Cutaneous T-cell lymphoma (CTCL): Current practices in blood assessment and the utility of T-cell receptor (TCR)-Vβ chain restriction

Juliet F. Gibson, Jing Huang, Kristina J. Liu, Kacie R. Carlson, Francine Foss, Jaehyuk Choi, Richard Edelson, Jerry W. Hussong, Ramsey Mohl, Sally Hill, Michael Girardi*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T-cell lymphoma is important for early detection, prognosis, and monitoring disease burden. Objective We sought to determine the spectrum of current clinical practices; critically evaluate elements of current International Society for Cutaneous Lymphomas (ISCL) B1 and B2 staging criteria; and assess the potential role of T-cell receptor-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, positive predictive value, and negative predictive value of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture 5 Yale cohort cases with immunophenotypic abnormalities that later progressed. T-cell receptor-Vβ testing was more specific than polymerase chain reaction and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of modified B1 criteria: CD4/CD8 ratio 5 or greater, %CD4+ CD26- 20% or greater, or %CD4+ CD7- 20% or greater, with evidence of clonality. T-cell receptor-Vβ testing should be considered in future diagnostic and staging algorithms.

Original languageEnglish (US)
Pages (from-to)870-877
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume74
Issue number5
DOIs
StatePublished - May 1 2016

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Cutaneous T-Cell Lymphoma
T-Cell Antigen Receptor
Lymphoma
Skin
CD4-CD8 Ratio
Tumor Burden
Flow Cytometry
Sensitivity and Specificity
Polymerase Chain Reaction

Keywords

  • Sézary syndrome
  • T-cell receptor-Vβ
  • cutaneous T-cell lymphoma
  • flow cytometry
  • mycosis fungoides
  • peripheral blood analysis

ASJC Scopus subject areas

  • Dermatology

Cite this

Gibson, Juliet F. ; Huang, Jing ; Liu, Kristina J. ; Carlson, Kacie R. ; Foss, Francine ; Choi, Jaehyuk ; Edelson, Richard ; Hussong, Jerry W. ; Mohl, Ramsey ; Hill, Sally ; Girardi, Michael. / Cutaneous T-cell lymphoma (CTCL) : Current practices in blood assessment and the utility of T-cell receptor (TCR)-Vβ chain restriction. In: Journal of the American Academy of Dermatology. 2016 ; Vol. 74, No. 5. pp. 870-877.
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title = "Cutaneous T-cell lymphoma (CTCL): Current practices in blood assessment and the utility of T-cell receptor (TCR)-Vβ chain restriction",
abstract = "Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T-cell lymphoma is important for early detection, prognosis, and monitoring disease burden. Objective We sought to determine the spectrum of current clinical practices; critically evaluate elements of current International Society for Cutaneous Lymphomas (ISCL) B1 and B2 staging criteria; and assess the potential role of T-cell receptor-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, positive predictive value, and negative predictive value of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture 5 Yale cohort cases with immunophenotypic abnormalities that later progressed. T-cell receptor-Vβ testing was more specific than polymerase chain reaction and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of modified B1 criteria: CD4/CD8 ratio 5 or greater, {\%}CD4+ CD26- 20{\%} or greater, or {\%}CD4+ CD7- 20{\%} or greater, with evidence of clonality. T-cell receptor-Vβ testing should be considered in future diagnostic and staging algorithms.",
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Cutaneous T-cell lymphoma (CTCL) : Current practices in blood assessment and the utility of T-cell receptor (TCR)-Vβ chain restriction. / Gibson, Juliet F.; Huang, Jing; Liu, Kristina J.; Carlson, Kacie R.; Foss, Francine; Choi, Jaehyuk; Edelson, Richard; Hussong, Jerry W.; Mohl, Ramsey; Hill, Sally; Girardi, Michael.

In: Journal of the American Academy of Dermatology, Vol. 74, No. 5, 01.05.2016, p. 870-877.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cutaneous T-cell lymphoma (CTCL)

T2 - Current practices in blood assessment and the utility of T-cell receptor (TCR)-Vβ chain restriction

AU - Gibson, Juliet F.

AU - Huang, Jing

AU - Liu, Kristina J.

AU - Carlson, Kacie R.

AU - Foss, Francine

AU - Choi, Jaehyuk

AU - Edelson, Richard

AU - Hussong, Jerry W.

AU - Mohl, Ramsey

AU - Hill, Sally

AU - Girardi, Michael

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T-cell lymphoma is important for early detection, prognosis, and monitoring disease burden. Objective We sought to determine the spectrum of current clinical practices; critically evaluate elements of current International Society for Cutaneous Lymphomas (ISCL) B1 and B2 staging criteria; and assess the potential role of T-cell receptor-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, positive predictive value, and negative predictive value of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture 5 Yale cohort cases with immunophenotypic abnormalities that later progressed. T-cell receptor-Vβ testing was more specific than polymerase chain reaction and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of modified B1 criteria: CD4/CD8 ratio 5 or greater, %CD4+ CD26- 20% or greater, or %CD4+ CD7- 20% or greater, with evidence of clonality. T-cell receptor-Vβ testing should be considered in future diagnostic and staging algorithms.

AB - Accurate quantification of malignant cells in the peripheral blood of patients with cutaneous T-cell lymphoma is important for early detection, prognosis, and monitoring disease burden. Objective We sought to determine the spectrum of current clinical practices; critically evaluate elements of current International Society for Cutaneous Lymphomas (ISCL) B1 and B2 staging criteria; and assess the potential role of T-cell receptor-Vβ analysis by flow cytometry. Methods We assessed current clinical practices by survey, and performed a retrospective analysis of 161 patients evaluated at Yale (2011-2014) to compare the sensitivity, specificity, positive predictive value, and negative predictive value of parameters for ISCL B2 staging. Results There was heterogeneity in clinical practices among institutions. ISCL B1 criteria did not capture 5 Yale cohort cases with immunophenotypic abnormalities that later progressed. T-cell receptor-Vβ testing was more specific than polymerase chain reaction and aided diagnosis in detecting clonality, but was of limited benefit in quantification of tumor burden. Limitations Because of limited follow-up involving a single center, further investigation will be necessary to conclude whether our proposed diagnostic algorithm is of general clinical benefit. Conclusion We propose further study of modified B1 criteria: CD4/CD8 ratio 5 or greater, %CD4+ CD26- 20% or greater, or %CD4+ CD7- 20% or greater, with evidence of clonality. T-cell receptor-Vβ testing should be considered in future diagnostic and staging algorithms.

KW - Sézary syndrome

KW - T-cell receptor-Vβ

KW - cutaneous T-cell lymphoma

KW - flow cytometry

KW - mycosis fungoides

KW - peripheral blood analysis

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