title: T-cell levels are prognostic in mantle cell lymphoma.
abstract: OBJECTIVE
  The purpose of this study was to investigate the impact of T-cell subsets on pathologic and clinical features including disease outcome in mantle cell lymphoma (MCL).
  
  
  METHODS
  Cell populations were investigated using flow cytometry in diagnostic MCL (n = 153) and reactive (n = 26) lymph node biopsies. Levels of tumor cells, T cells, T-cell subsets, and the CD4:CD8 ratio were assessed and related to pathologic and clinical parameters.
  
  
  RESULTS
  MCL cases with diffuse and nodular histologic subtypes showed lower levels of T cells, especially CD4(+) T cells, than those with mantle zone growth pattern. Both CD3 and CD4 levels were lower in the nodular subtype than in mantle zone (P = 0.007; P = 0.003) and in the diffuse compared with the nodular subtype (P = 0.022; P = 0.015). The CD4:CD8 ratios were inversely correlated to tumor cell proliferation (P = 0.003). Higher levels of CD3(+) and CD4(+) T cells and higher CD4:CD8 ratios were associated with indolent disease (P = 0.043, 0.021, and 0.003 respectively). In univariate analysis, a high CD4:CD8 ratio, but not the histologic subtype, was correlated to longer overall survival (OS). In multivariate analysis, the CD4:CD8 ratio correlated with OS independently of Mantle Cell Lymphoma International Prognostic Index (MIPI) and high p53 expression (P = 0.023).
  
  
  CONCLUSIONS
  CD3(+), CD8(+), and particularly CD4(+) T-cell levels are higher in indolent MCL and decrease with more aggressive histology as reflected by a diffuse growth pattern. High CD4:CD8 ratio correlated independently of other high-risk prognostic factors with longer OS, suggesting a prognostic role for T cells in MCL.
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. Department of Oto-Rhino-Laryngology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lina
authors.initials: L
authors.lastname: Nygren
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Agata M
authors.initials: AM
authors.lastname: Wasik
authors.affiliation: Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Baumgartner-Wennerholm
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Jeppsson-Ahlberg
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Monika
authors.initials: M
authors.lastname: Klimkowska
authors.affiliation: Department of Hematology and Coagulation, Stockholm South General Hospital, Stockholm, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Andersson
authors.affiliation: Department of Internal Medicine, Hematology St. Görans Hospital, Stockholm, Sweden.
authors.forename: Daren
authors.initials: D
authors.lastname: Buhrkuhl
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Birger
authors.initials: B
authors.lastname: Christensson
authors.affiliation: Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Kimby
authors.affiliation: Department of Medicine, Center for Haematology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Björn E
authors.initials: BE
authors.lastname: Wahlin
authors.affiliation: Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. birgitta.sander@ki.se.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Sander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016516:CD4-CD8 Ratio; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D008198:Lymph Nodes / Q000473:pathology; D018655:Lymphocyte Count; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011379:Prognosis; D012042:Registries; D016176:T-Lymphocyte Subsets / Q000276:immunology* / Q000378:metabolism / Q000473:pathology