Monocytosis Has Adverse Prognostic Significance and Impacts Survival in Patients with T-Cell Lymphomas.

Abstract 2647

New data concerning the important role of microenvironment on lymphoma growth are emerging, and in recent years surrogate biomarkers have been identified as prognostic factors for survival in non-Hodgkin lymphoma (NHL). Unlike follicular (FL), diffuse B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL), there is still no specific internationally accepted risk stratification scoring system for peripheral T-cell lymphomas (PTCL), and the International Prognostic Index (IPI) or the Prognostic Index for T-cell lymphomas (PIT) model are been used to identify higher risk cases of PTCL. Here we retrospectively analyzed the relevance of the well recognized prognostic parameters for T-NHL in 172 patients with different types of PTCL. In 94 cases in whom peripheral blood monocyte count (PBMC) at diagnosis was available, we evaluated whether monocytosis (PBMC >800/mm³) could be used as a simple prognostic factor for overall survival (OS) and outcome in PTCL.

For the entire group with a median follow-up of 19 months (range 1–168 months), the 5-years OS was 42%, and the median OS 48 months. Monocytosis was present in 23% of the evaluable cases and patients with high PBMC (>800/mm³) at diagnosis had a worse OS (median 12 months) compared to those with PBMC < 800/mm³.This difference showed strong statistical significance (p=0.003) (Fig 1) and the Hazard ratio (HR) for PBMC >800/mm³, stratified by histopathological subtype, was 2.81. In particular 3-years OS of patients with PBMC >800/mm³ with anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma, and peripheral T-cell lymphoma not otherwise specified was 50%, 25%, and 12%, respectively compared to 86%, 65%, and 50% for those patients with PBMC <800/mm³. In univariate analysis age >60y, advanced stage, bone marrow involvement, ECOG PS >1, LDH>UNL, PBMC >800/mm³, hemoglobin <12 gr/dL, albumin <3.5 gr/L were associated with inferior OS. In multivariate analysis, monocytosis alone retained a negative prognostic value even when adjusted for PIT and stratified by histolopathological subtype (HR 2.41, p=0.015).

In this study, as in others on B-NHL and HL, monocytosis had an independent negative impact on survival in patients with T-NHL. This data, which provide convincing support for the use of monocytosis as a simple prognostic parameter, now need to be further validated in a larger cohort of patients with T-NHL.

Figure 1:

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Overall survival (OS) of 94 patients with PTCL according to peripheral blood monocyte count (PBMC): monocytosis (PBMC >800/mm³) has a negative impact on OS (p=0.003)

Figure 1:

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Overall survival (OS) of 94 patients with PTCL according to peripheral blood monocyte count (PBMC): monocytosis (PBMC >800/mm³) has a negative impact on OS (p=0.003)

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