Multi-institutional Investigation: Circulating CD4:CD8 ratio is a prognosticator of response to total skin electron beam radiation in mycosis fungoides.

ABSTRACT: BACKGROUND AND PURPOSE:A lower proportion of CD8+ tumor infiltrating lymphocytes in mycosis fungoides (MF) patients is associated with worse survival. However, it is not known whether circulating CD4:CD8 ratio is a prognosticator of response to total skin electron beam therapy (TSEBT). METHODS AND MATERIALS:We identified 126 MF patients treated with TSEBT from 2001 to 20014 at two high-volume academic centers. Circulating CD4:CD8 ratio was obtained within 1?week before TSEBT. TSEBT was delivered with 6-9mEV electrons with low (12?Gy) or conventional (?12?Gy) doses. Treatment response was assessed with the modified Severity Weighted Assessment Tool (mSWAT). Post-treatment mSWAT decrease of ?75% was classified as near complete response (CR) while mSWAT decrease of <75% was considered partial response (PR). Receiver operating characteristic analysis determined an optimal CD4:CD8 threshold value to predict TSEBT response in the derivation cohort and was applied to an external validation cohort. RESULTS:71.4% and 28.6% of patients achieved CR and PR after TSEBT. Higher CD4:CD8 ratio predicted poorer response: median CD4:CD8 in patients with PR vs. CR was 4.84 vs. 1.97 (p?=?0.002). A threshold CD4:CD8 of 4.42 optimally discriminated in the discovery cohort patients with PR vs. XR (sensitivity 90%, specificity 59%, area under curve (AUC)?=?0.71; p?=?0.002). Within an independent test cohort (n?=?32), 73.9% of patients with CD4:CD8 <4.42 achieved CR vs. 33.3% of those with CD4:CD8 ?4.42 (p?=?0.033). Among all patients with CD4:CD8 <4.42 (n?=?73), 74% achieved CR with low-dose TSEBT vs. 93% with conventional dose TSEBT (p?=?0.02). On multivariable logistic regression, CD4:CD8 remained a significant independent predictor of TSEBT response in all patients (OR?=?0.107, 95% CI 0.395-0.290, p?

SUBMITTER: An Y 

PROVIDER: S-EPMC6662194 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature