Perspectives on cutaneous T cell lymphoma

T-cell subsets with a naive phenotype are selectively decreased in the peripheral blood of patients with mycosis fungoides

Peripheral blood lymphocytes of 33 patients with histopathologic confirmation of mycosis fungoides and 27 healthy controls matched for age and sex were analyzed with a panel of monoclonal antibodies using both single and dual color immunofluorescence. Patients with mycosis fungoides had a significant reduction in the percentage of circulating T cells with a naive phenotype (i.e., CD4+2H4+ and CD4+Leu8+), as well as a significant reduction in the absolute numbers of circulating lymphocytes with the phenotype CD8+Leu8+ compared to the control cohort. The reduction in circulating naive T cells was found to occur irrespective of stage of disease, duration of disease, or mode of treatment. The depletion of circulating naive T cells may reflect increased conversion to memory T cells in the peripheral blood or skin.

Topical carmustine (BCNU) for cutaneous T cell lymphoma: a 15-year experience in 143 patients

One hundred forty-three patients with cutaneous T cell lymphoma were treated with topical carmustine (BCNU). A complete response was obtained in 86% of those with limited extent (less than 10%) plaques (T1 stage), in 48% of those with extensive (greater than or equal to 10%) plaques (T2 stage), and in 21% of those with erythroderma. The median time to achieve complete response was 11.5 weeks. Favorable results were obtained in patients with less than 5% involvement treated locally. Mild hematopoietic depression occurred in less than 10% of patients. Erythematous reactions were common, but no secondary cutaneous malignancies occurred. Differences in freedom from relapse or in survival between T2-stage patients with and those without clinical adenopathy were not statistically significant. The 5-year overall survival rate was 77%; the median survival time was 9.4 years.

Progression of pigmented purpura-like eruptions to mycosis fungoides: report of three cases

The cases of three relatively young male patients with pigmented purpura-like eruptions evolving to mycosis fungoides are described. Initially, the eruptions, both clinically and histologically, very closely resembled pigmented purpuric dermatitis. After a follow-up period averaging 8.4 years, diagnostic histologic changes of mycosis fungoides were observed. Although uncommon, mycosis fungoides should be considered in the differential diagnosis of pigmented purpuric eruptions.