The course of mycosis fungoides (MF) is indolent except when transformation
to a large T-cell lymphoma occurs. The diagnosis of transformed MF (T-MF)
relies on the presence of more than 25% of large cells on biopsy of an MF l
esion. We analyzed 45 patients with T-MF recorded by the French Study Group
on Cutaneous Lymphomas to better determine clinicopathological features of
MF transformation and to analyze their impact on prognosis. Median time fr
om diagnosis of MF to transformation was 6.5 years, Extracutaneous progress
ion was present in 20 patients. Mean survival from transformation to death
was 22 months. In univariate analysis, only an extracutaneous progression w
as associated with a worse prognosis (5-year actuarial survival: 7.8% versu
s 32%), Neither sex, age, clinical and skin disease stage at transformation
, transformation speed, nor percentage of large cells or CD30 expression (1
4 of 45) had a prognostic value. When performing multivariate analysis, age
(at least 60 years), and extracutaneous spreading were found to be associa
ted with a poor prognosis. There was no difference between survival curves
of patients with T-MF and with pleomorphic large T-cell CD30- lymphomas, Th
e main diagnostic pitfall was "histiocytic-rich" MF, requiring CD68 stainin
g for the diagnosis of T-MF, Out of 45 patients, 6 presented an histologic
transformation before clinical progression, suggesting that an early histop
athological diagnosis may be performed by histological followup. The progno
stic value of such early histopathological diagnosis must be confirmed by p
rospective studies, (Blood, 2000;95:2212-2218) (C) 2000 by The American Soc
iety of Hematology.