T-cell receptor gene rearrangement analysis: cutaneous T cell lymphoma, peripheral T cell lymphoma, and premalignant and benign cutaneous lymphoproliferative disorders

T-cell receptor gene rearrangement analysis is a useful technique to detect clonality and determine lineage of lymphoid neoplasms. We examined 103 patients with mycosis fungoides, Sézary syndrome, peripheral T cell lymphoma, potentially malignant lymphoproliferative disorders including pre-Sézary syndrome, large plaque parapsoriasis, lymphomatoid papulosis and follicular mucinosis, and various benign inflammatory infiltrates. A clonal rearrangement was detected in skin samples in 20 of 24 patients with mycosis fungoides and in peripheral blood samples in 19 of 21 patients with Sézary syndrome. A clonal population was also detected in seven of eight cases classified as peripheral T cell lymphoma. The potentially malignant dermatoses tended to have clonal rearrangement, with the exception of large plaque parapsoriasis, and further follow-up is needed to correlate clonality with the disease course. These studies demonstrate the value of molecular genetics as an adjunct to morphology in the examination of patients with cutaneous lymphoproliferative disease.

Analysis of beta, gamma, and delta T-cell receptor genes in mycosis fungoides and Sezary syndrome

The authors have analyzed the configuration of immunoglobulin (Ig) and beta, gamma and delta T-cell receptor (TCR) genes in DNA extracted from skin, lymph nodes, and peripheral blood mononuclear cells obtained from 41 patients with mycosis fungoides (MF), 14 patients with Sezary syndrome, and 13 patients with benign inflammatory dermatoses. No discrete rearranged bands (DRB) were detected in patients with inflammatory dermatoses. In tissue DNA from 19 patients with MF DRB were detected with beta and gamma, but not delta TCR probes. Only one patient with MF had a rearrangement of gamma and delta with germ line beta TCR genes. In 13 patients multiple biopsies were analyzed and DRB, when present, were identical in different lesions from individual patients. In three patients analysis of DNA from dermatopathic lymph nodes did not reveal DRB. Analysis of peripheral blood DNA from 24 patients revealed a discrete rearrangement of the gamma TCR gene in four patients and both beta and gamma genes in four additional patients. In MF DRB were detected more frequently with advancing stage of disease in tissues (P less than 0.01) but not in peripheral blood (P equals 0.36). Of 14 patients with Sezary syndrome, eight had DRB in peripheral blood DNA with both beta and gamma probes and in three of these patients identical DRB were also detected in DNA from skin biopsy samples. In contrast, DRB were not detected in the peripheral blood of the other six patients. In both MF and Sezary syndrome there was no restricted usage of particular V gamma genes. These results indicate that in MF (1) T-cell clones can be detected in skin biopsy specimens from the majority of patients with early stage disease, (2) gamma delta T-cell clones are only rarely found, and (3) TCR gene analysis can detect T-cell clones in the peripheral blood with a greater degree of specificity than conventional light microscopic study. In Sezary syndrome these studies also suggest that a subset of patients have a polyclonal population of circulating atypical lymphoid cells. In addition these patients appear to have a better prognosis than those with monoclonal disease.

Implication of the ras and myc oncoproteins in the pathogenesis of mycosis fungoides

In the present work, we studied the expression of the c-myc oncoprotein p-62 and the ras oncoprotein p-21 in the dermal cellular infiltrate of paraffin embedded skin specimens, obtained from patients suffering from Mycosis Fungoides and Sezary syndrome. Nineteen specimens from early stage Mycosis Fungoides, nineteen from advanced stage Mycosis Fungoides and four from Sezary syndrome were included in the study. The oncoprotein detection was achieved immunohistochemically, using the mouse monoclonal antibody myc 1-9E10 and the rat monoclonal antibody Y13-259 for p-62 and p-21 respectively. Increased detection of both p-62 and p-21 in atypic lymphoid cells was shown in advanced stages of Mycosis Fungoides (third stage plaques and tumors) as compared to early stages (premycotic erythema, second stage plaques). In advanced stages, however, the percentage of P-62+ atypic cells proved to be higher than that of p-21+ atypic lymphoid cells. The implication of increased p-62 and p-21 oncoprotein expression in the process of lymphomagenesis in cutaneous T-cell lymphomas is discussed.

Cytogenetic follow-up in a case of Sézary syndrome

A cytogenetic follow-up study was performed for a 3-year period on a 70-year-old patient with Sézary syndrome (SS). The results showed formation of hypotetraploid cell clones with 60 to 89 chromosomes and 19 markers, some of which appeared during the period of study and stabilized thereafter. The incidence of these clonal cells increased from 29% to 85% during the follow-up study. The results confirm the presence of hypotetraploid cell clones, especially in the more advanced stages of SS. Moreover, some marker chromosomes in our patient (M2 and M3), derived from chromosome 2, were similar to those observed in SS by other investigators. According to our data and to those in the literature, SS appears to involve preferentially chromosomal regions 2p12-13, 2p21-22, 2q37, 17p13, 13q1, 9q11, 10p13, 14q11, 14q32, 7p1 and, to a lesser extent, 5q and 6q.

Sezary cell-like leukemia: a distinct type of mature T cell malignancy

We describe the clinical, ultrastructural, and immunophenotypical characteristics of four cases of an unusual type of T cell leukemia. Clinical features included high WBC, ranging from 26-148 x 10(9)/liter, bone marrow infiltration, splenomegaly, and lymphadenopathy. Skin involvement was not documented at presentation, but it was seen as a terminal event in one patient with a pattern of dermal lymphocytic infiltration different from that usually seen in Sezary syndrome. By ultrastructural analysis, the circulating lymphoid cells were indistinguishable from small Sezary cells in two cases, resembled large Sezary cells in one case, and consisted of a mixture of small Sezary cells and prolymphocytes in the remaining case. The cells from all cases had a mature T cell phenotype, TdT-, CD1a-, CD2+/-, CD3+, CD5+. In addition, the cells were either CD8+, CD4- or CD8+, CD4+ or CD4-, CD8-; and, in only one case, the findings were similar to those of Sezary syndrome cells: CD4+, CD8-, CD7-, BE-2+. In the latter case, serological and immunological assays were positive for HTLV-I while these were negative in two other patients investigated. The features of these patients suggest that Sezary cell leukemia is a distinct clinico-pathological entity although the alternative diagnosis of adult T cell leukemia/lymphoma could not be excluded in the HTLV-I+ case. Sezary cell leukemia appears to be resistant to current chemotherapy regimens and is associated with an aggressive clinical course and short survival.

Cytogenetic study of a patient with the Sézary syndrome

A cytogenetic study was performed in a patient with Sézary syndrome, which is a T-helper lymphoproliferative disorder. Metaphases were obtained from a phytohemagglutinin-stimulated lymphocyte culture. Normal, hypodiploid (42 to 45 chromosomes) and hypotetraploid (84 to 88 chromosomes) cells were observed. Both abnormal cell lines showed the same abnormalities involving chromosomes 1, 2, 4, 6, 10, 11, 12, 14, 16, and 20.

[Sézary syndrome: morpho-immuno-phenotypic, cytogenetic and molecular characterization]

The immunologic, cytogenetic and molecular data from a patient with Sézary syndrome are reported. Immunohistochemical analysis disclosed 90% helper CD4 cells and 10% CD8 cells. One of the most significant cytogenetic abnormalities was a t(7; 14) translocation at the level of the 7p13-15 and 14q11 bands, just where the T-cell receptors are located. At the molecular level, rearrangements of the alpha (in 14q11 chromosome), beta (in the 7q32) and gamma (in the 7p15) receptors were found. The translocation between chromosomes 7 and 14, at the level of the mentioned bands, could be responsible for some of the rearrangements found at the molecular level.

Cytogenetics of T-cell malignant lymphoma. Report of 17 cases and review of the chromosomal breakpoints

Cytogenetic studies are reported on 17 T-cell malignant lymphomas (ML) including six cutaneous T-cell malignant lymphomas (CTCL). Due to the low incidence of rearrangements on bands where the T-cell receptor genes are located, other cases reported in the literature were analyzed in order to estimate the most frequent chromosomal breakpoints in ML, CTCL, and adult T-cell leukemia-lymphoma. Besides chromosomes 1 and 6q, 14q11, 7p15p21, and 7q32q35, the most frequent rearrangements involved bands 14q32, 2p11-p14, 2p23-p25, 17cen, 9p21p23, and 10p13p15. These results show that molecular studies must be concentrated on these chromosomal regions in order to identify the DNA sequences that may be involved in T-cell malignancies.

Cytogenetic studies of Sézary cells

Cytogenetic studies of two patients with Sézary's syndrome and of one patient with mycosis fungoides are reported. One chromosome #14 at band 14q11 was involved in chromosomal rearrangements in one patient. A review of previously reported cases shows that some chromosome abnormalities appeared nonrandomly, involving chromosomes #1, #4, #6, #7, #9, #13, #14, and #17. Abnormalities on 2p and monosomy 10 were emphasized.

A continuous T-cell line from a patient with Sézary syndrome

A continuous cell line, Se-Ax, from a patient with Sézary syndrome has been established. The Se-Ax cell line is IL-2 dependent, requires human serum for permanent growth, and has the following phenotype: CD1-, CD2+, CD3+, CD4-, CD5-, CD8-, CD20-, CD25+; it expresses the T9, T10, and HLA-DR antigens. This cell line reveals multiple chromosome aberrations as seen in the most abundant abnormal clone in peripheral blood. Therefore, it is not unlikely that it derives from tumor cells. A putative cytotoxic cell line derived from the same patient has only weak killer-cell activity against the autologous permanent cell line: this CD8+ cytotoxic cell line has a 14q+ chromosomal marker. The fact that the patient demonstrated no natural killer-cell or activated killer-cell activity against the Se-Ax cell line may in part explain the successful establishment of the continuous cell line from bulk culture.

The structure of the T cell antigen receptor genes in normal and malignant T cells

In this review the genomic structure and the RNA transcripts of the alpha and beta chain of the T cell antigen receptor have been discussed. Studies of the structure of TcR beta in hematologic malignancies have revealed rearrangement in almost all of the T cell malignancies and a small proportion of non-T cell malignancies. In addition, clonal involvement of T cells in diseases such as Hodgkin's disease, angioimmunoblastic lymphadenopathy, and chronic T cell lymphocytosis have been observed. The study of the structure of the TcR beta gene is thus a useful tool for identifying clonal expansions of cells and in conjunction with studies of the immunoglobulin gene structure, and cell surface markers a useful tool for identifying cell lineage. At the present time the evaluation of the structure of the alpha chain genes has not been as fruitful. However, chromosome translocations involving the TcR alpha chain genes have been recognized and, in one case, this rearrangement has been in association with a known oncogene. With the isolation of more probes to the alpha chain region it should be possible to test its utility in identifying clonal populations and cell lineage. The recent isolation of the gamma gene of the T cell will also permit such studies. Preliminary results of studies carried out with a probe to the gamma chain gene of the T cell have paralleled results obtained with the TcR beta probe (unpublished observation).

3' c-myc rearrangement in a human leukemic T-cell line

The human leukemic T-cell line Hut 78, derived from a patient suffering from Sézary syndrome and expressing a mature postthymic membrane phenotype, shows a c-myc rearrangement beginning within 500 base pairs immediately 3' to the c-myc exon 3. Chromosome analysis of the Hut 78 reveals the presence of a hyperdiploid karyotype with a large number of markers and rearrangements, though trisomy is the only cytogenetic anomaly involving chromosome 8. Moreover, as the abnormal c-myc appears to be duplicated, a duplication of the chromosome 8 carrying the abnormal c-myc probably occurred. Unlike four other human leukemic T-cell lines tested, the Hut 78 cells express a high amount of c-myc transcript, suggesting that the 3' c-myc anomaly may cause a deregulation of the expression of this gene.

The most common chromosome change in 86 chronic B cell or T cell tumors: a 14q32 translocation

Among 46 patients with chronic lymphocytic leukemia (CLL) (40 B cell, 6 T cell) and 40 patients with cutaneous T cell lymphoma (CTCL), a chromosomally abnormal neoplastic clone was identified in 43 cases. A translocation involving 14q32 was present in nine cases (five B-CLL, two T-CLL, two CTCL). The donor chromosomal site was 11q13 in four patients and 1q12, 4q25-27, 17q21-22, 18q21, and 22q11 in one case each. The next most frequent abnormalities were rearrangements involving 6q21-23 (four cases), and trisomy 12 (four cases, all B-CLL). In one CTCL patient, the t(11;14) translocation was present in one of three apparently unrelated T cell clones. Recent studies indicate that the selective advantage conferred by the 14q+ chromosome in B cell neoplasms appears to result from an oncogene being brought adjacent to a rearranged and transcriptionally active immunoglobulin heavy chain locus. The present findings suggest that similar mechanisms may operate in certain T cell neoplasms, although the activating gene is not necessarily the same.

Functional properties in Sézary cells with an unusual phenotype

The immunological and functional characteristics of Sézary cells with an unusual phenotype are reported. The clinical, histologic, and hematologic picture was typical for Sézary syndrome. Studies with monoclonal antibodies showed that 80% Sézary cells had an CD3+, CD4+, CD5+, CD7-, CD8-, Leu-7+, Leu-8-, Leu-11-, OKM1- phenotype. By two-color immunofluorescence assay 80% FACS-sorted Leu-7+ cells coexpressed CD4 antigen and did not express the myeloid antigen OKM1, CD8, and antigens characteristic of immature T cells. The cells had no NK activity but did display a high helper activity. Unseparated and FACS-sorted Leu-7+ and Leu-7- Sézary cells did not respond to mitogens but were able to grow in the presence of exogenous IL-2. FACS sorted Leu-7- cells, cultured for 7 days in the presence of 20% IL-2, acquired the receptors for Leu-7. IL-2 and IFN-gamma production was studied in unseparated Leu-7+ and Leu-7- FACS-sorted Sézary cells. IL-2 production was lower than in normal cells. The addition of PHA or PHA plus TPA led to an increase in IL-2 production. Also IFN-gamma production was marked lower than in normal controls but increased after 7-day culture in exogenous IL-2. In conclusion in this case the Sézary cells may represent a neoplastic expansion of the CD3+, CD4+, CD5+, Leu-7+, Leu-11- subpopulation which is equivalent to the 2-4% of the Leu-7+ population in normal lymphocytes.

Rearrangements of genes for the antigen receptor on T cells as markers of lineage and clonality in human lymphoid neoplasms

The T alpha and T beta chains of the heterodimeric T-lymphocyte antigen receptor are encoded by separated DNA segments that recombine during T-cell development. We have used rearrangements of the T beta gene as a widely applicable marker of clonality in the T-cell lineage. We show that the T beta genes are used in both the T8 and T4 subpopulations of normal T cells and that Sézary leukemia, adult T-cell leukemia, and the non-B-lineage acute lymphoblastic leukemias are clonal expansions of T cells. Furthermore, circulating T cells from a patient with the T8-cell-predominantly lymphocytosis associated with granulocytopenia are shown to be monoclonal. Finally, the sensitivity and specificity of this tumor-associated marker have been exploited to monitor the therapy of a patient with adult T-cell leukemia. These unique DNA rearrangements provide insights into the cellular origin, clonality, and natural history of T-cell neoplasia.

Lymphoid tumors displaying rearrangements of both immunoglobulin and T cell receptor genes

Ig and T beta gene rearrangements can be used as genetic markers of lineage and clonality in the study of B and T cell populations. We have addressed the issue of the respective B and T lineage specificity of these rearrangements by analyzing a panel of 63 lymphoid tumors representative of the various clinicopathologic categories of both B and T neoplasias. We report that approximately 10% of the cases tested displayed rearrangements of both Ig and T beta genes. Despite their dual genotypic pattern, these tumors retain a pure immunophenotype, i.e. they display either B or T cell lineage-restricted cell surface antigens. The implications of these findings for both normal and neoplastic lymphoid differentiation are discussed.

Rearrangement of the gene for the beta chain of the T-cell receptor in T-cell chronic lymphocytic leukemia and related disorders

Although monoclonal B-cell populations can be identified both by surface-marker analysis and by immunoglobulin-gene rearrangements, this has not been possible with T cells. We have employed cDNA probes that are specific for the entire beta chain of the T-cell receptor, and for its constant and variable regions, to investigate gene rearrangements in T-cell chronic lymphocytic leukemia and related disorders. In three malignant proliferations of helper (T4-positive) T cells, rearrangements of the beta-chain constant-region gene were readily demonstrated. A patient from the Caribbean who had adult T-cell lymphoma and antibody to human T-cell lymphotrophic virus Type I (HTLV-I), a patient with virus-negative chronic lymphocytic leukemia, and a patient with cutaneous T-cell lymphoma (Sézary variant) made up the T4-positive group. Three additional patients with chronic T8 (cytotoxic-suppressor) lymphocytosis and neutropenia were studied; in two; rearrangements were found. In all five patients with constant-region rearrangements, deletions of variable-region restriction fragments were observed as well. The presence of rearrangements of a T-cell receptor gene provides presumptive evidence for the clonal nature of T-cell proliferation and for its neoplastic character.

T-cell receptor gene rearrangements as clinical markers of human T-cell lymphomas

The ability to detect immunoglobulin-gene rearrangements has proved useful in confirming diagnoses of suspected B-cell lymphomas and in establishing their monoclonality. By analogy, we employed a cloned DNA probe for the beta chain of the T-cell receptor gene to determine whether gene rearrangements were present in human T-cell neoplasms representing various stages of T-cell development. Gene rearrangements were present in all cases of T-cell disorders except a single case of T gamma lymphocytosis, a disorder that has not been proved to be a clonal T-cell neoplasm. A germline gene configuration was present in all patients with non-T-cell neoplasms and in normal tissues from patients with T-cell lymphoma. The probe promises to be useful for confirming the pathological an immunologic diagnosis in difficult cases of T-cell disorders and for assessing the extent of disease.

Chromosome studies in 17 patients with the Sézary syndrome

Chromosome studies were done on phytohemagglutinin-stimulated peripheral blood from 17 patients with Sézary syndrome. A chromosomally abnormal clone was found in five patients: each patient had an abnormal chromosome 6 and four had an abnormal chromosome 1. Six patients without abnormal clones had more than 20% metaphases with random heteroploidy and sporadic structural anomalies. Only normal metaphases were seen in four patients, and no metaphases were found in two. Four of the five patients with an abnormal clone died, and their median survival from chromosome analysis was 6 months; only one of these patients died of lymphoma. The six patients with increased heteroploidy had long survivals and no apparent malignant process. Two of the four patients with normal metaphases died of malignant disease: one had lymphoma and the other squamous cell carcinoma. A third patient with normal chromosomes died of extensive visceral cutaneous T-cell lymphoma.

Cytogenetic findings in a case of Sézary syndrome

Repeated cytogenetic studies were carried out on a Sézary syndrome patient during a 1-year period. The presence of a single clone of heteroploid (60-86 chromosomes) cells was a permanent finding in the PHA-stimulated blood cultures. The bone marrow was normal. Sister chromatid exchange (SCE) value was relatively lower in heteroploid cells.

Human leukocyte antigens in cutaneous T cell lymphoma

Mycosis fungoides (MF) and Sézary syndrome (SS) are malignant non-Hodgkin's lymphomas, characterized by the proliferation of helper type T lymphocytes with a predilection for the skin. Because of the similarities in cytologic, histologic, cytogenetic, immunologic, and functional aspects of the malignant cells, as well as overlapping clinical features, these disorders are currently classified as cutaneous T cell lymphoma (CTCL). Though the etiology of these disorders remains obscure, environmental factors as well as viral infection have been implicated. In this study, seventy-six white patients with CTCL were typed for human leukocyte antigen (HLA)-A, -B, and -C to assess genetic susceptibility as determined by the major histocompatibility complex. An increase in the frequency of B8 and Bw35 was seen in SS patients but not in MF patients.

Heterogeneity in the Phenotypic Profile of Cerebriform Cells from a Patient with Sézary Syndrome

This paper reports the results of a series of light and electron microscopic, cytochemical, immunologic and cytogenetic investigations performed in a patient with Sézary syndrome. Fifty-two percent of the cerebriform cells were OKIa-1 positive and 55 % were acid alpha-naphthylacetate esterase (ANAE) negative. Since activated T-lymphocytes are known to lose their peculiar ANAE activity while acquiring la-like antigens, it is conceivable that the ANAE-negative and OKIa-1-positive cells represent an in vivo activated subset. Thus, it appears that a typical Sézary cell population from a given individual can exhibit heterogeneous phenotypic profiles.