New tool predicts deadly form of rare cancer
Two patients with mycosis fungoides (MF) can appear to have identical diseases upon first diagnosis but can have radically different outcomes. MF in an unusual cancer of the T lymphocyte that begins in the skin rather than in the lymph nodes, with the first sign often being a rash. Most patients with MF, the most common type of cutaneous T cell lymphoma (CTCL), have a very slow-growing disease and often have normal life expectancies. But a subset of patients will develop an aggressive, deadly form of the disease that can spread throughout the skin and beyond, becoming untreatable. If identified early, patients with this aggressive form of MF may be eligible for a stem cell transplant to cure the disease, but once MF progresses and becomes treatment resistant, it is nearly impossible to achieve the complete remission required for a successful stem cell transplant.
A tool to accurately determine which early-stage patients are at risk of dying from MF and which patients are likely to only require conventional therapy is desperately needed. Investigators from Brigham and Women’s Hospital have found that next-generation, high-throughput sequencing of a specific gene (T-cell receptor beta or TCRB) is a stronger predictor of which early-stage patients will develop aggressive, progressive MF than any other established factor.
“We are excited to bring precision medicine to the management of MF patients,” said senior author Thomas Kupper, MD, chair of the BWH Department of Dermatology. “While more work needs to be done, we think this approach has the potential to prospectively identify a subgroup of patients who are destined to develop aggressive, life-threatening disease, and treat them in a more aggressive fashion with the intent to better manage, and ideally cure, their cancer.”
Brigham and Women’s Hospital