Low Level of Blood CD4+ T-Cells Is An Independent Predictor of Inferior Progression Free Survival in Diffuse Large B-Cell Lymphoma

Abstract Background Tumor-infiltrating immune cells influence diffuse large B-cell lymphoma (DLBCL) outcome. Relatively little, however, is known about the significance of peripheral blood immune cell numbers, on DLBCL behavior. Patients and Methods In this study, 43 newly diagnosed DLBCL patients had pretreatment multi-parameter peripheral blood flow cytometry (PBFCM) performed to assess immune cell numbers and these were correlated with the outcomes progression free survival (PFS) and overall survival (OS). Results After follow up of 0.8 to 152 months (median: 73), 25 (56%) were still alive. As continuous variables by univariate analysis, predictors of PFS were age and absolute CD4 cell count (ACD4C), while IPI was marginally significant. Age was also a significant predictor of OS, while IPI and ACD4C were marginally significant (P=0.08). The 17 patients with higher ACD4C ( ≥ 450/mm3 ) had better 5 year PFS than the 26 with low ACD4C ( 88% vs 50%, P= 0.02). Multivariable analysis including age as a continuous variable, IPI groups and ACD4C of 450/mm3 showed that age and ACD4C were significant for PFS (P=0.01 and 0.02 respectively). Conclusion Our data, though a small series, suggest that blood ACD4C may be a predictor of PFS in DLBCL, independent of age and IPI.