Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
Ann Hematol. 2021 Apr;100(4):995-1002. doi: 10.1007/s00277-021-04474-3. Epub 2021 Mar 2.
Waldenstrom macroglobulinemia (WM) is a rare type of non-Hodgkin lymphoma with great heterogeneity, and the data of peripheral blood T-lymphocyte subsets in WM are limited. This study aimed to investigate the clinical correlation and distribution of circulating T-lymphocyte subsets in newly diagnosed WM patients. We retrospectively searched medical records for 86 newly diagnosed WM patients. Comparisons of the absolute CD3 T-lymphocyte count (ACD3C), CD4 T-lymphocyte count (ACD4C), CD8 T-lymphocyte count (ACD8C), and CD4/CD8 T-lymphocyte ratio (CD4/CD8) as continuous parameters in different groups were calculated. Univariate and multivariate analyses were used to assess prognostic factors for overall survival (OS) and progression-free survival (PFS). Young patients (<65 years) had lower ACD8C levels and a higher CD4/CD8 ratio. And the lower level of β2-microglobulin (<3 mg/L) was associated with a higher CD4/CD8 ratio. With a median follow-up of 25 months, the univariate survival analysis showed that CD4/CD8 ratio inversion (CD4/CD8<1.5) was associated with shorter OS and PFS, and multivariate analysis confirmed that inverted CD4/CD8 ratio could be an independent adverse prognostic factor for OS and PFS. Additionally, initial treatment with rituximab or bortezomib significantly improved the PFS and OS of CD4/CD8 inversion patients but did not affect normal CD4/CD8 patients. We show that low circulating CD4/CD8 ratio at diagnosis is an adverse prognostic factor in WM patients and that first-line therapy which included rituximab or bortezomib significantly improved PFS and OS for patients with CD4/CD8 ratio less than 1.5.
华氏巨球蛋白血症（WM）是一种罕见的非霍奇金淋巴瘤，具有很大的异质性，WM 患者外周血 T 淋巴细胞亚群的数据有限。本研究旨在探讨新诊断 WM 患者循环 T 淋巴细胞亚群的临床相关性和分布。我们回顾性地检索了 86 例新诊断 WM 患者的病历。对不同组中连续参数的绝对 CD3 T 淋巴细胞计数（ACD3C）、CD4 T 淋巴细胞计数（ACD4C）、CD8 T 淋巴细胞计数（ACD8C）和 CD4/CD8 T 淋巴细胞比值（CD4/CD8）进行比较。采用单因素和多因素分析评估总生存期（OS）和无进展生存期（PFS）的预后因素。年轻患者（<65 岁）的 ACD8C 水平较低，CD4/CD8 比值较高。较低的β2-微球蛋白水平（<3mg/L）与较高的 CD4/CD8 比值相关。中位随访 25 个月，单因素生存分析显示 CD4/CD8 比值倒置（CD4/CD8<1.5）与 OS 和 PFS 较短相关，多因素分析证实倒置 CD4/CD8 比值是 OS 和 PFS 的独立不良预后因素。此外，初始使用利妥昔单抗或硼替佐米治疗显著改善了 CD4/CD8 倒置患者的 PFS 和 OS，但对正常 CD4/CD8 患者没有影响。我们表明，诊断时低循环 CD4/CD8 比值是 WM 患者的不良预后因素，包括利妥昔单抗或硼替佐米在内的一线治疗显著改善了 CD4/CD8 比值小于 1.5 的患者的 PFS 和 OS。
