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Boede M, Gellrich S, Hillen U. Keratosis pilaris-artige Mycosis fungoides bei einem Kind. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1887-3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ZusammenfassungDie Mycosis fungoides (MF) im Kindes- und Jugendalter ist selten und macht 0,5–7% der MF-Fälle aus. Bei Kindern und Jugendlichen sind häufiger MF-Varianten als die klassische MF zu beobachten. Wir berichten über einen 11 Jahre alten Jungen mit einer Keratosis pilaris-artigen MF (KPMF). Die KPMF ist eine seltene Manifestation der follikulotropen MF, die sich mit umschriebenen follikulären Papeln mit spikeartigen Hyperkeratosen darstellt, ggf. begleitet von mildem Juckreiz. Da die Läsionen sehr unscheinbar sein können, wird die Diagnose einer MF oft zunächst nicht in Betracht gezogen, sondern an eine Keratosis pilaris, einen Lichen spinulosus, Lichen planopilaris oder multiple filiforme Hyperkeratosen gedacht. Unter Therapie mit topischen Glukokortikoiden in Kombination mit einer Creme-PUVA-Therapie konnte bei unserem Patienten eine vollständige Remission erreicht werden. In nunmehr 3 Jahren nach Erstdiagnose traten mehrfach Rezidive auf, die jeweils mit hautgerichteter Therapie in komplette Remission gebracht werden konnten.
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Affiliation(s)
- Marcel Boede
- Klinik für Dematologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | | | - Uwe Hillen
- Klinik für Dematologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Hoffmann V, Schneider LC, Mechow N, Weilandt J, Gellrich S, Guski S, Kinzel M, Ludwig-Peitsch W. Randbetonte erythematöse Plaques bei einem Patienten mit kongenitaler Ichthyose: von häufigen und seltenen Dermatosen. Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1874-6275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ZusammenfassungNicht-syndromale autosomal-rezessive kongenitale Ichthyosen (ARCI) sind seltene hereditäre Verhornungsstörungen mit einem heterogenen Spektrum an Phänotypen von einer nahezu erscheinungsfreien Haut über eine milde bis schwere Erythrodermie bis hin zu Panzer-artigen Schuppen. Zu den Hauptvertretern zählen die lamelläre Ichthyose, die kongenitale ichthyosiforme Erythrodermie, die Harlekin-Ichythose, die „bathing suit ichthyosis“ und die „self-improving congenital ichthyosis“ (SICI), die sich im Laufe des ersten Lebensjahres bessert und im späteren Leben nur noch durch eine Xerosis cutis mit diskreten, feinen weißen Schuppen äußert.Wir berichten über einen 38-jährigen Patienten, der sich mit einer milden kongenitalen Ichthyose unbekannter genetischer Ursache und einem seit einem Monat erheblich verschlechterten Hautbefund vorstellte. Anhand des klinischen Befundes mit anulären, randbetonten, schuppenden erythematösen Plaques, der Histologie und einer Schuppenpilzkultur konnte eine durch Trichophyton rubrum hervorgerufene Tinea corporis als Ursache für die Exazerbation identifiziert werden. Diese heilte nach 4-wöchiger systemischer Therapie mit Terbinafin komplett ab. Zurück blieb nur eine Xerosis cutis mit einer feinen weißen Schuppung. Passend zur klinischen Verdachtsdiagnose einer SICI erbrachte die molekulargenetische Untersuchung zwei mutmaßlich compound-heterozygote, wahrscheinlich pathogene Varianten im ALOXE3-Gen, eine Spleiß-Variante (c.1392+2T>A;p.?) und ein komplexes Rearrangement. ALOXE3 kodiert für die Lipooxygenase E3, die für die epidermale Differenzierung und für den Aufbau des „cornified envelope“ bedeutsam ist. Varianten in diesem Gen sind eine der Hauptursachen für SICI.Patienten mit Ichthyosen weisen aufgrund des verdickten Stratum corneum, einer verzögerten Desquamation, einer gestörten epidermalen Barrierefunktion und einer Störung der Talg- und Schweißproduktion ein erhöhtes Risiko für Dermatophytosen auf. Diese präsentieren sich oft atypisch und können daher leicht verkannt werden. Insbesondere bei schweren kongenitalen Ichthyosen sind chronische Verläufe und Rezidive häufig. Unser Fall zeigt, dass auch und gerade bei Patienten mit seltenen Verhornungsstörungen an häufige infektiöse Dermatosen wie Tinea corporis gedacht werden muss.
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Affiliation(s)
- Vincent Hoffmann
- Klinik für Dematologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Lisa Christina Schneider
- Klinik für Dematologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Norma Mechow
- Klinik für Dematologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | - Juliane Weilandt
- Klinik für Dematologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
| | | | - Silja Guski
- Institut für Pathologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Miriam Kinzel
- Medicover Humangenetik Berlin-Lichtenberg, Berlin, Deutschland
| | - Wiebke Ludwig-Peitsch
- Klinik für Dematologie und Phlebologie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
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Gellrich F, Heronimus P, Heronimus K, Albinus J, Gellrich S. Alternative Anwendung von Imiquimod 5 % Creme in der Behandlung von Aktinischen Keratosen. Akt Dermatol 2017. [DOI: 10.1055/s-0042-120114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- F. Gellrich
- Klinik und Poliklinik für Dermatologie, Technische Universität Dresden
| | | | - K. Heronimus
- Klinik für Hautkrankheiten und Allergologie, Heinrich-Braun-Klinikum Zwickau
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Gellrich F, Klein N, Albinus J, Gellrich S. Retrospektive Analyse der individuellen Sonnenschutzberatung bei Patienten mit Aktinischen Keratosen. Akt Dermatol 2016. [DOI: 10.1055/s-0041-110609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- F. Gellrich
- Medizinische Fakultät der Technischen Universität Dresden
| | - N. Klein
- Dermatologische Praxis, Elisabethstraße 6, 12247 Berlin
| | - J. Albinus
- Medizinische Fakultät der Technischen Universität Dresden
| | - S. Gellrich
- Dermatologische Praxis, Baumschulenstraße 74, 12437 Berlin
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Robson A, Assaf C, Bagot M, Burg G, Calonje E, Castillo C, Cerroni L, Chimenti N, Dechelotte P, Franck F, Geerts M, Gellrich S, Goodlad J, Kempf W, Knobler R, Massone C, Meijer C, Ortiz P, Petrella T, Pimpinelli N, Roewert J, Russell-Jones R, Santucci M, Steinhoff M, Sterry W, Wechsler J, Whittaker S, Willemze R, Berti E. Aggressive epidermotropic cutaneous CD8+ lymphoma: a cutaneous lymphoma with distinct clinical and pathological features. Report of an EORTC Cutaneous Lymphoma Task Force Workshop. Histopathology 2015; 67:425-41. [PMID: 24438036 DOI: 10.1111/his.12371] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/12/2014] [Indexed: 12/11/2022]
Abstract
AIMS Aggressive epidermotropic cutaneous CD8(+) lymphoma is currently afforded provisional status in the WHO classification of lymphomas. An EORTC Workshop was convened to describe in detail the features of this putative neoplasm and evaluate its nosological status with respect to other cutaneous CD8(+) lymphomas. METHODS AND RESULTS Sixty-one CD8(+) cases were analysed at the workshop; clinical details, often with photographs, histological sections, immunohistochemical results, treatment and patient outcome were discussed and recorded. Eighteen cases had distinct features and conformed to the diagnosis of aggressive epidermotropic cutaneous CD8(+) lymphoma. The patients typically present with widespread plaques and tumours, often ulcerated and haemorrhagic, and histologically have striking pagetoid epidermotrophism. A CD8(+) /CD45RA(+) /CD45RO(-) /CD2(-) /CD5(-) /CD56(-) phenotype, with one or more cytotoxic markers, was found in seven of 18 patients, with a very similar phenotype in the remainder. The tumours seldom involve lymph nodes, but mucosal and central nervous system involvement are not uncommon. The prognosis is poor, with a median survival of 12 months. Examples of CD8(+) mycosis fungoides, lymphomatoid papulosis and Woringer-Kolopp disease presented the typical features well documented in the CD4(+) forms of those diseases. CONCLUSIONS Aggressive epidermotropic cutaneous CD8(+) lymphoma is a distinct lymphoma that warrants inclusion as a distinct entity in future revisions of lymphoma classifications.
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Affiliation(s)
| | - Chalid Assaf
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - Martine Bagot
- Department of Pathology, Universite Paris, Paris, France
| | - Gunter Burg
- Department of Dermatology and Venereology, University of Zurich, Zurich, Switzerland
| | | | | | - Lorenzo Cerroni
- Department of Dermatology Medical, University of Graz, Graz, Austria
| | - Nicola Chimenti
- Department of Dermatology, University of L'Aquila, Rome, Italy
| | - Pierre Dechelotte
- Department of Pathology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Frederic Franck
- Department of Pathology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Maria Geerts
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - Sylke Gellrich
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - John Goodlad
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Werner Kempf
- Department of Dermatology and Venereology, University of Zurich, Zurich, Switzerland
| | - Robert Knobler
- Department of Dermatology, University of Vienna, Vienna, Austria
| | - Cesare Massone
- Department of Dermatology Medical, University of Graz, Graz, Austria
| | - Chris Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Pablo Ortiz
- Hospital Universitario, Universidad Complutense, Madrid, Spain
| | - Tony Petrella
- Departmentof Pathology, Dijon's University Hospital, Dijon, France
| | - Nicola Pimpinelli
- Division of Dermatology, University of Florence Medical School, Florence, Italy
| | - Joclim Roewert
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | | | - Marco Santucci
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Mattias Steinhoff
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - Wolfram Sterry
- Department of Dermatology, Charité-University Medicine, Berlin, Germany
| | - Janine Wechsler
- Department of Pathology Henri-Mondor Hospital, University Paris-Val-de-Marne, Paris, France
| | | | - Rein Willemze
- Department of Dermatology, Leiden University, Leiden, the Netherlands
| | - Emilio Berti
- Department of Dermatology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico and Università degli Studi di Milano-Bicocca, Milan, Italy
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Wolk K, Mitsui H, Witte K, Gellrich S, Gulati N, Humme D, Witte E, Gonsior M, Beyer M, Kadin ME, Volk HD, Krueger JG, Sterry W, Sabat R. Deficient Cutaneous Antibacterial Competence in Cutaneous T-Cell Lymphomas: Role of Th2-Mediated Biased Th17 Function. Clin Cancer Res 2014; 20:5507-16. [DOI: 10.1158/1078-0432.ccr-14-0707] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gellrich F, Gellrich S. Ingenolmebutat zur Behandlung der Aktinischen Keratose in der ambulanten Routineversorgung. Akt Dermatol 2014. [DOI: 10.1055/s-0034-1377560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brandenburg A, Humme D, Terhorst D, Gellrich S, Sterry W, Beyer M. Long-term outcome of intravenous therapy with rituximab in patients with primary cutaneous B-cell lymphomas. Br J Dermatol 2013; 169:1126-32. [DOI: 10.1111/bjd.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 12/01/2022]
Affiliation(s)
- A. Brandenburg
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
- Dermatologikum Hamburg; Hamburg Germany
| | - D. Humme
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| | - D. Terhorst
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
- Centre d'Immunologie Marseille-Luminy; INSERM - CNRS - Université de la Mediterannée; Marseille France
| | - S. Gellrich
- Medical practice for Dermatology and Allergy Sylke Gellrich; Berlin Germany
| | - W. Sterry
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
| | - M. Beyer
- Department of Dermatology and Allergy; Skin cancer centre Charité; Charité-Universitätsmedizin Berlin; Charitéplatz 1 Berlin 10117 Germany
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Whittaker S, Ortiz P, Dummer R, Ranki A, Hasan B, Meulemans B, Gellrich S, Knobler R, Stadler R, Karrasch M. Efficacy and safety of bexarotene combined with psoralen-ultraviolet A (PUVA) compared with PUVA treatment alone in stage IB-IIA mycosis fungoides: final results from the EORTC Cutaneous Lymphoma Task Force phase III randomized clinical trial 21011 (NCT00. Br J Dermatol 2012; 167:678-87. [DOI: 10.1111/j.1365-2133.2012.11156.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Whittaker S, Ortiz-Romero PL, Dummer R, Ranki A, Hasan B, Meulemans B, Gellrich S, Knobler R, Stadler R, Shash E. Efficacy and safety of bexarotene combined with psoralen/ultraviolet A light (PUVA) compared to PUVA treatment alone in stage IB-IIa mycosis fungoides (MF): Final results from EORTC cutaneous lymphoma task force (CLTF) phase III clinical trial 21011. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.8076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8076 Background: Skin-directed treatment with methoxsalen (PUVA) is the current treatment standard in stage IB-IIA MF. A combination of PUVA and bexarotene might be of additional clinical benefit for MF stage I/II patients (pts). Methods: EORTC 21011 was a randomised, open label phase III study comparing combined bexarotene and PUVA versus PUVA alone in pts with stage IB and IIA MF. Study primary endpoint was response (complete clinical + partial response, CCR+PR) rate; secondary endpoints: cumulative dose of UVA and number of PUVA sessions necessary to achieve a CCR, duration of CCR, time to relapse, safety and percentage of drop-outs. Results: The study recruited stage IB/IIA MF pts and was prematurely closed due to low accrual after 93/145 required pts (65%) were randomized; 45 to PUVA, 48 to PUVA+bexarotene. Median number of PUVA weeks were 12 (1-17) in PUVA vs. 10.5 (1-16) in combination arm. Total UVA doses were 107J/cm2 (1.4-489.9) in PUVA vs. 101.7J/cm2 (0.2-529.9) in combination arm. Few grade 3-4 toxicities were observed in both arms (liver enzyme elevation, neutropenia, anemia, increased cholesterol, photosensitivity, pruritus, rash, hypertriglyceridemia). Best overall response (CCR/PR) rate was 71.1% (33/45) for PUVA alone and 77.1% (37/48) for combination arm (p-value=0.57). The median of duration of response was 9.6 for PUVA vs 5.8 months for combination arm (p value=0.33). CCR was seen in 25 pts, 10 in PUVA (CCR 24%) and 15 in combination therapy (CCR 33%) (pvalue=0.45). Similarily, a lower UVA dose was required to achieve a CCR in the combination arm (median of 55.8 J/cm2) compared to the PUVA arm (median of 117.58 J/cm2) (p value=0.5). Conclusions: No significant difference in response rate was observed in this study. There was a trend towards fewer PUVA sessions and lower UVA dose to achieve CCR in the PUVA/bexarotene combination arm (median of 27.5 vs. 22,p-value = 0.11) but this did not achieve statistical significance due to insufficient power. The safety profile was acceptable, as there were only few grade 3-4 toxicities observed in both arms.
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Affiliation(s)
| | | | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Baktiar Hasan
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Bart Meulemans
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | - Robert Knobler
- Department of Dermatology, Medical University, Vienna, Austria
| | - Rudolf Stadler
- Department of Dermatology, Medical Center Minden, Minden, Germany
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Forgber M, Gellrich S, Sharav T, Sterry W, Walden P. Proteome-based analysis of serologically defined tumor-associated antigens in cutaneous lymphoma. PLoS One 2009; 4:e8376. [PMID: 20020065 PMCID: PMC2793029 DOI: 10.1371/journal.pone.0008376] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Accepted: 11/16/2009] [Indexed: 01/09/2023] Open
Abstract
Information on specificities of serological responses against tumor cells in cutaneous lymphoma patients is relatively restricted. To advance the knowledge of serological immune responses against and to assess the scope of tumor antigenicity of cutaneous lymphoma, 1- and 2-dimensional Western blot analyses with sera from patients were combined with proteomics-based protein identification. Testing sera from 87 cutaneous lymphoma patients by 1-dimensional Western blot analysis, 64 cases of seroreactivity against lymphoma cells were found. The positive responses were relatively weak, restricted to few antigens in each case, and heterogeneous. To identify the antigens, proteins of the mycosis fungoides cell line MyLa and primary tumor cells were separated by 2-dimensional gel electrophoresis, Western-blotted and probed with heterogeneous and autologous patient sera. The antigens were identified from silver-stained replica gels by MALDI-TOF mass spectrometry. 14 different antigens were assigned and identified with this proteome-serological approach. Only one, vimentin, had been reported before, the other 13 are new antigens for cutaneous lymphomas.
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Affiliation(s)
- Michael Forgber
- Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, Humboldt University, Berlin, Germany
| | - Sylke Gellrich
- Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, Humboldt University, Berlin, Germany
| | - Tumenjargal Sharav
- Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, Humboldt University, Berlin, Germany
| | - Wolfram Sterry
- Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, Humboldt University, Berlin, Germany
| | - Peter Walden
- Department of Dermatology, Venerology and Allergy, Charité - Universitätsmedizin Berlin, Humboldt University, Berlin, Germany
- * E-mail:
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Lukowsky A, Marchwat M, Sterry W, Gellrich S. Evaluation of B-cell clonality in archival skin biopsy samples of cutaneous B-cell lymphoma by immunoglobulin heavy chain gene polymerase chain reaction. Leuk Lymphoma 2009; 47:487-93. [PMID: 16396773 DOI: 10.1080/10428190500305380] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Polymerase chain reaction (PCR)-based detection of clonal T- and B-cells is widely used in the diagnosis of various lymphomas, including those of the skin. A large number of corresponding methods have been published. Recently, for the first time, standardized PCR protocols were developed in common by 14 European centers of lymphoma diagnosis and research (Biomed-2 protocols). Here, we have applied Biomed-2 immunoglobulin heavy chain (IgH)-PCR for clonality detection in primary cutaneous B-cell lymphoma (CBCL) and compared it with previously established methods. The DNA of 43 paraffin-embedded lesional skin biopsies of confirmed CBCL cases [27 follicle center cell lymphoma (FCCL), 11 marginal zone B-cell lymphoma/immunocytoma (MZL/IC) and five large CBCL of the lower leg (CBCL-LL)] were amplified by the Biomed-2 IgH-PCR protocols as well as using four other assays, priming also the three IgH framework regions (FR) 1-3. All PCR products were analysed by fluorescence fragment analysis. Twenty-nine of 43 (67%) CBCL samples (5/5, 100% of CBCL-LL; six of 11, 54.5% of IC/MZL; 18 of 27, 66.7% of FCCL) showed monoclonal B-cell presence complementary in all of the IgH-PCR. The three Biomed-2 PCR indicated together clonality in 24 of 43 samples (56%). Considering each method separately, the Biomed-2 FR3-PCR showed the highest rate of clonality detection (20 of 43, 47%). In conclusion, the Biomed-2 FR3-PCR is recommended for detecting B-cell clonality in archival skin samples of CBCL but should be completed by FR1- and/or FR2-PCR.
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Affiliation(s)
- Ansgar Lukowsky
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Germany.
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Maza S, Gellrich S, Assaf C, Beyer M, Spilker L, Orawa H, Munz DL, Sterry W, Steinhoff M. Yttrium-90 ibritumomab tiuxetan radioimmunotherapy in primary cutaneous B-cell lymphomas: first results of a prospective, monocentre study. Leuk Lymphoma 2009; 49:1702-9. [DOI: 10.1080/10428190802258923] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Steinhoff M, Gellrich S, Maza S, Assaf C, Orawa H, Munz DL, Sterry W. Yttrium-90 ibritumomab tiuxetan radioimmunotherapy in primary cutaneous B-cell lymphomas: first results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Affiliation(s)
- S Gellrich
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Schumannstrasse 20/21, 10117 Berlin.
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Vermeer MH, van Doorn R, Dijkman R, Mao X, Whittaker S, van Voorst Vader PC, Gerritsen MJP, Geerts ML, Gellrich S, Soderberg O, Leuchowius KJ, Landegren U, Out-Luiting JJ, Knijnenburg J, IJszenga M, Szuhai K, Willemze R, Tensen CP. Novel and Highly Recurrent Chromosomal Alterations in Sezary Syndrome. Cancer Res 2008; 68:2689-98. [DOI: 10.1158/0008-5472.can-07-6398] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Assaf C, Gellrich S, Steinhoff M, Nashan D, Weisse F, Dippel E, Coors E, Stein A, Gollin P, Henke U, Adam-Murati S, Koch A, Klemke CD, Stadler R, Sterry W. Cutaneous lymphomas in Germany: an analysis of the Central Cutaneous Lymphoma Registry of the German Society of Dermatology (DDG). J Dtsch Dermatol Ges 2007; 5:662-8. [PMID: 17659039 DOI: 10.1111/j.1610-0387.2007.06337.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary cutaneous lymphomas form a heterogeneous group of lymphatic neoplasias. They manifest themselves on the skin and are the second most frequent group of non-Hodgkin lymphoma (NHL) following gastrointestinal lymphomas. The number of epidemiologic studies is small due to limited availability and limited comparability on population-based data. PATIENTS AND METHODS In the present study the first evaluation of the German Central Registry for Cutaneous Lymphomas (ZRKL) of the German Society of Dermatology (DDG) is undertaken on the basis of 998 patients. The epidemiology of cutaneous lymphomas in Germany is compared to other national or regional lymphoma registries. RESULTS Based on the registration of 998 patients from 26 clinics in Germany,a clear predominance of cutaneous T-cell lymphomas (85 %) in comparison to cutaneous B-cell lymphomas (14 %) is seen. The most frequent representative of CTCL is mycosis fungoides,composing 62 % of cases with a slight predominance of men (M:F = 1.6:1). Differences are also seen in stage of the disease at first presentation of patients with cutaneous lymphomas.While, for example, 80 % of patients with mycosis fungoides in Germany present in early stages (I-IIA),in the USA 34 % of patients are in the tumor stage or have organ involvement at presentation. CONCLUSIONS The ZRKL of the DDG for the first time presents epidemiologic data from Germany, allowing comparison with other nations for the study of etio-logical factors and socioeconomic influences. Further, the ZRKL supports the development of uniform and quality-oriented diagnostic criteria and therapeutic options. Finally, the ZRKL provides a foundation for future intensive study of clinical and scientific questions regarding cutaneous T- and B-cell lymphomas.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology, Allergy and Venereology, Skin Tumor Center Charité (HTCC), Charité University Medicine, Berlin, Germany.
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18
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Assaf C, Hirsch B, Wagner F, Lucka L, Grünbaum M, Gellrich S, Lukowsky A, Sterry W, Stein H, Dürkop H. Differential expression of TRAF1 aids in the distinction of cutaneous CD30-positive lymphoproliferations. J Invest Dermatol 2007; 127:1898-904. [PMID: 17392826 DOI: 10.1038/sj.jid.5700800] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lymphomatoid papulosis (LyP), primary cutaneous anaplastic large T-cell lymphoma (cALCL), and cutaneous infiltrates of systemic anaplastic large cell lymphoma (sALCL) are CD30-positive lymphoproliferative disorders of the skin that overlap clinically, histopathologically, immunophenotypically, and genetically but differ considerably in their prognosis. In particular, lesions of LyP regress spontaneously, whereas those of cALCL and sALCL persist and may progress and spread to extracutaneous sites. In contrast to patients with cALCL, LyP patients do not benefit from an aggressive radio- and/or chemotherapeutic approach. We generated a novel tumor necrosis factor receptor (TNFR)-associated factor 1 (TRAF1) antibody that recognizes a formalin-resistant epitope (Ber-TRAF1A) and investigated the expression of TRAF1, an intracellular component of TNFR signaling, in LyP and ALCL. We could show a strong TRAF1 expression in the tumor cells of most LyP cases (42/49, 84%). In contrast, tumor cells of primary and secondary cALCL revealed TRAF1 expression in only a few cases (3/41, 7%) as shown for sALCL without skin manifestation. The data indicate that TRAF1 expression reliably distinguishes LyP from primary or secondary cALCL. This might be of crucial diagnostic importance and has a strong impact on the treatment decision for patients with cALCL and LyP.
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology and Allergy, Skin Cancer Center Charité, CBF, Charité-Universitätsmedizin Berlin, Berlin, Germany
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19
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Assaf C, Gellrich S, Whittaker S, Robson A, Cerroni L, Massone C, Kerl H, Rose C, Chott A, Chimenti S, Hallermann C, Petrella T, Wechsler J, Bagot M, Hummel M, Bullani-Kerl K, Bekkenk MW, Kempf W, Meijer CJLM, Willemze R, Sterry W. CD56-positive haematological neoplasms of the skin: a multicentre study of the Cutaneous Lymphoma Project Group of the European Organisation for Research and Treatment of Cancer. J Clin Pathol 2006; 60:981-9. [PMID: 17018683 PMCID: PMC1972425 DOI: 10.1136/jcp.2006.042135] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cutaneous lymphomas expressing CD56, a neural cell adhesion molecule, are characterised in most cases by a highly aggressive clinical course and a poor prognosis. However, prognostic subsets within the CD56+ group have been difficult to identify due to the lack of uniform clinicopathological and immunophenotypical criteria. METHODS A multicentre study was conducted by the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer to define prognostic parameters and establish diagnostic and therapeutic guidelines for CD56+ haematological neoplasms presenting primarily in the skin. RESULTS Four different subtypes of lymphoproliferations with CD56 expression were identified: (1) haematodermic neoplasm; (2) skin infiltration as the first manifestation of CD56+ acute myeloid leukaemia; (3) nasal-type extranodal natural killer/T-cell lymphoma; and (4) "classical" cases of cutaneous T-cell lymphoma (CTCL) with co-expression of the CD56 molecule. Patients in the first three groups had a poor outcome (93% died) with a median survival rate of 11 months (95% CI 2-72 months), whereas all patients with CD56+ CTCL were alive at the last follow-up. CONCLUSION Results show that CD56+ cutaneous lymphoproliferative disorders, with the exception of CD56+ CTCL have a very poor prognosis. It is therefore clinically important to separate CD56+ CTCL from the remaining CD56+ haematological disorders.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- CD56 Antigen/analysis
- Child
- Female
- Genotype
- Humans
- Immunophenotyping
- Killer Cells, Natural/pathology
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/therapy
- Male
- Middle Aged
- Neoplasm Invasiveness
- Prognosis
- Skin Neoplasms/diagnosis
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Chalid Assaf
- Department of Dermatology, Charité, Berlin, Germany.
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20
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Urosevic M, Gellrich S, Dreno B, Schiller M, Dereure O, Baudard M, Bagot M, Khammari A, Bleuzen P, Dummer R. Adenovirus-interferon γ (TG1042) demonstrates good tolerance and efficacy in relapsing primary cutaneous lymphoma (PCL): Final results of a phase I/II multicentric trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7539 Background: Interferons (IFNs), which can offset the Th2 dominance associated with PCL have been successfully used to treat these PCL. Intratumoral (i.t.) injection of TG1042 (a non-replicating recombinant adenovirus with a human IFNγ cDNA insert) induces high local production of IFNγ without severe toxicity associated with systemic delivery. Methods: We undertook a phase I/II multicentric trial of repeated, i.t. injections of TG1042 in patients with advanced primary T cell (CTCL) or B cell (CBCL) CL. One to 3 lesions were injected on day 1, 8, and 15 (a 4-week cycle) and thereafter up to 12 cycles. Immunohistochemistry and quantitative PCR were performed on injected lesions biopsied at baseline and after the 1st cycle. In the phase I, 18 patients were enrolled in 3 successive cohorts at the doses of 3 × 109 viral particles (vp) (n = 3), 3 × 1010 vp (n = 3) and 3 × 1011 vp (n = 12). In the phase II, 18 evaluable patients were planned to be treated at 3 × 1011 vp. Results: To date, enrollment is complete, 39 patients (32 CTCL and 7 CBCL) have been included, 9 of them are still on treatment. Patients received a median of 4 lines of prior therapy. 11 patients were at stage Ib and 16 patients at higher stage. Altogether, 245 injections of TG1042 have been administered. Treatment was well tolerated with 8 grade 3 related adverse events. Injection site reaction and flu like syndrome are the most common adverse events. Histology demonstrates pronounced changes in infiltrate patterns with signs of vasculitis, increased numbers of eosinophils, neutrophils, CD8 and TIA-1+ve cells. CD4/CD8 ratio decreased in most tumors. Transgene-IFNγ mRNA was detected in injected lesions. Gene expression analysis of biopsies and PBMC shows up-regulation of IFNγ genes. Local clinical response has been observed in 17 (including 9 complete responses [CR]) out of 31 evaluable patients. 13 global responses (7 CR) out of 30 evaluable patients have been observed. All 5 evaluable CBCL responded (3 CR). Conclusions: These results demonstrate that TG1042 is well tolerated and presents a potential significant benefit for the treatment of both CTCL and CBCL. A phase II is planned in patients with CBCL to confirm those encouraging results. [Table: see text]
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Affiliation(s)
- M. Urosevic
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - S. Gellrich
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - B. Dreno
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - M. Schiller
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - O. Dereure
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - M. Baudard
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - M. Bagot
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - A. Khammari
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - P. Bleuzen
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
| | - R. Dummer
- University Hospital, Zurich, Switzerland; Charité Hospital, Berlin, Germany; University Hospital, Nantes, France; University Hospital, Munster, Germany; St Eloi Hospital, Montpellier, France; Lapeyronie Hospital, Montpellier, France; Henri Mondor Hospital, Creteil, France; Transgene, Strasbourg, France
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21
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Gellrich S, Muche JM, Wilks A, Jasch KC, Voit C, Fischer T, Audring H, Sterry W. Systemic eight-cycle anti-CD20 monoclonal antibody (rituximab) therapy in primary cutaneous B-cell lymphomas - an applicational observation. Br J Dermatol 2005; 153:167-73. [PMID: 16029344 DOI: 10.1111/j.1365-2133.2005.06659.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas (PCBCLs) are characterized by restriction to the skin and a variable but mostly favourable prognosis. Since 1997 the recombinant, chimeric anti-CD20 antibody rituximab has been used in patients suffering from non-Hodgkin's B-cell lymphomas. Different studies have shown that the effectiveness and safety in the treatment of patients with low-grade follicular lymphoma is comparable to or even higher than the standard CHOP chemotherapy. So far it has been unclear whether an extended duration of therapy leads to a benefit for the patients with PCBCL. OBJECTIVES To evaluate the objective response rate, time to progression, remission quality and histological changes and to compare our data with the literature. PATIENTS/METHODS Ten patients with PCBCL [eight with follicle centre cell lymphoma (FCCL), one with marginal zone lymphoma (MZL) and one with diffuse large B-cell lymphoma of the leg (DLBCL)] were treated by intravenous application of a chimeric antibody against the CD20 transmembrane antigen (rituximab) with a dosage of eight cycles, 375 mg m(-2) body surface, weekly. RESULTS The treatment regimen resulted in clinical overall response in 9 of 10 patients, in particular there were seven complete responses (70%) plus two partial responses (20%). The median duration of remission (durable remission, DR) is 23 months (4-30 months) to date. Histological assessment of responses in four patients showed no tumour-specific infiltration. In two patients histology revealed a residual infiltration and in one patient an increasing infiltration. In two patients no histology was taken after treatment; one patient developed a new lesion. No severe side-effects occurred. Observed side-effects were two bacterial infections, two patients with shivering during infusion, one patient with sweating for months and one patient with persisting itching. As expected the B-cell count in peripheral blood was depressed in all patients after infusion. CONCLUSIONS Intravenous therapy with eight cycles of the anti-CD20 antibody rituximab is a non-toxic and effective treatment for a subset of patients with PCBCL (relapsed, aggressive entity, old patients, multiple lesions) with a long DR.
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Affiliation(s)
- S Gellrich
- Department of Dermatology, Venerology and Allergy, Medical Faculty (Charité), Humboldt-University Berlin, Schumannstr. 20/21, 10117 Berlin, Germany.
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22
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Voit CA, Mayer T, Schäfer G, Gellrich S, Kron M, Sterry W, Schwürzer M, Schoengen A. Ultrasound (US) and ultrasound guided fine needle aspiration cytology (FNAC) reduces surgical procedures, sentinel node (SN) dissection in melanoma patients and reliably predicts lymph node involvement in cutaneous lymphoma patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. A. Voit
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - T. Mayer
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - G. Schäfer
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - S. Gellrich
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - M. Kron
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - W. Sterry
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - M. Schwürzer
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
| | - A. Schoengen
- Charite, Humboldt Univ, Berlin, Germany; Armed Forces Hosp, Ulm, Germany; Univ of Ulm, Ulm, Germany
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23
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Linnemann T, Gellrich S, Lukowsky A, Mielke A, Audring H, Sterry W, Walden P. On the possible relationship between staphylococcal superantigens and increased Vbeta5.1 usage in cutaneous T-cell lymphoma: reply from authors. Br J Dermatol 2005. [DOI: 10.1111/j.1365-2133.2005.06523.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Assaf C, Steinhoff M, Gellrich S, Sterry W. Classification of primary cutaneous lymphomas. Front Radiat Ther Oncol 2005; 39:25-37. [PMID: 16394666 DOI: 10.1159/000090801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Chalid Assaf
- Departments of Dermatology, Allergology and Venerology, Charité-University Medicine Berlin, Berlin, Germany
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25
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Gellrich S, Schewe C, Sterry W, Lukowsky A. Absence of SV40 and Other Polyomavirus (JCV, BKV) DNA in Primary Cutaneous B Cell Lymphomas. J Invest Dermatol 2005; 124:278-9. [PMID: 15654988 DOI: 10.1111/j.0022-202x.2004.23536.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Cutaneous biopsies are traditionally studied for the expression of cellular markers by immunoenzymatic techniques. However, immunofluorescent analysis is a valuable, and largely overlooked, ancillary technique that can resolve questions arising from conventional immunostaining, since it allows pairs of antigens to be simultaneously visualized. Furthermore, a novel technique, based on a combination of immunoperoxidase and immunofluorescent staining, allows three markers to be demonstrated together. Fluorescent microscopy also allows skin biopsies from lymphoma cases to be analyzed for chromosomal abnormalities by the fluorescent in situ hybridization (FISH) technique, which is now applicable to routine biopsy samples. In this review, we describe the technical aspects of immunofluorescent and FISH analysis of routine cutaneous biopsy samples.
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Affiliation(s)
- Sylke Gellrich
- Department of Dermatology, Venereology and Allergy, Medical Faculty, Humboldt-University, Berlin, Germany
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27
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Marcus Muche J, Karenko L, Gellrich S, Karhu R, Kytölä S, Kähkönen M, Lukowsky A, Sterry W, Ranki A. Cellular coincidence of clonal T cell receptor rearrangements and complex clonal chromosomal aberrations-a hallmark of malignancy in cutaneous T cell lymphoma. J Invest Dermatol 2004; 122:574-8. [PMID: 15086537 DOI: 10.1111/j.0022-202x.2004.22303.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Detection of a clonal T cell receptor (TCR) gene rearrangement is used in the diagnosis of primary cutaneous T cell lymphomas (CTCL) whereas chromosomal aberrations serve as a diagnostic tool for leukaemias and nodal lymphomas. To what extent both approaches specify the same cell population remains unknown. We investigated the coincidence of TCR clonality with complex clonal chromosomal aberrations, indicating qualitative alteration of the affected cells, in 17 CTCL patients. Out of 41 skin, blood, and lymph node samples studied, 34 gave results in chromosome and TCR analyses. With 88%, most specimens revealed corresponding results by both techniques (27 of 34 clonal, three of 34 non-clonal). In two patients, analysis of micro-dissected cells demonstrated that neoplastic T cells bear both a dominant TCR rearrangement and a complex chromosomal aberration. The cutaneous clone was found in blood samples of 11 of 12 patients (including early stages), and investigation of follow-up skin and blood samples indicated persistence of the T cell clone in 11 of 14 cases. In conclusion, we show that dominant TCR clones and chromosomal clones converge in all stages of CTCL. These clones disseminate into blood and skin at early disease stages and persist despite therapy. The coexistence of a dominant TCR clone and a clonal chromosomal aberration can thus be used as a hallmark of malignancy.
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Affiliation(s)
- J Marcus Muche
- Department of Dermatology and Allergy, Charité Berlin, Berlin, Germany.
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28
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Linnemann T, Gellrich S, Lukowsky A, Mielke A, Audring H, Sterry W, Walden P. Polyclonal expansion of T cells with the TCR Vbeta type of the tumour cell in lesions of cutaneous T-cell lymphoma: evidence for possible superantigen involvement. Br J Dermatol 2004; 150:1013-7. [PMID: 15149519 DOI: 10.1111/j.1365-2133.2004.05970.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The involvement of superantigens in the pathology of cutaneous T-cell lymphomas (CTCL) has been suggested before, but without unequivocal evidence for superantigen activity in the patients. Seeking evidence for superantigen activity we analysed clones and microdissected single cells isolated from the epidermis of early-stage lesions of a CTCL patient for their T-cell receptor (TCR) V beta expression and TCR V gamma gene rearrangements. The vast majority of these T cells expressed the TCR V beta family type of the tumour. From their TCR gamma gene rearrangements, however, these cells were polyclonal. The tumour cell clone accounted for about 60% of these cells, about 40% were of heterogeneous origin. This dominance of a single V beta family in the polyclonally expanded dermal T-cell populations implies superantigen activity in the CTCL lesions.
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Affiliation(s)
- T Linnemann
- Department of Dermatology and Allergy, Charité-University Medicine Berlin, Humboldt University, Schumannstr. 20/21, D-10117 Berlin, Germany
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29
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Fischer TC, Gellrich S, Muche JM, Sherev T, Audring H, Neitzel H, Walden P, Sterry W, Tönnies H. Genomic Aberrations and Survival in Cutaneous T Cell Lymphomas. J Invest Dermatol 2004; 122:579-86. [PMID: 15086538 DOI: 10.1111/j.0022-202x.2004.22301.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Information on chromosomal aberrations in cutaneous T cell lymphomas (CTCL), is scarce. In this study, comparative genomic hybridization (CGH) was used to analyze chromosomal imbalances (CI) in 32 patients with CTCL. CI were detected in 21 patients (66%). Euchromatic loss (dim) was localized most frequently (>16%) at the chromosomal regions 17p (28%), 13q (25%), 10q (16%), and 6q (19%), and gain of chromatin (enh) at 7 (25%), 8q (25%), and 17q (16%). The pattern dim6q-enh7-enh8-dim13 was the most frequent combination of CI. The number of aberrations per tumor sample varied between 0 and 19 and correlated with clinical tumor stages: from none in stage Ia to 8.75+/-1.8 (mean+/-SEM) in stage IVa. CI occurred more frequently in aggressive subtypes (9.33+/-2.16) than in indolent (2.88+/-0.8) subtypes. A high number of CI (>/=5) was associated with shorter survival. Gain of chromatin in 8q and loss of 6q and 13q correlated with a significantly shorter survival, whereas the most frequently observed aberrations (loss in 17p and gain in 7) did not influence the prognosis. In summary, CGH analysis revealed a characteristic pattern of recurring chromosomal gains and losses in CTCL. The association of the imbalances with the clinical course of the disease suggests that genes encoded at these loci may influence tumor development and progression.
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Affiliation(s)
- Tanja C Fischer
- Department of Dermatology, Charite, Humboldt University, Berlin, Germany.
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30
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Gellrich S, Wernicke M, Wilks A, Lukowsky A, Muche JM, Jasch KC, Audring H, Mason D, Sterry W. The Cell Infiltrate in Lymphomatoid Papulosis Comprises a Mixture of Polyclonal Large Atypical Cells (CD30-Positive) and Smaller Monoclonal T cells (CD30-Negative). J Invest Dermatol 2004; 122:859-61. [PMID: 15086582 DOI: 10.1111/j.0022-202x.2004.22304.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Female
- Germany/epidemiology
- Humans
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/epidemiology
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/mortality
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/therapy
- Male
- Middle Aged
- Multicenter Studies as Topic
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/pathology
- Mycosis Fungoides/therapy
- Neoplasm Staging
- PUVA Therapy
- Photopheresis
- Randomized Controlled Trials as Topic
- Registries
- Sezary Syndrome/diagnosis
- Sezary Syndrome/therapy
- Skin/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/drug therapy
- Skin Neoplasms/epidemiology
- Skin Neoplasms/genetics
- Skin Neoplasms/immunology
- Skin Neoplasms/mortality
- Skin Neoplasms/pathology
- Skin Neoplasms/therapy
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Affiliation(s)
- Edgar Dippel
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim, Ruprecht-Karls Universität Heidelberg.
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Tumenjargal S, Gellrich S, Linnemann T, Muche JM, Lukowsky A, Audring H, Wiesmüller KH, Sterry W, Walden P. Anti-tumor immune responses and tumor regression induced with mimotopes of a tumor-associated T cell epitope. Eur J Immunol 2003; 33:3175-85. [PMID: 14579286 DOI: 10.1002/eji.200324244] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mimotopes provide an alternative to natural T cell epitopes for cancer immune therapy, as they can recruit and stimulate T cell repertoires that deviate from the repertoires engaged with the tumor and exposed to disease-related immune suppression. Here, mimotopes of a shared tumor-associated T cell epitope in cutaneous lymphoma were tested for their capacities to induce clinical and immunological responses in cancer patients. The mimotope sequences had been determined by a combinatorial peptide library approach without knowledge of the corresponding natural tumor-associated antigen. Vaccination with these mimotopes together with helper T cell-inducing antigens led to complete tumor remission in the two patients tested. After each booster vaccination, enhanced frequencies of mimotope-specific CD8+ T cells were detected in the peripheral blood of the patients, and the CTL proved to be cytotoxic and tumoricidal when tested in vitro. These data provide a first indication of clinical efficacy of mimotopes in cancer patients.
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Affiliation(s)
- Sherev Tumenjargal
- Department of Dermatology and Allergy, Charité--University Medicine Berlin, Humboldt University, Berlin, Germany
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33
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Bohmeyer J, Stadler R, Kremer A, Nashan D, Muche M, Gellrich S, Luger T, Sterry W. Bexarotene - an alternative therapy for progressive cutaneous T-cell lymphoma? First experiences. J Dtsch Dermatol Ges 2003; 1:785-9. [PMID: 16281814 DOI: 10.1046/j.1439-0353.2003.03711.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A standard therapy for advanced cutaneous T-cell lymphomas has not yet been defined. Bexarotene is a new retinoid x receptor-specific retinoid that has been approved for systemic second-line therapy for cutaneous T-cell lymphomas in the USA and Europe. In order to evaluate the efficacy of bexarotene in cutaneous T-cell lymphomas, a pilot trial was initiated. PATIENTS AND METHODS In a pilot project 10 patients with advanced cutaneous T-cell lymphomas, who had received a variety of previous treatments, were treated with bexarotene at the departments of dermatology in Münster, Minden and Charité Berlin, Germany. The patients received bexarotene at a dose of 300 mg/m2 body surface daily. According to the percentage of tumour reduction and affected body surface, the response rates were divided in complete and partial remission, stable disease and progressive disease. Laboratory parameters i.e. cholesterol, triglycerides transaminases, T3, T4, and TSH were screened regularly. RESULTS In 2 patients a short partial remission was achieved; however, after a few weeks progression followed. In 4 patients a lasting stabilisation was obtained. The other 4 patients showed a progressive disease during therapy. 6 patients developed hypertriglyceridemia with levels up to 2000 mg/dl; therapy had to be suspended in 3 patients because of these adverse drug events. CONCLUSION Weighing benefits and risks, bexarotene can at present not be recommended as standard therapy in the treatment of patients with progressive cutaneous lymphomas.
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Affiliation(s)
- J Bohmeyer
- Department of Dermatology, Medical Centre Minden
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34
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Muche JM, Sterry W, Gellrich S, Rzany B, Audring H, Lukowsky A. Peripheral blood T-cell clonality in mycosis fungoides and nonlymphoma controls. Diagn Mol Pathol 2003; 12:142-50. [PMID: 12960696 DOI: 10.1097/00019606-200309000-00005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In mycosis fungoides (MF), T-cell clonality is reported in about 90% of skin and 40% of blood samples. However, identity of blood and cutaneous T-cell clone and prognostic relevance of blood T-cell clonality remain controversial. By PCR/fluorescence fragment analysis with estimation of clonal fragment lengths and relative peak heights, we objectively identified T-cell clonality unrelated to malignant lymphoproliferation in healthy donors (5/38), autoimmune dermatoses (3/8), and nonlymphoma skin cancer (9/39). This T-cell expansion of undetermined significance (TEXUS) was also found in 8/64 MF patients. Dissemination of neoplastic cells into blood, as identified by identical clonal fragment lengths in blood and skin, was detected in 23/64 MF patients. When monitoring for progression at TNM stage for a mean of 45.7 months, univariate analysis identified age of >60 years and detection of a related blood T-cell clone to be of prognostic relevance, whereas detection of TEXUS, sex, TNM stage at initial diagnosis, and detection of a cutaneous T-cell clone were irrelevant. Although multivariate analysis was not possible, further stratification clearly indicated an age of >60 years to be the predominating prognostic factor. In conclusion, investigation of T-cell clonality in skin and blood samples at the initial diagnosis cannot predict the clinical course of MF and the occurrence of TEXUS should be considered when assessing blood T-cell clonality.
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Affiliation(s)
- J Marcus Muche
- Department of Dermatology and Allergy, Charité, Humboldt University Medical School, Berlin, Germany.
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35
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Gellrich S, Wilks A, Lukowsky A, Wernicke M, Müller A, Marcus Muche J, Fischer T, Jasch KC, Audring H, Sterry W. T cell receptor-gamma gene analysis of CD30+ large atypical individual cells in CD30+ large primary cutaneous T cell lymphomas. J Invest Dermatol 2003; 120:670-5. [PMID: 12648233 DOI: 10.1046/j.1523-1747.2003.12101.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The hallmark of primary cutaneous CD30+ large T cell lymphoma are large lymphoid tumor cells, at least 75% of which, by definition, must be positive for CD30. The relatively benign clinical course of this lymphoma type has been explained with CD30-induced apoptosis, on the assumption that expression of CD30 defines the tumor clone; however, this hypothesis has not been tested on the molecular level to date. In this study we analyzed CD30+ cells in four patients with primary cutaneous CD30+ large T cell lymphoma by single cell polymerase chain reaction of T cell receptor-gamma genes followed by sequencing. Here, we demonstrate that most of the large CD30+ atypical cells possessed identical T cell receptor-gamma gene rearrangements, indicative of clonal proliferation. Nevertheless, polyclonally rearranged T cells were present in all CD30+ samples studied. In addition, one patient showed a second clone in a separate biopsy and three of four patients showed chromosomal imbalances as revealed by comparative genomic hybridization. Taken together, our data suggest that the CD30+ population in primary cutaneous CD30+ large T cell lymphoma indeed contains the tumor clone, thus providing molecular support for a link between clinical course and CD30-related signaling. Importantly, however, CD30 expression does not define the tumor clone as bystander T cells, as well as occasional additional clones, are also present in this population.
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MESH Headings
- Adult
- Aged
- Apoptosis
- Clone Cells
- Female
- Gene Rearrangement, T-Lymphocyte/genetics
- Humans
- Ki-1 Antigen/analysis
- Lymphoma, T-Cell, Cutaneous/chemistry
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Middle Aged
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Skin Neoplasms/chemistry
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
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Affiliation(s)
- Sylke Gellrich
- Department of Dermatology, Medical Faculty (Charité), Humboldt-University, Berlin, Germany.
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36
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Gellrich S, Zuberbier T. [Added information and corrections on the continuing education section "Indoor allergens"]. Hautarzt 2002; 53:292. [PMID: 12053700 DOI: 10.1007/s00105-002-0362-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Gellrich S, Rutz S, Golembowski S, Jacobs C, von Zimmermann M, Lorenz P, Audring H, Muche M, Sterry W, Jahn S. Primary cutaneous follicle center cell lymphomas and large B cell lymphomas of the leg descend from germinal center cells. A single cell polymerase chain reaction analysis. J Invest Dermatol 2001; 117:1512-20. [PMID: 11886516 DOI: 10.1046/j.0022-202x.2001.01543.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary cutaneous B cell lymphomas are defined as non-Hodgkin lymphomas that occur in the skin without extracutaneous involvement for 6 mo after diagnosis. They are characterized by a less aggressive course and better prognosis than their nodal counterparts. According to the European Organization for Research and Treatment of Cancer classification, the major subentities of primary cutaneous B cell lymphoma are follicle center cell lymphomas, immunocytomas, and large B cell lymphomas of the leg, which differ considerably regarding their clinical behavior, the former two being indolent, the latter being of intermediate malignancy. In this study, we applied a single cell polymerase chain reaction approach to analyze immunoglobulin V(H)/V(L) genes in 532 individual B lymphocytes from histologic sections of four follicle center cell lymphomas localized on the head and trunk, and four large B cell lymphomas on the leg. We found: (i) in six of eight patients a clonal heavy chain, and in seven of eight patients a clonal light chain rearrangement, all being potentially productive; (ii) no bias in VH gene usage, in four of seven light chain rearrangements the V kappa germline gene IGVK3-20*1 was used; (iii) no biallelic rearrangements; (iv) all V(H)/V(L) genes are extensively mutated (mutation rate 5.4-16.3%); (v) intraclonal diversity in six of eight cases (three of each group); and (vi) low replacement vs silent mutation ratios in framework regions indicating preservation of antigen-receptor structure, as in normal B cells selected for antibody expression. Our data indicate a germinal center cell origin of primary cutaneous follicle center cell lymphomas and large B cell lymphomas independent of those belonging to one of these subentities.
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Affiliation(s)
- S Gellrich
- Department of Dermatology, Medical Faculty (Charité), Humboldt University, Berlin, Germany.
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38
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Hombach A, Muche JM, Gerken M, Gellrich S, Heuser C, Pohl C, Sterry W, Abken H. T cells engrafted with a recombinant anti-CD30 receptor target autologous CD30(+) cutaneous lymphoma cells. Gene Ther 2001; 8:891-5. [PMID: 11423937 DOI: 10.1038/sj.gt.3301467] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2000] [Accepted: 03/19/2001] [Indexed: 11/09/2022]
Abstract
T cells can be directed to antigen-specific, MHC-independent target cell lysis by grafting with a recombinant receptor with antibody-like specificity. Here, we asked whether T cells from the peripheral blood of a patient with cutaneous T cell lymphoma can be recruited for an immune response against autologous tumor cells. Lymphoma cells with a CD3(-) CD4(+) CD30(+) phenotype and clonal TCR-Vbeta7 rearrangement were isolated from a cutaneous lesion. The lymphoma lesion additionally harbored CD3(+) CD25(+) activated normal T cells despite ongoing tumor progression. Peripheral blood-derived T cells from the lymphoma patient were retrovirally engrafted with a recombinant anti-CD30-scFv-gamma receptor. Upon cocultivation with autologous CD30(+)lymphoma cells, grafted T cells increase IFN-gamma secretion and lyse specifically lymphoma cells with high efficiency, even at an effector to target cell ratio of as low as 1:20. Our data demonstrate that the recombinant anti-CD30-gamma receptor overcomes T cell tolerance for tumor cells and directs T cells specifically against autologous lymphoma cells.
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MESH Headings
- Adult
- Cell Separation
- Coculture Techniques
- Flow Cytometry
- Gene Rearrangement, beta-Chain T-Cell Antigen Receptor
- Genetic Therapy/methods
- Genetic Vectors/administration & dosage
- Humans
- Immunotherapy, Adoptive/methods
- Ki-1 Antigen
- Lymphocyte Activation
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/therapy
- Male
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Recombinant Proteins/genetics
- Retroviridae/genetics
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Transduction, Genetic
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Affiliation(s)
- A Hombach
- Department I of Internal Medicine, Laboratory Tumor Genetics, University of Cologne, Germany
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39
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Gellrich S, Muche JM, Pelzer K, Audring H, Sterry W. [Anti-CD20 antibodies in primary cutaneous B-cell lymphoma. Initial results in dermatologic patients]. Hautarzt 2001; 52:205-10. [PMID: 11284065 DOI: 10.1007/s001050051291] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Primary cutaneous B cell lymphomas (pCBCL) are rare extra-cutaneous non-Hodgkin lymphomas which occur on the trunk as follicle center cell lymphoma or on the leg as large B cell lymphoma. The currently accepted therapy of pCBCL (excision and/or radiotherapy, systemic interleukin 2 and interferon alpha 2a, local injection of cisplatin or multiagent chemotherapy, i.e. CHOP) is insufficient for treatment of multifocal pCBCL and secondary extracutaneous involvement. For this reason, the new synthetic chimeric, monoclonal anti-CD20 antibody Rituximab is an alternative treatment for patients with pCBCL. PATIENTS/METHODS Four patients with pCBCL localized to the trunk or head were treated with Rituximab (375 mg/kg weekly for 4-8 weeks, then maintenance therapy every 4 weeks for 6 months). RESULTS All 4 patients showed a response (2/4 partial; 2/4 complete). Side effects were minimal. CONCLUSIONS Rituximab is an alternative immunotherapeutic drug for the treatment of pCBCL. Our initial experience with this new modality are presented and discussed.
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Affiliation(s)
- S Gellrich
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie mit Asthmapoliklinik, Schumannstrasse 20/21, 10117 Berlin.
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40
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Linnemann T, Tumenjargal S, Gellrich S, Wiesmüller K, Kaltoft K, Sterry W, Walden P. Mimotopes for tumor-specific T lymphocytes in human cancer determined with combinatorial peptide libraries. Eur J Immunol 2001; 31:156-65. [PMID: 11169449 DOI: 10.1002/1521-4141(200101)31:1<156::aid-immu156>3.0.co;2-p] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mimotopes of a tumor-associated T cell epitope were determined using randomized and combinatorial peptide libraries and a CD8(+) T cell clone specific for the cutaneous T cell lymphoma cell line MyLa. Antigen recognition by this clone was found to be HLA-B8 restricted. More than 80 % of HLA-matched patients with cutaneous T cell lymphoma had mimotope-specific CD8(+) T cells in their peripheral blood. Mimotope-specific T cells isolated and expanded from a patient lysed MyLa cells in in vitro assays thus demonstrating their cytolytic capacity and tumor specificity. Mimotope vaccination of a patient without detectable mimotope-specific T cells induced frequencies of these cells of up to 1.82 % of the peripheral blood CD8(+) T cells.
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Affiliation(s)
- T Linnemann
- Department of Dermatology and Allergy, Charité, Humboldt University, Berlin, Germany.
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41
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Gellrich S, Lukowsky A, Schilling T, Rutz S, Muche JM, Jahn S, Audring H, Sterry W. Microanatomical compartments of clonal and reactive T cells in mycosis fungoides: molecular demonstration by single cell polymerase chain reaction of T cell receptor gene rearrangements. J Invest Dermatol 2000; 115:620-4. [PMID: 10998133 DOI: 10.1046/j.1523-1747.2000.00980.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mycosis fungoides (MF) is a cutaneous T cell lymphoma, clinically characterized by patches, plaques and tumors occurring in successive stages of the disease. In early MF, an infiltrate consisting of mainly reactive T cells is seen in the papillary dermis while tumor cells are mostly confined to the epidermis. By contrast, later stages show nodular infiltrates formed mostly of tumor cells in the dermis while the epidermis is relatively devoid of tumor cells; however, knowledge of the localization of clonal T cells has been based on histomorphologic features and immunohistochemical stainings visualizing certain V-beta subfamilies of the T cell receptor (TCR). As these techniques do not allow for an unequivocal identification of clonal tumor cells, we used micromanipulation and single cell PCR amplifying the TCR chain gene rearrangement. A total number of 387 single T cells was isolated from six skin biopsies in five patients in patch, plaque, and tumor stages. Of these, 180 T cells were picked from the epidermis and 207 from the dermal infiltrate. The rearranged TCR-gamma DNA could be sequenced from 181 of 387 T cells. In three of six patients representing all three stages, epidermal T cells with a clonal rearrangement could be amplified. In early plaque stage a higher degree of epidermal T lymphocytes was found than in initial patch, later plaque, and tumor stages with an inverse distribution found for reactive T lymphocytes. In two patients a biallelic rearrangement was demonstrated that had not been detected in prior PCR analysis from blood and skin samples. These data show that clonal (neoplastic) and non-clonal (reactive) T lymphocytes in MF preferentially infiltrate different microanatomical compartments of the skin, depending on the stage of disease. The microanatomically distinct localization of reactive and clonal T cells suggests that the absence of direct contact between tumor and host-defense lymphocytes may contribute to tumor persistence and progression in epidermis, peripheral blood, and deep dermal tumor cell nests, respectively.
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Affiliation(s)
- S Gellrich
- Department of Dermatology, Medical Faculty (Charité), Humboldt-University Berlin, Germany.
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42
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Muche JM, Lukowsky A, Ahnhudt C, Gellrich S, Sterry W. Peripheral blood T cell clonality in mycosis fungoides -an independent prognostic marker? J Invest Dermatol 2000; 115:504-5. [PMID: 10951290 DOI: 10.1046/j.1523-1747.2000.00088.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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43
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Asadullah K, Haeussler-Quade A, Gellrich S, Hanneken S, Hansen-Hagge TE, Döcke WD, Volk HD, Sterry W. IL-15 and IL-16 overexpression in cutaneous T-cell lymphomas: stage-dependent increase in mycosis fungoides progression. Exp Dermatol 2000; 9:248-51. [PMID: 10949545 DOI: 10.1034/j.1600-0625.2000.009004248.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cytokines are of major importance for the pathogenesis of cutaneous T-cell lymphomas (CTCL). Recent data suggested that IL-15 and IL-16 are survival/growth factors for the malignant T cells in these entities. To investigate the expression of IL-15 and IL-16 in mycosis fungoides (MF) and CD30+ pleomorphic T-cell lymphoma in vivo, we established a competitive RT-PCR technique. Analyzing skin biopsies from CTCL patients at different stages in comparison to psoriatic and healthy skin, we found IL-15 and IL-16 mRNA overexpression in both CTCL entities. Remarkably, there was some evidence for a stage-dependent increase during MF progression. We found only slight overexpression in early stage MF, when only few tumor cells are detectable within the infiltrates, whereas marked overexpression was found in more advanced lesions, which are characterized by a higher density of malignant cells. These results suggested that CTCL cells themselves might produce the cytokines. To further elucidate this hypothesis, two CTCL cell lines were analyzed but gave conflicting results. Therefore, the cellular origin of the IL-15 and IL-16 overexpression in CTCL remains unclear. Considering the significant overexpression of IL-15 and IL-16 and their biological capacities it is likely that these cytokines contribute to the tumor development. So, they might be involved in growth and skin homing of CTCL cells.
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MESH Headings
- Adult
- Base Sequence
- Case-Control Studies
- DNA Primers/genetics
- Gene Expression
- Humans
- Interleukin-15/genetics
- Interleukin-15/metabolism
- Interleukin-16/genetics
- Interleukin-16/metabolism
- Ki-1 Antigen/metabolism
- Lymphoma, T-Cell, Cutaneous/etiology
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Mycosis Fungoides/immunology
- Psoriasis/immunology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- RNA, Neoplasm/genetics
- RNA, Neoplasm/metabolism
- Skin Neoplasms/etiology
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
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Affiliation(s)
- K Asadullah
- Department of Dermatology, University Hospital, Charité, Berlin Humboldt University, Germany
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44
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Abstract
Primary cutaneous T-cell lymphomas (CTCL), representing a heterogeneous group of non-Hodgkin's lymphomas (NHL), can be defined as clonal proliferation of skin-infiltrating T lymphocytes primarily presenting in the cutaneous compartment. They show a considerable variation in clinical presentation, histology, immunophenotype, and prognosis, which is best reflected by the proposal of the Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer (EORTC). Due to the heterogeneity of CTCL and the lack of curative therapy regimens, multiple strategies have been proposed for the management of the different CTCL entities. This includes topical application of corticosteroids, nitrogen mustard or carmustine (BCNU), radiotherapy, including total skin electron beam irradiation, photo(chemo)therapy, biological response modifiers, cytostatic chemotherapy, and combined regimens. More recently, fusion proteins and peptide vaccines have been introduced in the management of CTCL. Classification, staging, and treatment modalities are discussed in detail and summarized in a stage-adapted therapy regimen for CTCL.
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MESH Headings
- Adjuvants, Immunologic/therapeutic use
- Administration, Topical
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cancer Vaccines/therapeutic use
- Carmustine/administration & dosage
- Combined Modality Therapy
- Glucocorticoids/administration & dosage
- Humans
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/radiotherapy
- Lymphoma, T-Cell, Cutaneous/therapy
- Mechlorethamine/administration & dosage
- Phototherapy/methods
- Radiotherapy/methods
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Affiliation(s)
- J M Muche
- Department of Dermatology and Allergy, Charité Berlin, Germany
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45
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46
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47
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Linnemann T, Wiesmüller KH, Gellrich S, Kaltoft K, Sterry W, Walden P. A T-cell epitope determined with random peptide libraries and combinatorial peptide chemistry stimulates T cells specific for cutaneous T-cell lymphoma. Ann Oncol 2000; 11 Suppl 1:95-9. [PMID: 10707788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Mycosis fungoides is the most frequent T-cell lymphoma of the skin. Despite numerous attempts, no tumour antigens have yet been identified. Only in one case has an idiotype-derived peptide been found to trigger CTL of the respective patient. The identification of natural antigens requires the cultivation of large amounts of tumour cells in vitro, which has been possible in two exceptional cases. The identification of synthetic epitopes for tumour-specific CTL with random peptide libraries can overcome this limitation and is a powerful tool for application in the development of immune therapies for a wide range of patients. MATERIALS AND METHODS The critical amino acids for the construction of epitopes for the CTCL-specific CTL clone My-La CTL were determined with synthetic peptide libraries in positional scanning OX8 format in a standard 61chromium release assay. Sixteen different peptides could be synthesized from the combinatoric of these amino acids with the canonical anchor amino acids for MHC binding. These peptides were tested for their capacity to stimulate My-La CTL and PBMC of an HLA-matched CTCL patient. RESULTS A synthetic epitope could be identified for My-La CTL, which was recognized in a HLA-restricted manner. The response towards this epitope was comparable to the response towards their natural target My-La. Using these synthetic epitopes, T cells of a HLA-matched patient could be induced in vitro and led to the establishment of different cell lines and clones. Some of these lines recognized the peptides as well as the allogenic but HLA-matched tumour cell line My-La, indicating that they are specific for a naturally expressed tumour antigen. CONCLUSIONS The identification of synthetic epitopes for tumour-specific CTL clones can be used for the development of vaccines for immune therapies of cancer; such peptides can be applied inter-individually. Synthetic epitopes must not correspond to the natural ones, but they can be even more potent as stimulation of specific T cells and can be fine-tuned to increase the success of the therapy.
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MESH Headings
- Antigens, Differentiation, T-Lymphocyte/analysis
- Cells, Cultured
- Combinatorial Chemistry Techniques
- Epitopes, T-Lymphocyte/analysis
- Female
- Humans
- Immunotherapy
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/therapy
- Male
- Mycosis Fungoides/immunology
- Peptide Library
- Reference Values
- Sensitivity and Specificity
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Affiliation(s)
- T Linnemann
- Department of Dermatology, Medical Faculty Charité, Humboldt University, Berlin, Germany
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48
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Golembowski S, Gellrich S, von Zimmermann M, Rutz S, Lippert S, Audring H, Lorenz P, Sterry W, Jahn S. Clonal evolution in a primary cutaneous follicle center B cell lymphoma revealed by single cell analysis in sequential biopsies. Immunobiology 2000; 201:631-44. [PMID: 10834319 DOI: 10.1016/s0171-2985(00)80080-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
B cell neoplasias descending from germinal center cells harbor the hallmark of intraclonal diversity resulting from ongoing mutation in the variable parts of their immunoglobulin-encoding genes. To characterize a primary cutaneous follicle center B cell lymphoma in more detail, we analyzed the respective VH and VL genes in single cells mobilized from four sequential biopsies, three taken from the skin and one obtained after internal dissemination from a retrobulbar infiltrate. The lymphoma cells were found to contain V5-51/D6-12/JH5b (heavy chain) and A27/Jkappa2 (light chain) gene rearrangements detected on both the genomic and the transcriptional level. To provide an accurate mutation analysis, the specific VH gene counterpart (V5-51UK) was cloned from the patient's germline. Analyzing 226 single cells, we found: (i) complete nucleotide identity when VH and VL genes of lymphoma cells from one particular biopsy were compared among each other; (ii) intraclonal diversity due to ongoing mutation comparing the sequences obtained from sequential biopsies; (iii) both VH and VL genes to be highly mutated. Deducing from the sequence data, we propose a scenario of the clonal evolution of the B cell tumor in this patient. From the molecular-biological point of view, this primary cutaneous follicle center B cell lymphoma shows the features of a germinal center cell lymphoma. To draw this conclusion from single cell PCR data, however, a sample of sequential biopsies had to be analyzed.
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Affiliation(s)
- S Golembowski
- Department of Dermatology, Medical Faculty (Charité), Humboldt University, Berlin, Germany
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Abstract
Physiologically, B-lymphocytes are not present in the skin. Even in pathological situations they rarely occur. In contrast, primary cutaneous B-cell lymphomas (CBCL) are characterized by proliferation of B lymphocytes within the skin. This suggests the existence of a certain microenvironment supporting homing and expansion of clonal B cells. Cytokines were demonstrated to be involved in the pathogenesis of cutaneous lymphomas of T-cell origin. Cytokine expression in cutaneous B-cell lymphoma lesions, however, has not been investigated so far. Therefore, the mRNA level of several cytokines was analyzed in biopsies from 7 patients with CBCL and compared to pleomorphic T-cell lymphoma (n = 6), psoriasis (n = 9), and healthy skin (n = 7), using a competitive RT-PCR approach. An overexpression of TNF-alpha, IL-10, and IL-6 was found. Enhanced IL-8 mRNA expression was detected in 2/7 cases. The overexpression of IL-6 and IL-10 in CBCL might be of particular importance, since these cytokines are considered to support B-cell growth. Additionally, the overexpression of IL-10 may contribute to tumor progression since this immunosuppressive cytokine might be involved in downregulation of immunological tumor surveillance, in part by inhibiting type 1 cytokine formation. In fact, we did not detect IFN-gamma and IL-2 expression. Taken together, we found a cytokine pattern in CBCL lesions which might contribute to tumor B-cell growth.
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Affiliation(s)
- K Asadullah
- Department of Dermatology, Medical School Charité, Humboldt University Berlin, Germany
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50
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