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Analysis of T-cell receptor gene rearrangement for predicting clinical outcome in patients with cutaneous T-cell lymphoma: a comparison of Southern blot and polymerase chain reaction methods.
Arch Dermatol. 2005 Sep; 141(9):1107-13.AD

Abstract

OBJECTIVE

To extend previous observations regarding the prognostic value of analyzing lymph node DNA from patients with cutaneous T-cell lymphoma for the presence of a monoclonal T-cell population by Southern blot vs polymerase chain reaction (PCR) methods.

DESIGN

Inception cohort study from 1982 to 1998. Recruitment of new patients ended in 1994.

SETTING

A tertiary care referral center in Seattle, Wash. Patients Fifty-five uniformly staged patients with the diagnosis of cutaneous T-cell lymphoma who underwent a lymph node biopsy, 21 with clinically abnormal nodes and 34 with normal nodes. Interventions Lymph nodes were evaluated for T-cell receptor (TCR) gamma-chain gene rearrangement by 2 PCR methods: capillary electrophoresis and denaturing gradient gel electrophoresis. The same lymph nodes were evaluated by Southern blot analysis for TCR beta-chain gene rearrangement and examined histopathologically on the basis of the National Cancer Institute lymph node classification system. Patients were observed clinically for a mean of 9.5 years.

MAIN OUTCOME MEASURES

Skin stage, clinical lymph node examination, lymph node histologic examination, Southern blot analysis, and PCR analyses were evaluated as potential prognostic predictors by univariate and multivariate analyses. The statistical association of TCR analysis and clinical outcome was determined among all patients. Hazard ratios (HRs) by Cox proportional hazards regression analysis were used to estimate the risk of a poor clinical outcome. Cumulative survival rates were analyzed by the Kaplan-Meier method.

RESULTS

A skin stage of T3 (tumors) or T4 (erythroderma) was the most powerful predictor of a poor clinical outcome (HR, 31.3 vs T1; P<.001). Patients with detectable TCR gamma-chain gene rearrangement in lymph node DNA by PCR also were more likely to have a poor outcome (HR, 5.1; P<.001), but it was a less powerful predictor than skin stage. Even when the skin stage, presence or absence of lymphadenopathy, and histologic lymph node score were known for the patient, Southern blot analysis still added to prediction of a poor outcome (HR, 9.3; P = .007), whereas PCR provided no statistically significant additional information on outcome.

CONCLUSIONS

Detection of a monoclonal T-cell population by PCR in lymph nodes of patients with cutaneous T-cell lymphoma does not enhance prediction of clinical outcome and probability of survival beyond what can be determined from clinical examination and histologic lymph node scores. Skin stage and the presence or absence of lymphadenopathy remain the most important determinants of clinical outcome.

Authors+Show Affiliations

UCLA Neuropsychiatric Institute/West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16172307

Citation

Juarez, Thaddeus, et al. "Analysis of T-cell Receptor Gene Rearrangement for Predicting Clinical Outcome in Patients With Cutaneous T-cell Lymphoma: a Comparison of Southern Blot and Polymerase Chain Reaction Methods." Archives of Dermatology, vol. 141, no. 9, 2005, pp. 1107-13.
Juarez T, Isenhath SN, Polissar NL, et al. Analysis of T-cell receptor gene rearrangement for predicting clinical outcome in patients with cutaneous T-cell lymphoma: a comparison of Southern blot and polymerase chain reaction methods. Arch Dermatol. 2005;141(9):1107-13.
Juarez, T., Isenhath, S. N., Polissar, N. L., Sabath, D. E., Wood, B., Hanke, D., Haycox, C. L., Wood, G. S., & Olerud, J. E. (2005). Analysis of T-cell receptor gene rearrangement for predicting clinical outcome in patients with cutaneous T-cell lymphoma: a comparison of Southern blot and polymerase chain reaction methods. Archives of Dermatology, 141(9), 1107-13.
Juarez T, et al. Analysis of T-cell Receptor Gene Rearrangement for Predicting Clinical Outcome in Patients With Cutaneous T-cell Lymphoma: a Comparison of Southern Blot and Polymerase Chain Reaction Methods. Arch Dermatol. 2005;141(9):1107-13. PubMed PMID: 16172307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of T-cell receptor gene rearrangement for predicting clinical outcome in patients with cutaneous T-cell lymphoma: a comparison of Southern blot and polymerase chain reaction methods. AU - Juarez,Thaddeus, AU - Isenhath,Scott N, AU - Polissar,Nayak L, AU - Sabath,Daniel E, AU - Wood,Brent, AU - Hanke,Deena, AU - Haycox,Claire L, AU - Wood,Gary S, AU - Olerud,John E, PY - 2005/9/21/pubmed PY - 2005/10/19/medline PY - 2005/9/21/entrez SP - 1107 EP - 13 JF - Archives of dermatology JO - Arch Dermatol VL - 141 IS - 9 N2 - OBJECTIVE: To extend previous observations regarding the prognostic value of analyzing lymph node DNA from patients with cutaneous T-cell lymphoma for the presence of a monoclonal T-cell population by Southern blot vs polymerase chain reaction (PCR) methods. DESIGN: Inception cohort study from 1982 to 1998. Recruitment of new patients ended in 1994. SETTING: A tertiary care referral center in Seattle, Wash. Patients Fifty-five uniformly staged patients with the diagnosis of cutaneous T-cell lymphoma who underwent a lymph node biopsy, 21 with clinically abnormal nodes and 34 with normal nodes. Interventions Lymph nodes were evaluated for T-cell receptor (TCR) gamma-chain gene rearrangement by 2 PCR methods: capillary electrophoresis and denaturing gradient gel electrophoresis. The same lymph nodes were evaluated by Southern blot analysis for TCR beta-chain gene rearrangement and examined histopathologically on the basis of the National Cancer Institute lymph node classification system. Patients were observed clinically for a mean of 9.5 years. MAIN OUTCOME MEASURES: Skin stage, clinical lymph node examination, lymph node histologic examination, Southern blot analysis, and PCR analyses were evaluated as potential prognostic predictors by univariate and multivariate analyses. The statistical association of TCR analysis and clinical outcome was determined among all patients. Hazard ratios (HRs) by Cox proportional hazards regression analysis were used to estimate the risk of a poor clinical outcome. Cumulative survival rates were analyzed by the Kaplan-Meier method. RESULTS: A skin stage of T3 (tumors) or T4 (erythroderma) was the most powerful predictor of a poor clinical outcome (HR, 31.3 vs T1; P<.001). Patients with detectable TCR gamma-chain gene rearrangement in lymph node DNA by PCR also were more likely to have a poor outcome (HR, 5.1; P<.001), but it was a less powerful predictor than skin stage. Even when the skin stage, presence or absence of lymphadenopathy, and histologic lymph node score were known for the patient, Southern blot analysis still added to prediction of a poor outcome (HR, 9.3; P = .007), whereas PCR provided no statistically significant additional information on outcome. CONCLUSIONS: Detection of a monoclonal T-cell population by PCR in lymph nodes of patients with cutaneous T-cell lymphoma does not enhance prediction of clinical outcome and probability of survival beyond what can be determined from clinical examination and histologic lymph node scores. Skin stage and the presence or absence of lymphadenopathy remain the most important determinants of clinical outcome. SN - 0003-987X UR - https://www.unboundmedicine.com/medline/citation/16172307/Analysis_of_T_cell_receptor_gene_rearrangement_for_predicting_clinical_outcome_in_patients_with_cutaneous_T_cell_lymphoma:_a_comparison_of_Southern_blot_and_polymerase_chain_reaction_methods_ L2 - https://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/archderm.141.9.1107 DB - PRIME DP - Unbound Medicine ER -