Cutaneous T-cell lymphoma overall survival associated with TCR clonality, flow cytometry

Overall survival was lower for patients with early-stage cutaneous T-cell lymphoma who had low-level blood involvement, according to a study.

“Cutaneous T-cell lymphoma (CTCL) is a non-Hodgkin lymphoma primarily limited to skin; however, approximately 20% of patients with CTCL progress to advanced-stage disease,” Jennifer A. Marks, MD, of the department of internal medicine at Emory University School of Medicine, and colleagues wrote. “Patients with early-stage disease who experience progression have an inferior life expectancy and a poor quality of life. T-cell receptor (TCR) gene rearrangement is a marker of clonality and may be used to detect early progression in the blood.”

A retrospective cohort analysis used an internal CTCL database at Emory University Hospital and Grady Memorial Hospital to identify patients with early-stage disease. Medical records were analyzed to identify T-cell receptor gene rearrangement and flow cytometry of peripheral blood.

Of the 322 patients identified, data were present for both TCR clonality and positive flow cytometry for 258. Of this group, 74.4% had negative results for both TCR clonality and flow cytometry, 21.7% were positive for either of the two variables, and 3.9% had positive results for both.

Overall survival was worse for patients who had positive tests for TCR clonality compared with those with negative tests for both (HR = 2.86; 95% CI, 1.02-8.06; P = .046).

An association was not found between overall survival and only TCR clonality (HR = 1.31; 95% CI, 0.70-2.47) or only flow cytometry (HR = 1.21; 95% CI, 0.58-2.52).

The study’s limitations included its small sample size and retrospective nature.

“Low-level blood involvement as identified by positive results for both TCR clonality and flow cytometry was associated with worse [overall survival] for patients with newly diagnosed stage IA to IIA disease, whereas positive results for either TCR clonality or flow cytometry alone were not associated with survival,” the authors wrote.

The researchers recommended larger multi-institutional studies to identify further significance.