Clonal heterogeneity in XXXX and its relationship to clinical course.

@entity4888 @entity1 @entity784 @entity66
@entity4888 ( @entity4888 ) is a @entity784 characterized by multifocal disease and protracted clinical course. The few studies that have assessed T-cell receptor (TCR) gene rearrangements (GRs) present at different anatomic sites in @entity4888 have generally reported a common clone. We used a previously validated 4-color polymerase chain reaction (PCR) assay to assess the size and V-family usage of TCR-gamma GRs in 102 concurrent and/or sequential morphologically involved biopsy specimens (91 skin and 11 lymph nodes) from 39 @entity4888 @entity1 . This assay detected TCR-gamma clonal GRs in 89 samples (87%) from 36 @entity1 (92%). In 24 @entity1 (77%), an identical clonal GR was present in at least 2 skin samples. However, in one third of these @entity1 , additional different clonal GRs were also noted. Four @entity1 (13%) had clonal GRs that were distinct in different skin samples. In 3 @entity1 (10%), no GR was detected in any sample. In a comparison of lymph node and skin samples, 8 @entity1 had the identical clonal GRs at both sites, 2 @entity1 had different clonal GRs, and 1 @entity1 had no GR identified at either site. Independent of clinical stage, @entity1 who had the same GR detected in multiple concurrent biopsy specimens at the time of diagnosis were more likely to have progressive disease than those who had different GRs (P =.04). Four-color TCR-gamma PCR analysis can uncover multiple distinct clonal GRs in different samples consistent with multiclonal or @entity66 in a significant proportion of @entity4888 @entity1 . Demonstration of identical clonal GRs in multiple biopsy specimens at the time of diagnosis may provide prognostic information related to disease progression.
