Abstract Recent advances in immunotherapy demonstrate the need to further understand the characteristics of an individual cancer patient’s immune system and how it influences responses to cancer treatment. Here, we developed an immunoprofiling platform to evaluate the features in the blood of cancer patients to test the hypothesis that peripheral immune cell heterogeneity could be used to stratify these patients into different categories or immunotypes to monitor disease progression and treatment response. To that end, we established a unique diagnostic immunoprofiling assay and analytical framework based on the analysis of leukocytes in the peripheral blood using multiparameter flow cytometry. Supervised manual gating of flow cytometry data from a cohort of 50 healthy donors identified 415 cell types and immune activation states that were used to train and later independently validate machine learning models to automatically identify immune cell subsets from raw cytometry data. By applying this tool to peripheral blood samples from a mixed cohort of 299 healthy donors and 323 cancer patients, we developed a machine-learning classification model that can differentiate between these two groups with 93% accuracy. This model was further refined using spectral clustering with bootstrapping, revealing 5 clusters, or immunotypes, characterized by specific physiological immune profiles: (1) Myeloid-derived suppressor/NK cell, (2) Terminally-differentiated CD8+ T cells, (3) Mixed CD4+ T helper cells, (4) CD4+ Th1 & CD8+ T cell memory, and (5) Naive T and B lymphocytes. Interestingly, very few healthy donors could be found in clusters 1 and 2 but were assigned most frequently to cluster 5. Matched RNA-seq was used to further validate these profiles using the cellular deconvolution algorithm, Kassandra, and differential gene expression analysis revealed immunotype-specific signatures that are consistent with immune response potential. Patients in the terminally-differentiated CD8+ T cell cluster had a narrower range of HLA-types than the other clusters, and TCR repertoire analysis indicated significantly increased clonality and reduced clonotype diversity. Within this cluster there was a high degree of overlap between TCR sequences in the peripheral blood and the tumor, indicating a relationship between peripheral blood immunotype and tumor infiltration. Altogether, the establishment of these immunotypes using peripheral blood immunoprofiling represents a promising signature that can be used to identify and stratify cancer patients that will benefit from immune-based therapies. Citation Format: Daniiar Dyikanov, Iris Wang, Tatiana Vasileva, Polina Shpudeiko, Polina Turova, Arseniy A. Sokolov, Olga Golubeva, Evgenii Tikhonov, Anna Kamysheva, Ilya Krauz, Mary Abdou, Madison Chasse, Tori Conroy, Nicholas R. Merriam, Boris Shpak, Anastasia Radko, Anastasiia Kilina, Lira Nigmatullina, Linda Balabanian, Christopher J. Davitt, Alexander A. Ryabykh, Olga Kudryashova, Cagdas Tazearslan, Ravshan Ataullakhanov, Alexander Bagaev, Aleksandr Zaitsev, Nathan Fowler, Michael F. Goldberg. Comprehensive immunoprofiling of peripheral blood reveals five conserved immunotypes with implications for immunotherapy in cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6664.