CLINICAL AND LABORATORY INVESTIGATIONS BJD British Journal of Dermatology Serum and tissue CTACK ⁄ CCL27 chemokine levels in early mycosis fungoides may be correlated with disease-free survival following treatment with interferon alfa and psoralen plus ultraviolet A therapy G. Goteri, S. Rupoli,* A. Campanati, A. Zizzi, P. Picardi,* M. Cardelli,à F. Giantomassi, L. Canafoglia,* F. Marchegiani,à G. Mozzicafreddo,§ G. Brandozzi, D. Stramazzotti, G. Ganzetti, R. Lisa,à O. Simonetti,  A. Offidani, I. Federici,* G. Filosa– and P. Leoni* Anatomic Pathology, *Hematology Clinic,  Dermatological Clinic, Ancona Hospital, Polytechnic Marche University, Via Conca 71, Ancona 60020, Italy àAdvanced Technology Center for Aging Research, Scientific Technological Area and Scientific Direction, §Division of Dermatology, I.N.R.C.A-I.R.C.C.S., Ancona, Italy –Division of Dermatology, Murri Hospital, Jesi, Italy Correspondence Gaia Goteri. Anatomic Pathology, Ancona Hospital, Polytechnic Marche University, via Conca 71, Ancona 60020 Italy E-mail: g.goteri@univpm.it Accepted for publication 20 December 2011 Funding sources The study was partly supported by AIL Onlus (Italian Leukemia, Lymphoma and Myeloma Association), Ancona section. Conflicts of interest None declared. DOI 10.1111/j.1365-2133.2012.10818.x Summary Background Neoplastic T-cell recruitment into the skin is a critical step in the pathogenesis of mycosis fungoides (MF), and the cutaneous T-cell attracting chemokine, CTACK ⁄ CCL27, might be involved. Objectives To investigate the clinical and prognostic significance of CTACK ⁄ CCL27 levels in patients with early-stage MF. Methods Serum samples and skin biopsy specimens were collected from 15 patients at the time of diagnosis and after the end of treatment with psoralen plus ultra- violet A ⁄ interferon alfa-2b combination therapy. Serum samples were also col- lected from 20 healthy donors as controls. CTACK ⁄ CCL27 serum levels were analysed by enzyme-linked immunosorbent assays. CTACK ⁄ CCL27 tissue expres- sion was determined by immunohistochemistry on skin biopsy specimens taken at diagnosis and after therapy. Event-free survival was taken as the primary clinical outcome. Results In patients with MF at diagnosis, CTACK ⁄ CCL27 serum levels were not significantly different from healthy controls, whereas CTACK ⁄ CCL27 expression in the skin was increased in 87% of cases compared with normal controls. After therapy, all patients obtained a clinical complete remission, serum levels did not change significantly and tissue expression remained abnormal in 80% of patients, even if complete histological remission was recorded. Serum levels were not sig- nificantly different in cases with different intensity of cutaneous immunostaining. Eight patients experienced a relapse: the combination of high CTACK ⁄ CCL27 levels both in sera and skin increased the probability of experiencing an event at 51 months from 36% to 83%. Conclusions Our data seem to indicate that CTACK ⁄ CCL27 levels in skin and sera after therapy might be correlated with risk of recurrence. Mycosis fungoides (MF) is the most common form of cutane- ous T-cell lymphoma. Neoplastic T CD4+ lymphoid cell clonal expansion leads to a release of cytokines and growth factors that stimulate epidermal keratinocyte proliferation, resulting in skin thickening and ⁄ or scaling and inflammation in the epi- dermal and dermal compartments leading to erythema. 1 Several chemokines involved in the skin trafficking and T-cell survival have been implicated in the pathogenesis and progres- sion of these lymphomas. 2 They include thymus and activation-regulated chemokine (TARC ⁄ CCL17) and macro- phage-derived chemokine (MDC ⁄ CCL22), which bind to the CC chemokine receptor 4 (CCR4) on T helper (Th) 2 cells, the interferon-inducible protein-10 (IP10 ⁄ CXCL10), and the monokine induced by interferon-a (MIG ⁄ CXCL9), which bind to CXC chemokine receptor 3 (CXCR3) on Th1 cells. 3–13 Their pathogenetic role is influenced by the link to the correspond- ing receptors in lymphocyte populations, and it has been shown that chemokine production and receptor expression on Ó 2012 The Authors 948 BJD Ó 2012 British Association of Dermatologists 2012 166, pp948–952