Detection of Mature T-Cell Leukemias by Flow Cytometry Using Anti-T-Cell Receptor V b Antibodies

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Abstract
A broad array of antibodies directed against the variable (V) region of the T-cell receptor (TCR) β(Vβ) chain has become available in a directly conjugated multicolor format that permits assessment of 19 of 25 Vβfamilies, covering 70% of the normal circulating T-cell repertoire. These antibodies were used to detect expanded T-cell populations in 43 peripheral blood samples submitted for suspected T-cell malignancy. Of 43 samples, 27 were diagnosed as follows: T-cell large granular lymphocyte leukemia, 14 samples; Sézary syndrome, 4 samples; T-cell prolymphocytic leukemia, 5 samples; or T-cell non-Hodgkin lymphoma or T-cell lymphoproliferative disorder not otherwise specified, 4 samples. The remaining 16 samples were determined to be nonneoplastic. All samples were diagnosed before assessment with anti-Vβflow cytometry. By using a cutoff of 1.6 times the upper limit of normal range (ULN) to define malignant restriction of Vβuse, pathologic restriction of Vβuse was found directly or indirectly in all 27 samples carrying a diagnosis of malignancy and directly in 2 of 16 samples without a diagnosis of malignancy. TCR gene rearrangement studies were used to confirm Vβflow cytometry results. By using a cutoff of 1.6 times the ULN for the detection of malignancy, the antibody panel had a diagnostic sensitivity of 89% for direct detection of pathologic Vβrestriction and a specificity of 88%, making it useful for rapid diagnosis of T-cell leukemia.

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