Prognostic Immune Effector Signature in Adult Acute Lymphoblastic Leukemia Patients Is Dominated by ?d T Cells

The success of immunotherapy has highlighted the critical role of the immune microenvironment in acute lymphoblastic leukemia (ALL); however, the immune landscape in ALL remains incompletely understood and most studies have focused on conventional T cells or NK cells. This study investigated the prognostic impact of circulating ?d T-cell alterations using high-dimensional analysis in a cohort of newly diagnosed adult ALL patients (10 B-ALL; 9 Philadelphia(+) ALL; 9 T-ALL). Our analysis revealed common alterations in CD8(+) T cells and ?d T cells of relapsed patients, including accumulation of early stage differentiation and increased expression of BTLA and CD73. We demonstrated that the circulating ?d T-cell signature was the most discriminating between relapsed and disease-free groups. In addition, Vd2 T-cell alterations strongly discriminated patients by relapse status. Taken together, these data highlight the role of Gd T cells in adult ALL patients, among whom Vd2 T cells may be a pivotal contributor to T-cell immunity in ALL. Our findings provide a strong rationale for further monitoring and potentiating Vd2 T cells in ALL, including in the autologous setting.