Proportions of bone marrow lymphocyte subsets at diagnosis may predict survival in patients with newly diagnosed diffuse large B‐cell lymphoma independently of the international prognostic index

Abstract

There is substantial evidence to support that the immune system plays a role in the outcome of lymphoma. For a long time, it is known that lymphoma can regress spontaneously, [1] and immunotherapy such as interferon and vaccine have some activity against the disease [2,3]. More recently, several studies in diffuse large B-cell lymphoma (DLBCL) have shown the potential value of the assessment of peripheral blood absolute lymphocyte count (PBALC) as well as nonmalignant lymphocyte subsets in the blood and the lymph node obtained at diagnosis in predicting clinical outcome [4-12]. Finally, molecular profiling of DLBCL show that genes associated with lymph node signature (host response) are predictive of overall survival (OS) independent of the commonly used International Prognostic Index (IPI) [13]. These studies of the effect of immune system on DLBCL have focused primarily on the blood and lymph node but not the bone marrow. In our retrospective study, we showed that that a higher proportion of total T-cells in the bone marrow as measured by flow cytometry was predictive of a better OS and disease-specific survival (DSS) independent of IPI in patients with newly diagnosed DLBCL treated with anthracycline-based chemotherapy. In contrast to previous studies, we did not find PBALC to have predictive importance. As bone marrow aspiration and biopsy is generally performed as part of DLBCL staging, enumeration of bone marrow lymphocyte subsets by flow cytometry may provide additional prognostic information in patients with newly diagnosed DLBCL and deserves further investigation.