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Peter Heald, MD; Shu-Ling Yan, MD; Richard Edelson, MD

Arch Dermatol. 1994;130(2):198-203.

Abstract
Background and Design
To accurately assess tumor burden in cutaneous T-cell lymphoma as well as to determine the number of residual normal circulating T cells, it is necessary to accurately distinguish malignant cells. Because cutaneous T-cell lymphoma cells regularly display many normal phenotypic markers of T cells (CD2⁺, CD3⁺, CD4⁺) these surface proteins have been of limited value. We have used a set of monoclonal antibodies with specificity for those T-cell receptor proteins containing variable regions on the β chain to distinguish normal from malignant T cells in patients with cutaneous T-cell lymphoma.

Results
The results revealed an unanticipated and profound expansion of the malignant cell populations (59% to 87% of blood T cells) in six patients with total T-cell counts in the normal or near normal range. By subtracting the percentages of malignant T cells, identified in this manner, from the total T-cell counts, we found that the residual normal T-cell compartments were small (0 to 0.155 x10⁹/L) in four of the six patients. Sézary cell counts by peripheral blood smear analysis by routine light microscopy underestimated the number of malignant T cells. Markedly elevated CD4/CD8 ratios (10 to 90) occurred in all cases, reflecting expansion of the CD4⁺ malignant population and parallel reduction of the normal residual CD8⁺ subset.

Conclusions
Patients with erythrodermic cutaneous Tcell lymphoma often have markedly depressed levels of normal blood T cells, to the range seen in advanced acquired immunodeficiency syndrome, and absolute numbers of malignant cells substantially exceed those recognized with less sensitive techniques.

(Arch Dermatol. 1994;130:198-203)

Author Affiliations
From the Department of Dermatology, Yale University School of Medicine, New Haven, Conn.

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