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(+)T 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 x 10(9)/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 x 10(9)/l) and severe (<0.2 x 10(9)/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 x 10(9)/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 x 10(9)/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.