Decreased CD4+-Th/CD8+-Tc ratio in Bone marrow at diagnosis of acute myeloid leukemia Predicts Increased Risk of Graft-Versus-Host-Disease in Transplant Patients

Abstract

Abstract Introduction Acute myeloid leukemia (AML) is an aggressive disease with high morbidity and mortality. Transplant is one of the most important treatments for AML. However, graft-versus-host-disease (GVHD) remains one of major problems in transplant patients. Since immune repertoire plays an important role in the GVHD occurrence, we investigate the relationship between lymphocyte subsets and the risk of GVHD. Methods 60 initial diagnostic flow data of AML transplant patients were reviewed (Oregon Health and Science University 2010 to 2016, 30 females and 30 males, with a median age of 51.417 years, range 13–72). 36 patients with GVHD including acute and chronic GVHD while 24 patients without GVHD. The lymphocyte subsets were analyzed including CD3+T-cells, CD3+CD4+Th, CD3+CD8+Tc, CD4/CD8 ratio, CD19+CD20+B, CD19+CD5+B1, CD3+CD56+NKT, CD3−CD56+NK, and three NK subsets (CD56brightNK, CD56normalNK, CD56dimNK). Results As to the overall survival (OS), there’s no statistic difference between age<60 years old or age ≥60 years. Compared with non-GVHD group, decreased percentage (%) of Th, increased % of Tc & low Th/Tc ratio were observed in GVHD group (P=0.0281, P=0.0394, P=0.0340 accordingly). Receiver operating characteristic (ROC) analysis indicates that low Th/Tc ratio predicts increased risk of GVHD (P=0.0231, AUC=0.663, 95% Confidence Interval is 0.530 to 0.780). There’re no statistic differences between GVHD and non-GVHD for all other lymphocyte subsets percentage (P>0.05). Conclusions AML patients with GVHD post transplant have a lower Th cell percentage and higher Tc cell percentage at diagnosis. This is to say, decreased Th/Tc ratio in BM of initial diagnosed AML patients may predict a high risk of GVHD post transplant.