title: High levels of regulatory T cells in blood are a poor prognostic factor in patients with diffuse large B-cell lymphoma.
abstract: OBJECTIVE
  Host immunity likely plays a role in preventing progression of diffuse large B-cell lymphoma (DLBCL). Analysis of host immune cells may provide useful information for assessing prognosis or possibly clinical management.
  
  
  METHODS
  Peripheral blood samples from 77 patients with DLBCL and 30 healthy volunteers were analyzed using flow cytometry immunophenotyping. CBC counts, T-cell subsets, and dendritic cells (DCs) were detected, and the results were correlated with clinicopathologic characteristics.
  
  
  RESULTS
  Compared with healthy volunteers, patients with DLBCL had significantly higher leukocyte and monocyte counts (P < .001); higher percentages of neutrophils (P < .001), "natural" regulatory T cells (Tregs; CD3+Foxp3+, P < .001), and immature DCs (CD83-CD1a+, P = .005); and lower percentages of lymphocytes (P < .001) and helper T cells (P = .038). In univariate analysis, high neutrophil counts (≥6,000/μL, P = .014) and "induced" Tregs (CD4+CD25+, P = .026) were poor survival factors along with high International Prognostic Index scores (P < .001) and other high-risk clinical parameters. In multivariate analysis, high Tregs retained significance. Suppression of lymphocytes correlated with poor clinical factors; higher natural Tregs correlated with a lower CD4+/CD8+ ratio (P = .035) and more immature DCs (P = .055).
  
  
  CONCLUSIONS
  Changes in blood immune cells occur in patients with DLBCL. The results also support a suppressive role of Tregs in adaptive immunity and correlate with poor-risk prognostic factors.
authors.affiliation: From the Department of Pathology, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine and.
authors.forename: Chen
authors.initials: C
authors.lastname: Chang
authors.affiliation: Institute of Clinical Medicine, College of Medicine and Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; and.
authors.forename: Shang-Yin
authors.initials: SY
authors.lastname: Wu
authors.affiliation: From the Department of Pathology, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan;
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Kang
authors.affiliation: From the Department of Pathology, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan;
authors.forename: Kun-Piao
authors.initials: KP
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; and.
authors.forename: Tsai-Yun
authors.initials: TY
authors.lastname: Chen
authors.affiliation: Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: L Jeffrey
authors.initials: LJ
authors.lastname: Medeiros
authors.affiliation: From the Department of Pathology, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine and changkc@mail.ncku.edu.tw.
authors.forename: Kung-Chao
authors.initials: KC
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D016130:Immunophenotyping; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*; D055815:Young Adult
keywords: Antitumor immunity; Diffuse large B-cell lymphoma; Flow cytometry; Peripheral blood; Regulatory T cells