44 patients, including 38 who had multiple sequential PB samples (2-8 samples each), were assessed. RESULTS: Abnormalities were seen in the expression level of one or more T-cell markers in 41 cases (93%) including CD3 in 34% of patients, CD4 in 54%, CD26 in 86% and CD 45 in 40% (10 cases tested). In all but 2 cases, the abnormal T-cell immunophenotype remained similar over the course of treatment and correlated with the relative numbers of tumor cells counted on PB smear. CONCLUSIONS: Using a standard T-cell panel, stable phenotypically aberrant T-cell populations representing the tumor are detected in the vast majority of involved PB samples in MF/SS and can be used to monitor response to therapy.

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Figures

Figure 1

Figure 1

Sézary syndrome with multiple immunophenotypic aberrancies in tumor cells. Aberrant events representing neoplastic cells are painted red and normal CD4 and CD8 T-cell populations are painted green. A. Tumor cells are CD3 bright(+)CD45 dim(+). B. They are also CD4 dim(+)CD7 bright(+) phenotype and are separable from the normal CD4(+) T-cell population. C Tumor cell population is CD4 dim(+) CD26(-).

Figure 2

Figure 2

Absence of CD26 expression is useful in isolating neoplastic T-cell populations. A. Non-neoplastic PB shows normal variable expression of CD26 in CD4(+) T-cells. B. The forward/side scatter histogram from a case of MF in PB. Aberrant events representing neoplastic cells are painted red and phenotypically normal CD4 and CD8 T-cell populations are painted green. C. CD4/CD26 histogram shows a discrete uniformly CD26(-) abnormal T-cell population representing tumor cells.

Figure 3

Figure 3

Mycosis fungoides in peripheral blood with multiple aberrant T-cell populations. A. CD3 versus forward scatter identifies two abnormal populations, one large and one small, that are distinct from normal T cells. Examination of PB smear identified small (cerebriform) and large (transformed) tumor cell populations (not shown). B. Another case of MF in PB shows two atypical T-cell population; one CD4dim(+) (colored green) and another CD4(-) (red) distinct from the normal CD4(+) T-cells (blue). The CD4(-) population was also negative for CD8 (data not shown). C. Forward/side scatter histograms revealed the CD4(-) population predominantly comprised the larger (transformed) tumor lymphocyte population that was noted on PB smear.

Figure 4

Figure 4

Stability of abnormal tumor immunophenotype of sequential samples from a SS patients undergoing treatment. There is stable expression of dim CD4 in the tumor cells, with CD7dim(+) and CD7bright(+) populations painted red and green, respectively. The histogram on the far right shows a decrease in the CD7dim(+) population in response to pentostatin therapy. No overall decreases in tumor cell number in response to the prior Targretin, interferon or photopheresis treatments were noted.

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