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

Prognostic Value of Peripheral Blood Lymphocyte Subsets in Children and Adolescents With High-Grade Mature B-Cell Non-Hodgkin Lymphoma: A Real-World Outcomes Study

BACKGROUND

Little progress has been made in determining prognostic factors for patients with high-grade mature B-cell non-Hodgkin lymphoma (HG B-NHL). Based on the important role of lymphocytes in cancer progression, this study aimed to explore the effect of peripheral blood lymphocytes on the prognosis of pediatric HG B-NHL.

METHODS

Patients aged less than 18 years with newly diagnosed HG B-NHL were enrolled. Peripheral blood lymphocyte subset levels were detected at diagnosis, and their optimal cutoff values were determined according to event-free survival (EFS).

RESULTS

In total, 206 patients were enrolled. The 5-year EFS and overall survival (OS) rates of the whole group were 92.1% ± 1.9% and 96.6% ± 1.3%, respectively. The 5-year EFS rate was worse in patients with a low relative CD4+ T-cell count (87.2% vs. 97.0%, p = 0.008), high relative CD8+ T-cell count (79.1% vs. 93.4%, p = 0.03), low CD4/CD8 ratio (80.5% vs. 94.2%, p = 0.01), and low B-cell count (80.0% vs. 93.4%, p = 0.02) at diagnosis than their counterparts. Cox multivariate analysis identified low relative CD4+ T-cell (HR = 4.91) and B-cell (HR = 3.87) counts at diagnosis as independent adverse prognostic factors. Patients with simultaneously low levels of CD4+ T and B cells had the worst outcomes in the entire cohort, with a 5-year EFS rate of 60.0%.

CONCLUSION

Low relative CD4+ T-cell and B-cell counts at diagnosis are associated with poor prognosis in children and adolescents with HG B-NHL in the real world.

Low levels of CD3 + and CD8 + T cells in peripheral blood can predict poor efficacy of first-line chemotherapy in patients with angioimmunoblastic T cell lymphoma

To investigate the prognostic significance of lymphocyte subsets in newly diagnosed angioimmunoblastic T-cell lymphoma (AITL) patients and track the dynamic changes in these subsets during treatment. We retrospectively analyzed the medical records in 56 patients with AITL. Lymphocyte subsets were assessed by flow cytometry at diagnosis. Receiver operating characteristic curves were employed to establish optimal cut-off values for lymphocyte subset assessment. Univariate and multivariate analyses were used to evaluate overall survival (OS) and progression-free survival (PFS). The first-line treatment demonstrated an overall response rate (ORR) of 71.4%. Optimal cut-off values for ORR were determined for CD3 + T cell percentage (61.9%) and CD8 + T cell percentage (28.4%), with corresponding AUC of 0.756 [95% CI (0.611-0.902), p = 0.003] and 0.745 [95% CI (0.596-0.894), p = 0.004]. The ORR for the Low CD3+/CD8 + Group (CD3 + T < 61.9% and CD8 + T < 28.4%) and High CD3+/CD8 + Group (CD3 + T ≥ 61.9% or CD8 + T ≥ 28.4%) was 25.0% and 84.1%, respectively (p < 0.001). With a median follow-up time of 37.4 months, the median PFS were 5.6 and 16.0 months for the both groups. After two cycles of chemotherapy, a significant elevation in the percentage of CD3 + T cells was observed comparing to pre-treatment. Three months post-treatment, the CD4/CD8 ratio reduced significantly, indicating a rebalancing of T cell populations. Reduced levels of CD3 + and CD8 + T lymphocyte may indicate inferior chemotherapy efficacy and poorer PFS in AITL. Monitoring the baseline lymphocyte subsets and their dynamic changes can assist in clinical treatment decision - making.

Identification and validation of ubiquitin-proteasome system related genes as a prognostic signature for papillary renal cell carcinoma

Dysregulation of the ubiquitin-proteasome system (UPS) pathway greatly affects uncontrolled proliferation, genomic instability, and carcinogenesis, particularly in those with renal papillary cell carcinoma (PRCC). However, there is little information at the molecular level about the full link between changes in the genes involved in ubiquitin-mediated proteolysis and PRCC.

METHODS

The Cancer Genome Atlas (TCGA) and GeneCards databases were utilized to find the clinical data and gene expression patterns of patients with PRCC. Univariate Cox regression analysis and absolute shrinkage and selection operator (LASSO) analyses identified a risk signature formed by ten optimal UPS genes. The predictive value of the risk signature in TCGA-PRCC cohorts was evaluated using Kaplan-Meier analysis and receiver operating characteristic (ROC) curves. By utilizing GO enrichment and the KEGG pathway, the interactions of differentially expressed genes connected to ubiquitin-mediated proteolysis were functionally examined. The protein expression of the hub genes was affirmed using the Human Protein Atlas (HPA) database. The effectiveness of particular CDC20 and UBE2C in vitro was confirmed by experimental research.

RESULTS

Ten of the best ubiquitin-mediated proteolysis genes (UBE2C, DDB2, CBLC, BIRC3, PRKN, UBE2O, SIAH1, SKP2, UBC, and CDC20) were detected to create a risk signature. The high-risk score group stratified was associated with advanced tumor status and poor survival of PRCC patients. 10 genes were also found to be associated with the cell cycle pathway and ubiquitin-mediated proteolysis to GO and KEGG analysis. Of these 10 genes, CDC20 and UBE2C are highly expressed in tumor tissue and correlated with cancer immunity founded on the analyses of the expression of human protein atlas and TISIDB. The downregulation of UBE2C facilitated tumor inhibition and the anti-immune effect was confirmed by in vitro experiments.

CONCLUSION

Our results indicate that the risk model created from the ubiquitin-mediated proteolysis genes can be reliably and accurately predict the prognosis of PRCC patients, highlighting its targeted value for PRCC treatment. Particularly, the expression of UBE2C may be crucial for the prognosis and immunological treatment of renal cancer.

Towards Next Generation Biomarkers in Natural Killer/T-Cell Lymphoma

Natural killer/T-cell lymphoma (NKTCL) is an Epstein-Barr virus-associated non-Hodgkin lymphoma linked to an aggressive clinical course and poor prognosis. Despite an improvement in survival outcomes with the incorporation of novel agents including immune checkpoint inhibitors in the treatment of NKTCL, a significant proportion of patients still relapse or remain refractory to treatment. Several clinical prognostic models have been developed for NKTCL patients treated in the modern era, though the optimal approach to risk stratification remains to be determined. Novel molecular biomarkers derived from multi-omic profiling have recently been developed, with the potential to improve diagnosis, prognostication and treatment of this disease. Notably, a number of potential biomarkers have emerged from a better understanding of the tumor immune microenvironment and inflammatory responses. This includes a recently described 3'UTR structural variant in the PD-L1 gene, which confers susceptibility to checkpoint immunotherapy. In this review, we summarize the biomarker landscape of NKTCL and highlight emerging biomarkers with the potential for clinical implementation.

An Immune-Clinical Prognostic Index (ICPI) for Patients With De Novo Follicular Lymphoma Treated With R-CHOP/CHOP Chemotherapy

Purpose

Although the role of tumor-infiltrating T cells in follicular lymphoma (FL) has been reported previously, the prognostic value of peripheral blood T lymphocyte subsets has not been systematically assessed. Thus, we aim to incorporate T-cell subsets with clinical features to develop a predictive model of clinical outcome.

Methods

We retrospectively screened a total of 1,008 patients, including 252 newly diagnosed de novo FL patients with available peripheral blood T lymphocyte subsets who were randomized to different sets (177 in the training set and 75 in the internal validation set). A nomogram and a novel immune-clinical prognostic index (ICPI) were established according to multivariate Cox regression analysis for progression-free survival (PFS). The concordance index (C-index), Akaike’s information criterion (AIC), and likelihood ratio chi-square were employed to compare the ICPI’s discriminatory capability and homogeneity to that of FLIPI, FLIPI2, and PRIMA-PI. Additional external validation was performed using a dataset (n = 157) from other four centers.

Results

In the training set, multivariate analysis identified five independent prognostic factors (Stage III/IV disease, elevated lactate dehydrogenase (LDH), Hb <120g/L, CD4+ <30.7% and CD8+ >36.6%) for PFS. A novel ICPI was established according to the number of risk factors and stratify patients into 3 risk groups: high, intermediate, and low-risk with 4-5, 2-3, 0-1 risk factors respectively. The hazard ratios for patients in the high and intermediate-risk groups than those in the low-risk were 27.640 and 2.758. The ICPI could stratify patients into different risk groups both in the training set (P < 0.0001), internal validation set (P = 0.0039) and external validation set (P = 0.04). Moreover, in patients treated with RCHOP-like therapy, the ICPI was also predictive (P < 0.0001). In comparison to FLIPI, FLIPI2, and PRIMA-PI (C-index, 0.613-0.647), the ICPI offered adequate discrimination capability with C-index values of 0.679. Additionally, it exhibits good performance based on the lowest AIC and highest likelihood ratio chi-square score.

Conclusions

The ICPI is a novel predictive model with improved prognostic performance for patients with de novo FL treated with R-CHOP/CHOP chemotherapy. It is capable to be used in routine practice and guides individualized precision therapy.

Absolute Lymphocyte Counts After Lenalidomide Initiation may Predict the Prognosis of Patients With Relapsed or Refractory Multiple Myeloma

BACKGROUND/AIM

We assessed the prognosis of patients with refractory or relapsed multiple myeloma (RRMM) by focusing on the change in absolute lymphocyte counts (ALCs) after lenalidomide and dexamethasone (Ld) initiation.

PATIENTS AND METHODS

In total, 72 patients with RRMM were treated with Ld. ALCs were evaluated before treatment and at 1, 2, and 3 months after Ld initiation. The median ALCs in the entire cohort before and at 1, 2, 3 months after Ld initiation were 1,131, 1,059, 1,222, and 1,162/μl, respectively.

RESULTS

ALCs before Ld initiation did not affect time to next treatment (TNT) or overall survival (OS). However, the patients with ALCs equal to or greater than the median at 3 months showed relatively better TNT than those with lower lymphocyte counts, with a significant difference. OS was also significantly longer in patients with higher ALCs.

CONCLUSION

Immunomodulation by lenalidomide may improve prognosis in patients with RRMM.

The predictive value of dynamic monitoring of peripheral blood lymphocyte to monocyte ratio in patients with extranodal NK/T cell lymphoma

Background

To investigate the value of dynamic monitoring peripheral blood lymphocyte-to-monocyte (LMR) ratio in evaluating the treatment response and prognosis of patients with extranodal NK/T cell lymphoma (ENKTL).

Methods

A total of 148 patients with ENKTL were retrospectively analyzed in the Affiliated Tumor Hospital of Zhengzhou University between March 2012 and March 2018. The optimal cut-off value of LMR was determined using the receiver operating characteristic curve (ROC) method, then patients were divided into low LMR group and high LMR group. The LMR level was dynamically measured at various time points, and the relationships between LMR and therapeutic response, and survival were analyzed.

Results

The complete remission rate (CR) was 85.7% in patients with high LMR at diagnosis, which was remarkably higher than that of patients with low LMR at diagnosis (64.9%) (P = 0.009). The 5-year overall survival (OS) and progression-free survival (PFS) were 49.28% and 44.89% in the low LMR group, respectively; 5-year OS and PFS in the high LMR group were 84.50% and 67.12%, respectively, significantly longer (P values were < 0.001 and 0.034, respectively). The OS and PFS of patients with elevated LMR after treatment were longer than those with decreased LMR after treatment (all P values < 0.05). The LMRs at relapse were significantly lower in both high and low LMR groups than those of the last follow-up (P values were 0.001 and 0.016, respectively). Univariate and multivariate analysis demonstrated that low LMR was an independent risk factor for poor prognosis in ENKTL patients (P values were < 0.001 and 0.009, respectively).

Conclusions

Lymphocyte to monocyte ratio can be used as an indicator of treatment response, prognosis and recurrence in patients with ENKTL. Low LMR before and after treatment is a poor prognostic factor.