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dc.contributor.authorKeane, Colm
dc.contributor.authorGill, Devinder
dc.contributor.authorVari, Frank
dc.contributor.authorCross, Donna
dc.contributor.authorGriffiths, Lyn
dc.contributor.authorGandhi, Maher
dc.date.accessioned2017-05-03T12:43:22Z
dc.date.available2017-05-03T12:43:22Z
dc.date.issued2013
dc.date.modified2014-04-14T23:55:15Z
dc.identifier.issn03618609
dc.identifier.doi10.1002/ajh.23398
dc.identifier.urihttp://hdl.handle.net/10072/58414
dc.description.abstractDespite the Revised International Prognostic Index's (R-IPI) undoubted utility in diffuse large B-cell lymphoma (DLBCL), significant clinical heterogeneity within R-IPI categories persists. Emerging evidence indicates that circulating host immunity is a robust and R-IPI independent prognosticator, most likely reflecting the immune status of the intratumoral microenvironment. We hypothesized that direct quantification of immunity within lymphomatous tissue would better permit stratification within R-IPI categories. We analyzed 122 newly diagnosed consecutive DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemo-immunotherapy. Median follow-up was 4 years. As expected, the R-IPI was a significant predictor of outcome with 5-year overall survival (OS) 87% for very good, 87% for good, and 51% for poor-risk R-IPI scores (P?<?0.001). Consistent with previous reports, systemic immunity also predicted outcome (86% OS for high lymphocyte to monocyte ratio [LMR], versus 63% with low LMR, P?=?0.01). Multivariate analysis confirmed LMR as independently prognostic. Flow cytometry on fresh diagnostic lymphoma tissue, identified CD4+ T-cell infiltration as the most significant predictor of outcome with =23% infiltration dividing the cohort into high and low risk groups with regard to event-free survival (EFS, P?=?0.007) and OS (P?=?0.003). EFS and OS were independent of the R-IPI and LMR. Importantly, within very good/good R-IPI patients, CD4+ T-cells still distinguished patients with different 5 year OS (high 96% versus low 63%, P?=?0.02). These results illustrate the importance of circulating and local intratumoral immunity in DLBCL treated with R-CHOP.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.languageEnglish
dc.language.isoeng
dc.publisherJohn Wiley & Sons
dc.publisher.placeUnited States
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrom273
dc.relation.ispartofpageto276
dc.relation.ispartofissue4
dc.relation.ispartofjournalAmerican Journal of Hematology
dc.relation.ispartofvolume88
dc.rights.retentionY
dc.subject.fieldofresearchCancer Cell Biology
dc.subject.fieldofresearchChemotherapy
dc.subject.fieldofresearchCardiorespiratory Medicine and Haematology
dc.subject.fieldofresearchcode111201
dc.subject.fieldofresearchcode111205
dc.subject.fieldofresearchcode1102
dc.titleCD4+ Tumor infiltrating lymphocytes are prognostic and independent of R-IPI in patients with DLBCL receiving R-CHOP chemo-immunotherapy
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.facultyGriffith Health, School of Medical Science
gro.date.issued2013
gro.hasfulltextNo Full Text
gro.griffith.authorGriffiths, Lyn
gro.griffith.authorKeane, Colm


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