dc.contributor.author | Keane, Colm | |
dc.contributor.author | Gill, Devinder | |
dc.contributor.author | Vari, Frank | |
dc.contributor.author | Cross, Donna | |
dc.contributor.author | Griffiths, Lyn | |
dc.contributor.author | Gandhi, Maher | |
dc.date.accessioned | 2017-05-03T12:43:22Z | |
dc.date.available | 2017-05-03T12:43:22Z | |
dc.date.issued | 2013 | |
dc.date.modified | 2014-04-14T23:55:15Z | |
dc.identifier.issn | 03618609 | |
dc.identifier.doi | 10.1002/ajh.23398 | |
dc.identifier.uri | http://hdl.handle.net/10072/58414 | |
dc.description.abstract | Despite 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.peerreviewed | Yes | |
dc.description.publicationstatus | Yes | |
dc.language | English | |
dc.language.iso | eng | |
dc.publisher | John Wiley & Sons | |
dc.publisher.place | United States | |
dc.relation.ispartofstudentpublication | N | |
dc.relation.ispartofpagefrom | 273 | |
dc.relation.ispartofpageto | 276 | |
dc.relation.ispartofissue | 4 | |
dc.relation.ispartofjournal | American Journal of Hematology | |
dc.relation.ispartofvolume | 88 | |
dc.rights.retention | Y | |
dc.subject.fieldofresearch | Cancer Cell Biology | |
dc.subject.fieldofresearch | Chemotherapy | |
dc.subject.fieldofresearch | Cardiorespiratory Medicine and Haematology | |
dc.subject.fieldofresearchcode | 111201 | |
dc.subject.fieldofresearchcode | 111205 | |
dc.subject.fieldofresearchcode | 1102 | |
dc.title | CD4+ Tumor infiltrating lymphocytes are prognostic and independent of R-IPI in patients with DLBCL receiving R-CHOP chemo-immunotherapy | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dc.type.code | C - Journal Articles | |
gro.faculty | Griffith Health, School of Medical Science | |
gro.date.issued | 2013 | |
gro.hasfulltext | No Full Text | |
gro.griffith.author | Griffiths, Lyn | |
gro.griffith.author | Keane, Colm | |