Lack of intrafollicular memory CD4 + T cells is predictive of early clinical failure in newly diagnosed follicular lymphoma

• DOI: 10.1038/s41408-021-00521-4
• Publication Date: 2021-07-15T10:04:57Z
• Authors: Patrizia Mondello; Angelo Fama; Melissa C. Larson; Andrew L. Feldman; Jose C. Villasboas; Zhi-Zhang Yang; Ilia Galkin; Viktor Svelolkin; Ekaterina Postova...; Alexander Bagaev; Pavel Ovcharov; Arina Varlamova; Sarah Huet; Bruno Tesson; Kaitlyn R. McGrath; Susan Slager; Brian K. Link; Sergei Syrbu; Anne J. Novak; Thomas M. Habermann; Thomas E. Witzig; Grzegorz S. Nowak...; Gilles Salles; James R. Cerhan; Stephen M. Ansell
• Keywords: Adult; Male; [SDV]Life Sciences [q-bio]; 610; Cancer microenvironment, CD4-positive T cells, Lymphoma, Follicular, Memory T Cells;; Article; Memory T Cells; Young Adult; 03 medical and health sciences; Tumor Microenvironment; Humans; Prospective Studies; Lymphoma, Follicular; RC254-282; Aged; Aged, 80 and over; 0303 health sciences; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; 600; Middle Aged; Prognosis; 3. Good health; Gene Expression Regulation, Neoplastic; CD4 Antigens; Female

AbstractDespite a characteristic indolent course, a substantial subset of follicular lymphoma (FL) patients has an early relapse with a poor outcome. Cells in the microenvironment may be a key contributor to treatment failure. We used a discovery and validation study design to identify microenvironmental determinants of early failure and then integrated these results into the FLIPI. In total, 496 newly diagnosed FL grade 1–3 A patients who were prospectively enrolled into the MER cohort from 2002 to 2012 were evaluated. Tissue microarrays were stained for CD4, CD8, FOXP3, CD32b, CD14, CD68, CD70, SIRP-α, TIM3, PD-1, and PD-L1. Early failure was defined as failing to achieve event-free survival at 24 months (EFS24) in immunochemotherapy-treated patients and EFS12 in all others. CyTOF and CODEX analysis were performed to characterize intratumoral immunophenotypes. Lack of intrafollicular CD4 expression was the only predictor of early failure that replicated with a pooled OR 2.37 (95%CI 1.48–3.79). We next developed a bio-clinical risk model (BioFLIPI), where lack of CD4 intrafollicular expression moved patients up one FLIPI risk group, adding a new fourth high-risk group. Compared with BioFLIPI score of 1, patients with a score of 2 (OR 2.17; 95% CI 1.08–4.69), 3 (OR 3.53; 95% CI 1.78–7.54), and 4 (OR 8.92; 95% CI 4.00–21.1) had increasing risk of early failure. The favorable intrafollicular CD4 T cells were identified as activated central memory T cells, whose prognostic value was independent from genetic features. In conclusion, lack of intrafollicular CD4 expression predicts early failure in FL and combined with FLIPI improves identification of high-risk patients; however, independent validation is warranted.