THE PROGNOSTIC-SIGNIFICANCE OF DELAYED-HYPERSENSITIVITY TO DINITROCHLOROBENZENE AND MECHLORETHAMINE HYDROCHLORIDE IN CUTANEOUS T-CELL LYMPHOMA

Recent studies suggest that cells elaborating type 1 cytokines are imp ortant mediators of anti-tumor cell-mediated immunity in cutaneous T c ell lymphoma. Type 1 cell-mediated immune responsiveness was assessed in 276 patients with cutaneous T cell lymphoma (mycosis fungoides and Sezary syndrome) using 2,4-dinitrochlorobenzene (DNCB) skin testing as part of the initial evaluation. The overall rate of sensitization aft er one and two DNCB challenges was 32% and 67%, respectively, which is much decreased compared with the expected rate of more than 95% for n ormal individuals. Moreover, the frequency of DNCB sensitization and a llergic contact dermatitis to topically applied mechlorethamine decrea sed with advancing stage of disease. In addition to the expected stron g correlation with stage, we observed that patients who were DNCB test positive were significantly less likely to experience disease progres sion and had a better overall prognosis compared with DNCB-negative pa tients. These results support the concept that cell-mediated responses are important in cutaneous T cell lymphoma, and that augmentation of these responses would be therapeutically beneficial.