Original Article Lesional skin chemokine ccl27/ctcak expression in mycosis fungoides and the disease control by therapy
Gaia Goteri, Serena Rupoli, Anna Campanati, Antonello Costagliola, Simona Sabato, Stramazzotti D, Paola Picardi, Lucia Canafoglia, Stefano Pulini, Anna Maria Offidani, Pietro Leoni
Anatomia Patologica, Clinica Ematologia and Clinica Dermatologica, Azienda Ospedaliera Ospedali Riuniti di Ancona/Università Politecnica delle Marche, Ancona, Italy; Dipartimento Ematologia, Ospedale Spirito Santo, Pescara, Italy
Received January, 2009; accepted January, 2009; available online January, 2009
Abstract: Recruitment of neoplastic T-cells in skin is a critical step in the pathogenesis of Mycosis Fungoides (MF) lesions. The chemokine CCL27 attracts memory T cells to the skin and an increased expression have been observed in MF patients compared to normal controls. The interactions between neoplastic cells and the skin immune system needs to be further elucidated. We investigated CCL27 expression and density of dendritic cells, CD8+ and CD4+ lymphocytes in skin lesions of 52 early stage-MF patients, 34 M/18 F, treated by PUVA plus interferon alpha. Immunohistochemistry was done on specimens obtained at diagnosis and after treatment. At diagnosis, CCL27 expression was abnormal/suprabasal in 36. A normal/basal CCL27 expression tended to be correlated with a high DC density and a low neoplastic infiltrate density. Treatment induced a significant CCL27 expression increase. During follow-up (median, 92.5 mo.s; range, 43-165), 33 patients relapsed (median EFS, 46 mo.s). A normal/basal CCL27 expression at the end of treatment, was correlated with a lower incidence of disease recurrence and a longer median EFS (111 mo.s vs 39 mo.s with suprabasal expression; log rank test: P=0.031). We conclude that increased CCL27 expression in early-stage MF lesions might be related to a balance between neoplastic cells and immunomodulant dendritic cells. A normal CCL27 expression after treatment designates a subset of patients with a favourable behaviour. The mechanisms involved in the increased CCL27 expression after therapy in the remaining patients, which have a higher probability to recur, need to be further investigated. (AJTR901010).