TY - JOUR
T1 - Sézary cell counts in erythrodermic cutaneous T-cell lymphoma
T2 - Implications for prognosis and staging
AU - Vonderheid, Eric C.
AU - Pena, Jane
AU - Nowell, Peter
PY - 2006/9
Y1 - 2006/9
N2 - In this retrospective study, quantitative Sézary cell counts were performed at presentation on 192 patients with erythrodermic cutaneous T-cell lymphoma (E-CTCL). Per recommendation of the International Society of Cutaneous Lymphomas (ISCL), the impact on staging of using an absolute Sézary cell count of 1.0 K μL-1 or more as equivalent to lymph node involvement was investigated. Of 132 patients with disease initially classified at stage III using the current TNM staging system, 25% were up staged to IVa, resulting in a clearer separation of associated survival curves between the stages. Furthermore, the current ISCL definition of B0, B1 and B2 ratings were improved using Sézary cell count levels of <1.0 K μL-1, ≥ 1.0-4.99 K μL-1 and ≥ 5.0 K mu;L-1, respectively. These modified B ratings potentially could be used in an alternative staging system for E-CTCL without N rating. Advanced age, prior exposure to multiple systemic drugs, enlargement of peripheral lymph nodes (> 3 cm), other measures of blood tumor burden (CD4/CD8 ratio ≥ 10, chromosomally-abnormal clone) and 2-fold increase in serum LDH level were other factors of prognostic significance. The clinical importance of these variables vis-à-vis the modified TNBM staging system will need to be clarified in future studies.
AB - In this retrospective study, quantitative Sézary cell counts were performed at presentation on 192 patients with erythrodermic cutaneous T-cell lymphoma (E-CTCL). Per recommendation of the International Society of Cutaneous Lymphomas (ISCL), the impact on staging of using an absolute Sézary cell count of 1.0 K μL-1 or more as equivalent to lymph node involvement was investigated. Of 132 patients with disease initially classified at stage III using the current TNM staging system, 25% were up staged to IVa, resulting in a clearer separation of associated survival curves between the stages. Furthermore, the current ISCL definition of B0, B1 and B2 ratings were improved using Sézary cell count levels of <1.0 K μL-1, ≥ 1.0-4.99 K μL-1 and ≥ 5.0 K mu;L-1, respectively. These modified B ratings potentially could be used in an alternative staging system for E-CTCL without N rating. Advanced age, prior exposure to multiple systemic drugs, enlargement of peripheral lymph nodes (> 3 cm), other measures of blood tumor burden (CD4/CD8 ratio ≥ 10, chromosomally-abnormal clone) and 2-fold increase in serum LDH level were other factors of prognostic significance. The clinical importance of these variables vis-à-vis the modified TNBM staging system will need to be clarified in future studies.
KW - Cutaneous T-cell lymphoma
KW - Erythroderma
KW - Prognosis
KW - Sézary syndrome
KW - Staging
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U2 - 10.1080/10428190600709655
DO - 10.1080/10428190600709655
M3 - Article
C2 - 17064997
AN - SCOPUS:33750450142
SN - 1042-8194
VL - 47
SP - 1841
EP - 1856
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 9
ER -