title: Low Level of Blood CD4+T Cells Is an Independent Predictor of Inferior Progression-free Survival in Diffuse Large B-cell Lymphoma.
abstract: Tumor-infiltrating immune cells influence diffuse large B-cell lymphoma (DLBCL) outcomes. Relatively little, however, is known about the significance of peripheral blood immune cell numbers on DLBCL behavior.
  
  
  
  In the present study, 43 patients with newly diagnosed DLBCL had pretreatment multiparameter peripheral blood flow cytometry performed to assess the immune cell numbers. These cell numbers were correlated with the outcomes of progression-free survival (PFS) and overall survival.
  
  
  
  After follow-up period of 0.8 to 152 months (median, 73), 25 patients (56%) were still alive. As continuous variables on univariate analysis, the predictors of PFS were patient age and absolute CD4 cell count (ACD4C), with the International Prognostic Index (IPI) marginally significant. Age was also a significant predictor of overall survival, and the IPI and ACD4C were marginally significant (P = .08). The 17 patients with a greater ACD4C (≥ 450/mm3) had better 5-year PFS than the 26 with a low ACD4C (88% vs. 50%; P = .02). Multivariable analysis, including age as a continuous variable, IPI group, and ACD4C of 450/mm3showed that age and ACD4C were significant for PFS (P = .01 and P = .02, respectively).
  
  
  
  Our data, although from a small series, suggest that the blood ACD4C might be a predictor of PFS for patients with DLBCL, independent of age and the IPI.
authors.affiliation: Department of Internal Medicine Residency, Temple University Hospital, Philadelphia, PA.
authors.forename: Julia
authors.initials: J
authors.lastname: Judd
authors.affiliation: Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Essel
authors.initials: E
authors.lastname: Dulaimi
authors.affiliation: Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Millenson
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Borghaei
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA. Electronic address: smithm14@ccf.org.
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Smith
authors.affiliation: Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Tahseen
authors.initials: T
authors.lastname: Al-Saleem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
keywords: Flow cytometry; Lymphocyte subsets; Lymphoma prognosis; NK cells; T-cell subsets