Negative prognostic impact of low absolute CD4⁺ T cell counts in peripheral blood in mantle cell lymphoma

Abstract

Tumor microenvironment and host immunity are closely related to outcome in patients with mantle cell lymphoma (MCL). However, few researchers have focused on the prognostic value of peripheral blood lymphocyte subsets counts. The purpose of this study was to investigate the prognostic value of lymphocyte subsets and absolute monocyte counts. Sixty‐eight patients were analyzed retrospectively. Absolute CD4+ T cell counts (ACD4C), CD8+ T cell counts, nature killer cell counts, and CD4/CD8 ratios were assessed by peripheral blood flow cytometry and correlated with clinical parameters and long‐term outcomes. The median follow‐up for all patients was 21 months and the median survival time was 44 months. The overall survival (OS) rate at 1, 3, and 5 years was 80%, 51%, and 41%, respectively. In our cohort, high absolute monocyte count, and low ACD4C and CD4/CD8 ratio were associated with unfavorable OS (P = 0.029, P = 0.027, and P = 0.045, respectively) by univariate analysis. Multivariate analysis indicated that low ACD4C was a significant predictor of unfavorable OS (P = 0.004) independent of the simplified MCL International Prognostic Index (P = 0.048) in patients treated with or without rituximab (P = 0.011). Low CD4+ T cell counts proved to be a significant predictor of unfavorable OS in patients with MCL.

<p>The Neutrophil to Lymphocyte and Lymphocyte to Monocyte Ratios as New Prognostic Factors in Hematological Malignancies – A Narrative Review</p>

“…The 3-year OS among patients with high CD4/ CD8 ratio amounted to 60%, while OS among patients with low CD4/CD8 ratio was 25%. 62 Another study, comparing T cell subgroups in lymph node biopsy in patients with MCL and patients with reactive lymph nodes, revealed that higher levels of T cells, CD8+ T cells, and most of all CD4+ T cells, correlated with indolent MCL. Cell counts were decreased in more aggressive tumors.…”

“…32 MIPI has been introduced for advanced staged patients, in pre-rituximab era. 62 Ki-67 index exhibits some additional discriminatory application, as well as gene expression profiling. 58 For example, SOX11 expression is believed to identify low-risk, indolent cases.…”

“…32 Also, prognostic value of peripheral blood lymphocyte subsets counts has been thoroughly analyzed. 62 One and only research considering the subject was carried out on 68 MCL patients. The parameters measured by peripheral blood flow cytometry were established as follows: absolute CD4+ T cell counts (ACD4C), CD8+ T cell counts (ACD8C), nature killer cell counts, and CD4/CD8.…”

Primary gastric diffuse large B-cell lymphoma: Prognostic factors in the immune-oncology therapeutics era

“…Many studies have found that rituximab has an effect on lymphocytes and the CD4:CD8 ratio. For example, Zhang et al [35] found that low CD4:CD8 ratio was associated with poor OS in patients with mantle cell lymphoma. In addition, in cases of granulomatosis with polyangiitis, the CD4:CD8 ratio decreased slightly after initial rituximab treatment and gradually increased during rituximab maintenance [36].…”

T-Cell Lymphopenia in Patients with Advanced Thyroid Carcinoma Is Associated with Poor Prognosis

“…Interestingly, an increased neutrophil‐to‐lymphocyte ratio has been described in patients with papillary TC (PTC), most probably because of a lymphopenia . Furthermore, total lymphopenia and specifically T‐cell lymphopenia have been described in several other cancer types and have been associated with poor prognosis . Different mechanisms could be underlying T‐cell lymphopenia: (a) increased T‐cell apoptosis, as described in melanoma and head and neck cancer , and possibly concomitant decreased homeostatic proliferation of T cells; (b) a decreased thymic output; or (c) redistribution of T cells to the tumor site.…”