Sezary syndrome: A model for migration of T lymphocytes to skin

We describe a patient with the Sezary syndrome who had a cyclical clinical course with rises and falls in Sezary-cell counts and with intermittent skin reactions. The migratory pattern of the neoplastic cells was studied with indium-labeled Sezary cells. We studied Sezary-cell migration in a patient who had a progressive but cyclical course. Each episode of erythroderma was preceded by a rising count and accompained by a fall in Sezary-cell count. This pattern strongly suggeted that Sezary cells accumulated in the blood and migrated into the skin. Scanning of white cells with indium-oxine labels showed distribution of Sezary cells into skin during intense erythroderma. Kinetic analysis revealed that these cells gradually accumulated in skin and that there was apparently no reentry of labeled cells into the circulation. The fate of the Sezary cell after it has migrated to the skin is uncertain. We noticed that these rashes terminated with an exfoliative phase, which may indicate that these cells were sloughed after migration to the skin.