Increased CTLA-4(+) T cells and an increased ratio of monocytes with loss of class II (CD14(+) HLA-DR(lo/neg)) found in aggressive pediatric sarcoma patients.
BACKGROUND
There is little information regarding the composition of peripheral blood immunity in sarcoma patients and even less in the context of pediatric sarcomas. We describe the immune status using flow cytometry of peripheral blood in patients with osteosarcoma and Ewing sarcoma and demonstrate excessive CD14 in tumor tissues.


METHODS
Peripheral blood from patients with OS and ES was collected at diagnosis or relapse, and used for immune phenotyping of 74 different leukocyte phenotypes. Blood from young adult healthy volunteers was collected as controls. Tumor tissues were analyzed by immunohistochemistry.


RESULTS
Nineteen patients (average age = 14 y) and 16 controls (average age = 25y) were enrolled on study. Of the 74 phenotypes, 14 were different between sarcoma patients and HV. Sarcoma patients' leukocytes contained a higher percentage of granulocytes (67 % sarcoma vs. 58 % HV; p = 0.003) and fewer lymphocytes (20 % sarcoma vs. 27 % HV; p = 0.001). Increased expression of CTLA-4 was seen in both T cells in sarcoma patients as compared to HV (p = 0.05). Increased CD14(+) HLA-DR(lo/neg) immunosuppressive monocytes were seen in sarcoma patients (p = 0.03); primarily seen in OS. Increased tumor necrosis factor receptor II expression was seen on CD14(+) cells derived from sarcoma patients as compared to HV (p = 0.01). Massive infiltration of CD14(+) cells was seen in OS (>50 % of cells in the majority of tumors) compared to ES (<10-25 % of cells). In contrast, both OS and ES had limited T cell infiltration (generally <10 % of cells).


CONCLUSIONS
Pediatric sarcoma patients exhibit several immune phenotypic differences that were exacerbated in more severe disease. These phenotypes have the potential to contribute to immune suppression and may indicate potential targets for immune therapies.
Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ USA.
Pooja
P
Hingorani
Human Cellular Therapy Lab, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
Mary L
ML
Maas
Human Cellular Therapy Lab, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.
Michael P
MP
Gustafson
Department of Pathology, Phoenix Children's Hospital, Phoenix, AZ USA.
Paul
P
Dickman
Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ USA.
Roberta H
RH
Adams
Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ USA.
Masayo
M
Watanabe
Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ USA.
Francis
F
Eshun
Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ USA.
James
J
Williams
Orthopedic Oncology, Scottsdale, AZ USA.
Matthew J
MJ
Seidel
Human Cellular Therapy Lab, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA.|Division of Experimental Pathology, Department of Laboratory Medicine and Pathology, and Division of Immunology, Mayo Clinic, Rochester, MN USA.
Allan B
AB
Dietz
Ewing sarcoma; Immune phenotype; Immune suppression; Lymphocytes; Monocytes; Osteosarcoma