The prognostic impact of lymphocyte subsets in newly diagnosed acute myeloid leukemia

Yumi Park; Jinsook Lim; Seonyoung Kim; Ikchan Song; Kyechul Kwon; Sunhoe Koo; Jimyung Kim

doi:10.5045/br.2018.53.3.198

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Original Article

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Blood Res 2018; 53(3):

Published online September 28, 2018

https://doi.org/10.5045/br.2018.53.3.198

The prognostic impact of lymphocyte subsets in newly diagnosed acute myeloid leukemia

Yumi Park¹, Jinsook Lim¹, Seonyoung Kim¹, Ikchan Song², Kyechul Kwon¹, Sunhoe Koo¹, and Jimyung Kim^1*

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¹Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Korea.

²Department of Hemato-Oncology, Chungnam National University Hospital, Daejeon, Korea.

Correspondence to : Correspondence to Jimyung Kim, M.D. Department of Laboratory Medicine, Chungnam National University Hospital, 282 Moonhwa-ro, Joong-gu, Daejeon 35015, Korea. jmkim@cnuh.co.kr

Received: August 2, 2017; Revised: March 6, 2018; Accepted: May 10, 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

Tumor-infiltrating lymphocytes, which form a part of the host immune system, affect the development and progression of cancer. This study investigated whether subsets of lymphocytes reflecting host-tumor immunologic interactions are related to the prognosis of patients with acute myeloid leukemia (AML).

Methods

Lymphocyte subsets in the peripheral blood of 88 patients who were newly diagnosed with AML were analyzed by quantitative flow cytometry. The relationships of lymphocyte subsets with AML subtypes, genetic risk, and clinical courses were analyzed.

Results

The percentages of T and NK cells differed between patients with acute promyelocytic leukemia (APL) and those with AML with myelodysplasia-related changes. In non-APL, a high proportion of NK cells (>16.6%) was associated with a higher rate of death before remission (P=0.0438), whereas a low proportion of NK cells (≤9.4%) was associated with higher rates of adverse genetic abnormalities (P=0.0244) and relapse (P=0.0567). A multivariate analysis showed that the lymphocyte subsets were not independent predictors of survival.

Conclusion

Lymphocyte subsets at diagnosis differ between patients with different specific subtypes of AML. A low proportion of NK cells is associated with adverse genetic abnormalities, whereas a high proportion is related to death before remission. However, the proportion of NK cells may not show independent correlations with survival.

Keywords Acute myeloid leukemia, Lymphocyte subset, NK cells, Prognosis

Article

Original Article

Blood Res 2018; 53(3): 198-204

Published online September 28, 2018 https://doi.org/10.5045/br.2018.53.3.198

The prognostic impact of lymphocyte subsets in newly diagnosed acute myeloid leukemia

Yumi Park¹, Jinsook Lim¹, Seonyoung Kim¹, Ikchan Song², Kyechul Kwon¹, Sunhoe Koo¹, and Jimyung Kim^1*

¹Department of Laboratory Medicine, Chungnam National University Hospital, Daejeon, Korea.

²Department of Hemato-Oncology, Chungnam National University Hospital, Daejeon, Korea.

Correspondence to:Correspondence to Jimyung Kim, M.D. Department of Laboratory Medicine, Chungnam National University Hospital, 282 Moonhwa-ro, Joong-gu, Daejeon 35015, Korea. jmkim@cnuh.co.kr

Received: August 2, 2017; Revised: March 6, 2018; Accepted: May 10, 2018

Abstract

Background

Methods

Results

Conclusion

Keywords: Acute myeloid leukemia, Lymphocyte subset, NK cells, Prognosis

Abstract

Fig 1.

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Figure 1.

Correlation between bone marrow blast percentage and NK cell percentage.

Blood Research 2018; 53: 198-204https://doi.org/10.5045/br.2018.53.3.198

Fig 2.

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Figure 2.

Kaplan-Meier plots of disease free survival (A) and overall survival (B) in the subgroups according to the NK cell percentages.

Blood Research 2018; 53: 198-204https://doi.org/10.5045/br.2018.53.3.198

Table 1 Clinical and laboratory characteristics.

Continuous data are presented as median (range)..

Abbreviations: AML, acute myeloid leukemia; APL, acute promyelocytic leukemia; PBSCT, peripheral blood stem cell transplantation; WBC, white blood cell..

Table 2 Frequency distribution of lymphocyte subsets in peripheral blood according to the AML subtypes at diagnosis.

^a)Other AMLs excluded APL with t(15;17) and AML-MRC. ^b)AML with favorable risk excluded APL with t(15;17)..

Abbreviations: AML, acute myeloid leukemia; AML-MRC, acute myeloid leukemia with myelodysplasia-related changes; AML-NOS, acute myeloid leukemia, not otherwise specified; APL, acute promyelocytic leukemia; NK, natural killer..

Table 3 Clinical and laboratory data of the groups based on the proportion of NK cells in treated 71 non-APL patients.

Continuous data are presented as median (range)..

Abbreviations: APL, acute promyelocytic leukemia; DFS, disease free survival; Hb, hemoglobin; NK, natural killer; OS, overall survival; PBSCT, peripheral blood stem cell transplantation; WBC, white blood cell..

Table 4 Univariate and multivariate analyses to identify the factors affecting DFS and OS in 71 treated non-APL patients.

Continuous data are presented as median (range) and dichotomous data are presented as N (%)..

Abbreviations: APL, acute promyelocytic leukemia; BM, bone marrow; CI, confidence interval; DFS, disease free survival; HR, hazard ratio; NK, natural killer; OS, overall survival; PBSCT, peripheral blood stem cell transplantation; WBC, white blood cell..