title: T-helper phenotypes in the blood of myeloma patients on ECOG phase III trials E9486/E3A93.
abstract: T-helper blood populations are frequently altered in multiple myeloma (MM). We measured the numbers of naive and activated cell subsets in the blood of a cohort of both previously untreated and treated MM patients. Two-colour flow cytometry to detect total CD4+, CD4+, CD4 5RA+ (naive) and CD4+, CD45RO+ (activated) subsets was then used to quantify the T-cell subsets in controls and MM patients. Previously treated MM patients either on or off treatment (n = 105) had significantly reduced (P< 0.0001) total CD4 and naive/activated cells than controls. Previously treated MM patients sampled for naive/activated cells while currently off therapy (n = 45) had no difference in the levels of CD4 and naive/activated cells compared to the currently treated patients (n = 60). However, newly diagnosed patients (n = 58) had a significantly reduced total CD4 (P = 0.023) and activated CD4 (P = 0.004), but not naive CD4 subsets, compared to controls. CD19+ cell levels above 125/microl were positively associated with higher T-helper cell levels. There was a strong positive association for better overall survival for patients with >395 CD4 cells/microl (P = 0.0001). These data indicate that MM patients at diagnosis have altered T-helper subsets, with a selective reduction in activated but not naive cells. Subsequent chemotherapy or the disease process contributes to a further reduction in CD4 cells. Importantly, the association of higher CD19+ cell levels with higher T helper cells indicates that certain myeloma patients can be identified with a more quantitatively intact immune system.
authors.affiliation: Virginia Piper Cancer Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407-3799, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Kay
authors.forename: T
authors.initials: T
authors.lastname: Leong
authors.forename: N
authors.initials: N
authors.lastname: Bone
authors.forename: R A
authors.initials: RA
authors.lastname: Kyle
authors.forename: P R
authors.initials: PR
authors.lastname: Greipp
authors.forename: B
authors.initials: B
authors.lastname: Van Ness
authors.forename: M M
authors.initials: MM
authors.lastname: Oken
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D009101:Multiple Myeloma / Q000097:blood* / Q000188:drug therapy; D010641:Phenotype; D016019:Survival Analysis; D016176:T-Lymphocyte Subsets / Q000276:immunology*; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology*