Receiver operating characteristic curve analysis of circulating blood dendritic cell precursors and T cells predicts response to extracorporeal photopheresis in patients with chronic graft-versus-host disease.
BACKGROUND
One proposed mechanism of extracorporeal photopheresis (ECP) in reducing chronic graft-versus-host disease (cGVHD) is alteration in numbers of circulating dendritic cells (DCs). This hypothesis was tested by correlating numbers of DC precursors and T cells in the blood before and during ECP therapy with response of cGVHD.


METHODS
Twenty-five patients with cGVHD were treated with ECP. Data were collected with emphasis on blood cellular markers, clinical response to ECP, and overall survival.


RESULTS
Fourteen patients (56%) responded and had better 2-year survival than nonresponders (88% vs. 18%, p=0.003). Responders had higher baseline circulating myeloid DC (mDC) and plasmacytoid DC precursors and CD4+ and CD8+ T cells compared with nonresponders. Receiver operating characteristic curve analyses showed that the best baseline cutoff values to predict response to ECP were mDC counts of 3.7 cells/µL (79% sensitivity, 82% specificity) and CD4+ T-cell counts of 104 cells/µL (71% sensitivity, 82% specificity). CD4+ T cells declined in responders over time, but not in nonresponders, and no significant changes were seen in CD8 T-cell or DC numbers over a 12-month period in responder or nonresponder groups.


CONCLUSIONS
Higher baseline numbers of circulating DCs and T cells may predict clinical response to ECP in patients with cGVHD.
Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia 30322, USA.
Mojtaba
M
Akhtari
Cynthia R
CR
Giver
Zahir
Z
Ali
Christopher R
CR
Flowers
Charise L
CL
Gleason
Christopher D
CD
Hillyer
Jonathan
J
Kaufman
H Jean
HJ
Khoury
Amelia A
AA
Langston
Mary Jo
MJ
Lechowicz
Sagar
S
Lonial
Heather M
HM
Renfroe
John D
JD
Roback
Mourad
M
Tighiouart
Louette
L
Vaughn
Edmund K
EK
Waller
D000328:Adult; D000368:Aged; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology*; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology*; D002908:Chronic Disease; D003713:Dendritic Cells / Q000166:cytology*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017893:Photopheresis / Q000379:methods* / Q000401:mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012680:Sensitivity and Specificity; D055815:Young Adult