Cancer Res Treat.  2019 Jan;51(1):368-377. 10.4143/crt.2018.010.

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

• Zhang YP
• Zhang R
• Zhu HY
• Wang L
• Wu YJ
• Liang JH
• Shi WY
• Liu H
• Xu W
• Li JY

• KMID: 2437627
• DOI: http://doi.org/10.4143/crt.2018.010

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 < 0.30×109/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.

Keyword

CD4⁺ T cell counts; Extranodal NK-T-cell lymphoma; Prognosis; Progression-free survival; Overall survival

MeSH Terms

Cell Count*
Cohort Studies
Diagnosis
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
L-Lactate Dehydrogenase
Lymphocyte Subsets
Lymphocytes
Lymphoma*
Lymphoma, Extranodal NK-T-Cell
Lymphoma, Non-Hodgkin
Medical Records
Multivariate Analysis
Prognosis*
Retrospective Studies
T-Lymphocytes
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1. Overall survival (OS) of 70 patients with extranodal natural killer/T-cell lymphoma, nasal type (ENKTL). OS of 70 patients with ENKTL, according to the absolute counts of T cell subsets (ACD4Cs) at the time of diagnosis, using Kaplan-Meier estimations.

• 

  Fig. 2. Progression-free survival (PFS) of 70 patients with extranodal natural killer/T-cell lymphoma, nasal type (ENKTL). PFS of 70 patients with ENKTL, according to the absolute counts of T cell subsets (ACD4Cs) at the time of diagnosis, using Kaplan-Meier estimations.

• 

  Fig. 3. Survivals of 41 early stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) patients. Survivals of 41 early stage ENKTL patients, according to the absolute counts of T cell subsets (ACD4Cs) at the time of diagnosis. (A) Overall survival. (B) Progression-free survival.

• 

  Fig. 4. Survivals of 29 advanced stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) patients. Survivals of 29 advanced stage ENKTL patients, according to the absolute counts of T cell subsets (ACD4Cs) at the time of diagnosis. (A) Overall survival. (B) Progression-free survival.

Reference

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