%0 Journal Article
%T Prognostic Implications of Blood B Ratings for Erythrodermic Cutaneous T cell Lymphoma
%A Eric C. Vonderheid
%J Open Journal of Immunology
%D 2018
%R 10.4172/2155-9554.1000452
%X Objective: The magnitude of blood involvement in cutaneous T cell lymphoma (CTCL) has prognostic significance. Several groups have proposed hematologic criteria for B ratings for use in clinical staging of CTCL, but in practice B ratings are only relevant for the staging of erythrodermic CTCL without lymph node or visceral involvement, i.e., T4N0-2M0B0 defines sub-stage IIIA, T4N0-2M0B1 defines sub-stage IIIB and T4N0-2M0B2 defines sub-stage IVA1. This retrospective study examines the effect of various B rating criteria on prognoses of patients with erythrodermic CTCL.

Methods: At initial presentation, 152 patients diagnosed with E-CTCL had quantitative S¨¦zary cell counts performed on blood smears and CD4+/CD8- ratios determined in the blood by flow cytometry. In addition, 39 patients had percentages of CD4+CD26- and CD4+CD7- lymphocytes directly measured. The Kaplan-Meier method and Cox proportional hazards model were used to estimate mean overall and CTCL-specific survival and to compare survival curves of sub-stages of erythrodermic CTCL.

Results: With B2 rating defined as absolute S¨¦zary cell counts ¡Ý 1.0 K/¦ÌL or CD4+/CD8- ratio ¡Ý 10, a better separation of survival curves between sub-stages IIIA and IIIB was observed if the threshold for B1 was defined as S¨¦zary cells ¡Ý 20% and CD4+/CD8- ratio defined as ¡Ý 4 plus confirmation of blood involvement. With either criterion, the survival of patients at sub-stages IVA1 and IVA2 were not statistically different. There was also a suggestion that percentage of CD4+CD26- or CD4+CD7- cells (which ever was higher) might be used to define B1 and B2 thresholds (¡Ý 30% and ¡Ý 60%, respectively) as an alternative to absolute counts. Maximum CD4+CD26-/CD4+CD7- ¡Ý 30% plus confirmation also might provide a hematologic definition of leukemic CTCL.

Conclusion: Additional studies on larger number of patients and evaluation with other measures of blood tumor burden are indicated.
%K Eric C. Vonderheid
%K Cutaneous lymphoma
%K Erythroderma
%K B rating
%K Prognosis
%K Survival
%U https://www.longdom.org/abstract/prognostic-implications-of-blood-b-ratings-for-erythrodermic-cutaneous-t-cell-lymphoma-17486.html