Lymphopenia during routine follow-up may predict relapse in patients with extranodal NK/T cell lymphoma

Abstract

Recently, absolute lymphocyte count (ALC) at diagnosis, as a surrogate marker of host immunity, has been reported to be a prognostic factor for clinical outcomes in extranodal NK/T cell lymphoma (ENKTL). In this retrospective study, we set out to investigate whether ALC at the time of confirmed relapse or at last follow-up is a marker for relapse after chemoradiotherapy in 84 patients with stage I/II ENKTL. Receiver operating characteristics (ROC) curve and area under the curve (AUC) analysis showed that ALC at follow-up was a significant marker for relapse (AUC = 0.883, P < 0.001). Using 1.215 × 10(9)/L as the optimal cutoff value of ALC, 44 patients (52.4%) were in lower ALC group and 40 patients (47.6%) were in higher ALC group. The sensitivity and specificity for ALC at the time of confirmed relapse or at last follow-up was 94.1 and 76.0%, respectively. The relative risk of relapse with an ALC < 1.215 × 10(9)/L was 14.5. The positive predictive value with an ALC < 1.215 × 10(9)/L was 72.7%, and the negative predictive value with an ALC ≥ 1.215 × 10(9)/L was 95.0%. The 4-year cumulative incidence rate for an ALC < 1.215 × 10(9)/L was 73.2% compared with 3.2% for an ALC ≥ 1.215 × 10(9)/L (P< 0.001). In a multivariate regression analysis, ALC at the time of confirmed relapse or last follow-up remained to be a significant factor for relapse (P < 0.001). In conclusion, lymphopenia observed during routine follow-up can predict relapse in patients with ENKTL, which needs further validation in prospective trials.

DDGP vs. SMILE in Relapsed/Refractory Extranodal Natural Killer/T‐cell Lymphoma, Nasal Type: A Retrospective Study of 54 Patients

“…ENKL can cause destruction in the involved site because of its highly invasive behavior, which greatly affects patients’ quality of life. In addition, ~ 30–50% patients will relapse after initial treatment within 5 years, and the treatment of relapsed/refractory ENKL remains challenging 3 …”

Circulating Low Absolute CD4+ T Cell Counts May Predict Poor Prognosis in Extranodal NK/T-Cell Lymphoma Patients Treating with Pegaspargase-Based Chemotherapy

“…In ENKTL, previous studies of circulating immune cells mainly focused on ALCs, which considered ALCs as a predictor of immune status. The decreasing ALCs as an indicator of pre-existing immune suppression is an unfavorable prognostic index for ENKTL [9,10]. Because of high-level expression of multidrug resistance P-glycoprotein on ENKTL lymphoma cells, pegaspargase-based therapies were given to untreated ENKTL patients in this study.…”

“…Several retrospective studies have demonstrated that a decreasing absolute lymphocyte counts (ALCs) is an unfavorable prognostic index for ENKTL, while an increasing ALCs is a favorable prognostic index. However, treatment is heterogeneous and many patients received an inferior regimen like anthracycline-containing treatment [9,10]. Data are limited with respect to the role of specific circulating lymphocyte subsets in the progression of ENKTL patients, especially those treated with asparaginase-containing regimens [11,12].…”

The why and how of amino acid analytics in cancer diagnostics and therapy

“…The enzymotherapy is also applied in the treatment of Non-Hodgkin lymphomas in combination with various other therapeutic agents (d'Amore et al, 2015;Dreyling et al, 2013;Wang et al, 2015). Of note, type II asparaginases are induced in bacteria under aerobic conditions only and have a highly specific (but not exclusive) asparagine activity while type I arginases are expressed independently of the environmental condition and similarly hydrolyze L-asparagine and L-glutamine (Batool et al, 2016).…”