Circulating Low Absolute CD4+ T Cell Counts May Predict Poor Prognosis in Extranodal NK/T-Cell Lymphoma Patients Treating with Pegaspargase-Based Chemotherapy
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Purpose Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) is a rare subtype of non- Hodgkin lymphoma, and asparaginase-based regimens are the best first-line treatments. Data on the role of specific circulating lymphocyte subsets in the progression of ENKTL are limited. The aim of this study was to investigate the clinical correlation and distribution of circulating absolute CD4+ T-cell counts (ACD4Cs) in ENKTL. Materials and Methods We retrospectively searched medical records for 70 newly diagnosed ENKTL patients treated with pegaspargase-based regimens. Comparison of ACD4Cs as a continuous parameter in different groups was calculated. Univariate and multivariate analyses were used to assess prognostic factors for overall survival (OS) and progression-free survival (PFS). Results Stage III/IV, B symptoms, elevated lactate dehydrogenase, monocytopenia, high-intermediate and high risk International Prognostic Index (IPI) and Korean Prognostic Index (KPI), high risk Prognostic Index of Natural Killer Lymphoma (PINK), and lower lymphocytes were significantly associated with low ACD4C at diagnosis. With a median follow-up time of 32 months, patients who had an ACD4C < 0.30109/L had a worse OS. Median OS was 11 months and median PFS was 5 months in the low ACD4C cohort. There were significant differences in both OS and PFS between the two cohorts. Moreover, multivariate Cox analysis identified ACD4Cs as an independent predictor for OS and PFS. Conclusion Low ACD4Cs were associated with poorer survival and could act as a negative predictor for ENKTL patients treated with asparaginase-based regimens.
Abstract
Purpose Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) is a rare subtype of non- Hodgkin lymphoma, and asparaginase-based regimens are the best first-line treatments. Data on the role of specific circulating lymphocyte subsets in the progression of ENKTL are limited. The aim of this study was to investigate the clinical correlation and distribution of circulating absolute CD4+ T-cell counts (ACD4Cs) in ENKTL. Materials and Methods We retrospectively searched medical records for 70 newly diagnosed ENKTL patients treated with pegaspargase-based regimens. Comparison of ACD4Cs as a continuous parameter in different groups was calculated. Univariate and multivariate analyses were used to assess prognostic factors for overall survival (OS) and progression-free survival (PFS). Results Stage III/IV, B symptoms, elevated lactate dehydrogenase, monocytopenia, high-intermediate and high risk International Prognostic Index (IPI) and Korean Prognostic Index (KPI), high risk Prognostic Index of Natural Killer Lymphoma (PINK), and lower lymphocytes were significantly associated with low ACD4C at diagnosis. With a median follow-up time of 32 months, patients who had an ACD4C < 0.30109/L had a worse OS. Median OS was 11 months and median PFS was 5 months in the low ACD4C cohort. There were significant differences in both OS and PFS between the two cohorts. Moreover, multivariate Cox analysis identified ACD4Cs as an independent predictor for OS and PFS. Conclusion Low ACD4Cs were associated with poorer survival and could act as a negative predictor for ENKTL patients treated with asparaginase-based regimens.
참고문헌 (27)
- Yang QP, "Subtype distribution of lymphomas in Southwest China : analysis of 6, 382 cases using WHO classification in a single institution", Diagn Pathol, 6, pp.77~ (2011)
- Xu W, "Distribution of lymphomas subtypes in Jiangsu Province : a multicenter analysis of 5 147 cases", Zhonghua Xue Ye Xue Za Zhi, 35, pp.300~303 (2014)
- Au WY, "Clinical differences between nasal and extranasal natural killer", T-cell lymphoma : a study of 136cases from the International Peripheral T-Cell Lymphoma Project, 2009, pp.113, 3931~3937
- Perry AM, "Non-Hodgkin lymphoma in the Far East : review of 730 cases from the international non-Hodgkin lymphoma classification project", Ann Hematol, 95, pp.245~251 (2016)
- Lee J, "Extranodal natural killer T-cell lymphoma, nasal-type : a prognostic model from a retrospective multicenter study", J Clin Oncol, 24, pp.612~618 (2006)
- Kim SJ, "A prognostic index for natural killer cell lymphoma after nonanthracycline-based treatment : a multicentre, retrospective analysis", Lancet Oncol, 17, pp.389~400 (2016)
- Peng RJ, "Circulating and tumor-infiltrating Foxp3(+)regulatory T cell subset in Chinese patients with extranodal NK", T cell lymphoma, 2011, pp.7, 1027~1036
- Kwong YL, "PD1 blockade with pembrolizumab is highly effective in relapsed or refractory NK", T-cell lymphoma failing l-asparaginase, 2017, pp.129, 2437~2442
- Huang JJ, "Absolute lymphocyte count is a novel prognostic indicator in extranodal natural killer", T-cell lymphoma, nasal type, 2011, pp.22, 149~155
- Wang L, "Lymphopenia during routine follow-up may predict relapse in patients with extranodal NK", T cell lymphoma, 2015, pp.36, 1747~1753
- Yang Y, "Prognostic nomogram for overall survival in previously untreated patients with extranodal NK", T-cell lymphoma, nasal-type : a multicenter study, 2015, pp.29, 1571~1577
- Suzuki R, "Prognostic factors for mature natural killer(NK)cell neoplasms : aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type", Ann Oncol, 21, pp.1032~1040 (2010)
- He L, "Low absolute CD4(+)T cell counts in peripheral blood are associated with inferior survival in follicular lymphoma", Tumour Biol, 37, pp.12589~12595 (2016)
- Zhang XY, "Negative prognostic impact of low absolute CD4(+)T cell counts in peripheral blood in mantle cell lymphoma", Cancer Sci, 107, pp.1471~1476 (2016)
- Sabattini E, "WHO classification of tumours of haematopoietic and lymphoid tissues in 2008 : an overview", Pathologica, 102, pp.83~87 (2010)
- Camp RL, "X-tile : a new bioinformatics tool for biomarker assessment and outcome-based cut-point optimization", Clin Cancer Res, 10, pp.7252~7259 (2004)
- Gaulard P, "The microenvironment in T-cell lymphomas : emerging themes", Semin Cancer Biol, 24, pp.49~60 (2014)
- Coupland SE, "The challenge of the microenvironment in B-cell lymphomas", Histopathology, 58, pp.69~80 (2011)
- Blaker YN, "The tumour microenvironment influences survival and time to transformation in follicular lymphoma in the rituximab era", Br J Haematol, 175, pp.102~114 (2016)
- Wein F, "The role of T cells in the microenvironment of Hodgkin lymphoma", J Leukoc Biol, 99, pp.45~50 (2016)
- Chang C, "High levels of regulatory T cells in blood are a poor prognostic factor in patients with diffuse large B-cell lymphoma", Am J Clin Pathol, 144, pp.935~944 (2015)
- Chim CS, "Primary nasal natural killer cell lymphoma : long-term treatment outcome and relationship with the International Prognostic Index", Blood, 103, pp.216~221 (2004)
- Kim WY, "Increased quantity of tumor-infiltrating FOXP3-positive regulatory T cells is an independent predictor for improved clinical outcome in extranodal NK", T-cell lymphoma, 2009, pp.20, 1688~1696
- Salama P, "Tumor-infiltrating FOXP3+ T regulatory cells show strong prognostic significance in colorectal cancer", J Clin Oncol, 27, pp.186~192 (2009)
- Hsieh PP, "EBV viral load in tumor tissue is an important prognostic indicator for nasal NK", T-cell lymphoma, 2007, pp.128, 579~584
- Ding ZC, "Polyfunctional CD4(+)T cells are essential for eradicating advanced B-cell lymphoma after chemotherapy", Blood, 120, pp.2229~2239 (2012)
- Bos R, "CD4+ T-cell help in the tumor milieu is required for recruitment and cytolytic function of CD8+ T lymphocytes", Cancer Res, 70, pp.8368~8377 (2010)