Sydney Kimmel Cancer Center, Johns Hopkins Medical Institutions, Tucson, AZ.
Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD.
Clin Lymphoma Myeloma Leuk. 2021 Apr;21(4):279-288.e7. doi: 10.1016/j.clml.2020.11.007. Epub 2020 Nov 12.
A recent serologic study and reports of increased serum total IgE (IgE-t) and eosinophil counts have suggested that the prevalence of atopy is more common in patients with mycosis fungoides (MF) than previously recognized.
Patients with clinicopathologic features that were diagnostic and/or consistent with MF and/or the presence or absence of an atopic disorder (eg, allergic rhinitis, asthma, eczematous dermatitis), which was determined by patient history, eosinophil counts, and serum IgE-t obtained at evaluation, were selected from a patient registry. The MF population was divided into those with atypical and typical clinical presentations. We performed matching of controls using age, sex, and race from the 2005 to 2006 National Health Education Survey.
A history of allergic rhinitis was recorded for 186 of 728 patients (25.5%) with typical MF and 71 of 229 patients (31%) with atypical MF. However, the prevalence of asthma and eczema was low. The IgE-t and eosinophil counts were higher for patients with typical MF than for controls and for patients with atopic diathesis than for patients without atopy. The IgE-t and eosinophil counts were higher for the patients with advanced-stage MF compared with those for the patients with less-advanced disease for both atopic and nonatopic cohorts. In the Cox model with age and clinical stage as covariates, a history of atopy, increased IgE-t, and blood eosinophilia (> 500 cells/mm3) did not correlate with overall survival.
The findings from the present study did not reveal a significant association of atopy in patients with MF. However, atopy is a factor in the increased IgE-t and eosinophil counts observed in MF. Another factor is related to the disease stage, including possibly the influence of cytokines secreted by T-helper type 2-polarized neoplastic cells.
最近的一项血清学研究以及血清总 IgE（IgE-t）和嗜酸性粒细胞计数增加的报告表明，蕈样肉芽肿（MF）患者的过敏症患病率比以前认识到的更为常见。
从患者登记处选择了具有诊断和/或符合 MF 的临床病理特征的患者，以及存在或不存在特应性疾病（例如过敏性鼻炎、哮喘、湿疹性皮炎）的患者，这些疾病是通过病史、评估时获得的嗜酸性粒细胞计数和血清 IgE-t 确定的。MF 人群分为具有典型和非典型临床表现的人群。我们使用 2005 年至 2006 年国家健康教育调查的年龄、性别和种族对对照组进行了匹配。
186 例典型 MF 患者（25.5%）和 71 例非典型 MF 患者（31%）有过敏性鼻炎病史。但是，哮喘和湿疹的患病率较低。典型 MF 患者的 IgE-t 和嗜酸性粒细胞计数高于对照组，特应性患者的 IgE-t 和嗜酸性粒细胞计数高于非特应性患者。与非特应性患者相比，晚期 MF 患者的 IgE-t 和嗜酸性粒细胞计数高于疾病进展较轻的患者。在年龄和临床分期为协变量的 Cox 模型中，特应性病史、IgE-t 升高和嗜酸性粒细胞增多（>500 个细胞/mm3）与总生存无关。
本研究的结果并未显示 MF 患者过敏症存在显著相关性。然而，特应性是 MF 中观察到的 IgE-t 和嗜酸性粒细胞计数增加的一个因素。另一个因素与疾病阶段有关，包括可能与 T 辅助细胞 2 极化肿瘤细胞分泌的细胞因子有关。
