IMPACT OF THE PRE-TREATMENT CD4+ T-LYMPHOCYTE DEFICIENCY IN THE PERIPHERAL BLOOD ON THE RESULTS OF CHEMORADIOTHERAPY IN PATIENTS WITH HODGKIN’S LYMPHOMA

Introduction. CD4+ Т lymphocytopenia constitutes a well-known manifestation of immune disorders in classical Hodgkin’s lymphoma (HL); however, it is not considered as a risk factor in existing prognostic models. Studies established a connection between CD4+ T-lymphocytopenia (<0.2 × 109 /l) and a pronounced reduction in the life expectancy of cancer patients.

Aim. To assess the impact of initial CD4+ T-lymphocyte deficiency in the peripheral blood on the overall survival (OS) and progression-free survival (PFS) in HL patients.

Materials and methods. The authors performed a retrospective analysis of the prognostic significance of a reduced CD4+ T-lymphocyte count in the peripheral blood prior to treatment. The analysis included 162 HL patients who had undergone combined modality therapy at the A. Tsyb Medical Radiological Research Center (2000–2016). The analysis distinguished between moderate (0.2–0.4 × 109 / l) and severe (<0.2 × 109 /l) deficiency of CD4+ T-lymphocytes.

Results. Moderate and severe CD4+ -lymphopenia was observed in 36 (22 %) and 24 (15 %) of 162 patients, respectively. The CD4+ lymphocyte count of <0.2 × 109 /l was associated with age ≥45 years (p = 0.063), advanced disease stage (p = 0.03) and international prognostic index (IPS) ≥4 (p = 0.000). With a median follow-up of 72 months, patients with an initial CD4+ T-lymphocyte count of ≤0.4 × 109 /l showed a decrease in PFS and OS, as compared to the patients without CD4+ lymphopenia. In 6 patients with CD4+ lymphopenia from the group with unfavourable stages I–II HL (n = 29), PFS came to 50 % versus 95 % (p = 0.001), and OS decreased to 40 % versus 100 % (p = 0.000). In 53 patients with CD4+ deficiency from the group with stage III–IV HL (n = 120) PFS and OS were 57 % versus 83 % (p = 0.002) and 75 % versus 98 % (p = 0.004), respectively. In 32 (34 %) patients with CD4+ deficiency from the favourable prognostic subgroup including stage III–IV HL patients with IPS 0–3 (n = 94), 5-year PFS came to 66 % versus 84 % (p = 0.037) and OS decreased to 84 % versus 100 % (p = 0.117).

Conclusion. The association of CD4+ deficiency with the treatment failure in HL patients is important in the early stages of the disease, as well as in the subgroup of patients with stages III–IV HL (IPS 0–3). The modifications of risk-adapted therapy for a small cohort of patients with an initial decrease in CD4+ seem to be justified. 

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