Monitoring the Decrease of Circulating Malignant T Cells in Cutaneous T-Cell Lymphoma During Photopheresis and Interferon Therapy
Katalin Ferenczi, MD;
Nikhil Yawalkar, MD;
David Jones, MD, PhD;
Thomas S. Kupper, MD
Arch Dermatol. 2003;139:909-913.
Background The prognosis of patients with stage IV cutaneous T-cell lymphoma (CTCL) is grim and therapeutic options are limited. Treatment of advanced-stage CTCL is aimed at suppressing the dominant T-cell clone, which is typically present in the skin, peripheral blood, and lymph nodes.
Observations We detected the expansion of 1 T-cell clone expressing the T-cell receptor V 14 in the peripheral blood of a patient with stage IVA CTCL. Before initiation of combination therapy with photopheresis and low-dose interferon  , the dominant T-cell clone represented 84% of the total T-cell population. After successful therapy, this clone showed a dramatic decrease to 6% of the T-cell population after 6 months of treatment. This reduction in the percentage of the malignant T-cell population in response to therapy was paralleled by clinical skin improvement from initial generalized erythroderma to undetectable skin disease.
Conclusions This case demonstrates that response to combination treatment with photopheresis and low-dose interferon in patients with advanced CTCL may be accurately and quantitatively followed up by monitoring the percentage of the malignant T-cell clone (when identifiable) within the total circulating T-cell population by flow cytometry.
From the Harvard Skin Disease Research Center, Boston, Mass. The authors have no relevant financial interest in this article.
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