A J Woolford

Absence of the t(14;18) chromosomal translocation in primary cutaneous B-cell lymphoma.

Background The t(14;18)(q32;q21) chromosomal translocation is found in the majority of nodal follicular lymphomas and in a lower percentage of systemic high‐grade diffuse large B‐cell lymphomas. The translocation results in the juxtaposition of the bcl‐2 gene on chromosome 18 with the immunoglobulin heavy chain joining region on chromosome 14. Bcl‐2 protein prevents apoptosis and the translocation leads to overexpression of a functionally normal Bcl‐2 protein that prevents apoptosis of neoplastic cells.

CD8‐positive juvenile onset mycosis fungoides: an immunohistochemical and genotypic analysis of six cases

Background Childhood cases of cytotoxic T‐cell lymphoma have not been well described.

T‐cell depletion and autologous stem cell transplantation in the management of tumour stage mycosis fungoides with peripheral blood involvement

Nine patients with tumour stage mycosis fungoides (MF) have been entered into a pilot study of T‐cell depletion and autologous stem cell transplantation (SCT). Eight patients had detectable rearrangements of the T‐cell receptor (TCR) γ‐gene demonstrated by polymerase chain reaction (PCR)/single‐stranded conformation polymorphism (SSCP) in the peripheral blood. The median age was 47 years and the median duration of disease before SCT was 61 months; Peripheral blood progenitor cells were mobilized using high‐dose etoposide (1·6 g/m2) and granulocyte colony‐stimulating factor (G‐CSF). The apheresis products underwent rigorous T‐cell depletion with immunomagnetic methods. Double CD34‐positive and CD4/CD8‐negative selection achieved a median reduction of 3·89 log of T cells. All nine patients have been transplanted. Conditioning included carmustine (BCNU), etoposide and melphalan (BEM) in seven patients and total body irradiation plus etoposide or melphalan in two. Eight patients engrafted promptly and one patient died of septicaemia. All survivors entered complete remission. Seven patients have relapsed at a median of 7 months (2–14) post SCT. However, most patients have relapsed into a less aggressive stage, which has responded to conventional therapy. Four out of seven evaluable patients had detectable TCR rearrangements in the T‐cell depleted graft. A T‐cell clone was also detected in the peripheral blood before relapse in four cases. Autologous SCT is feasible, safe and can result in complete remission in a significant proportion of patients with tumour stage mycosis fungoides. Despite a short relapse‐free survival, most patients achieved good disease control at the time of relapse.

Rituximab in cutaneous B-cell lymphoma: a report of two cases

We report two patients with primary cutaneous B‐cell lymphoma who were treated with rituximab, a new anti‐CD20 monoclonal antibody. The first patient, who had a diffuse large B‐cell lymphoma of the lower leg, achieved an 85% improvement. The second patient, who had a primary cutaneous B‐cell lymphoma, which had undergone high‐grade transformation and systemic spread, achieved a minor response of approximately 30%. Both patients subsequently relapsed. The first patient achieved complete clearance with a second course of rituximab given with systemic chemotherapy, but again relapsed. Treatment with rituximab has been reported to produce response rates of 48% in relapsed systemic low‐grade or follicular lymphoma, but there are no previous reports of the use of rituximab in primary cutaneous B‐cell lymphoma.