Proliferating CD8+ T Cell Infiltrates Are Associated with Improved Survival in Glioblastoma

Background: tumor-infiltrating lymphocytes are prognostic in many human cancers. However, the prognostic value of lymphocytes infiltrating glioblastoma (GBM), and roles in tumor control or progression are unclear. We hypothesized that B and T cell density, and markers of their activity, proliferation, differentiation, or function, would have favorable prognostic significance for patients with GBM. Methods: initial resection specimens from 77 patients with IDH1/2 wild type GBM who received standard-of-care treatment were evaluated with multiplex immunofluorescence histology (mIFH), for the distribution, density, differentiation, and proliferation of T cells and B cells, as well as for the presence of tertiary lymphoid structures (TLS), and IFN gamma expression. Immune infiltrates were evaluated for associations with overall survival (OS) by univariate and multivariate Cox proportional hazards modeling. Results: in univariate analyses, improved OS was associated with high densities of proliferating (Ki67(+)) CD8(+) cells (HR 0.36, p = 0.001) and CD20(+) cells (HR 0.51, p = 0.008), as well as CD8(+)Tbet(+) cells (HR 0.46, p = 0.004), and ROR gamma t(+) cells (HR 0.56, p = 0.04). Conversely, IFN gamma intensity was associated with diminished OS (HR 0.59, p = 0.036). In multivariable analyses, adjusting for clinical variables, including age, resection extent, Karnofsky Performance Status (KPS), and MGMT methylation status, improved OS was associated with high densities of proliferating (Ki67(+)) CD8(+) cells (HR 0.15, p < 0.001), and higher ratios of CD8(+) cells to CD4(+) cells (HR 0.31, p = 0.005). Diminished OS was associated with increases in patient age (HR 1.21, p = 0.005) and higher mean intensities of IFN gamma (HR 2.13, p = 0.027). Conclusions: intratumoral densities of proliferating CD8 T cells and higher CD8/CD4 ratios are independent predictors of OS in patients with GBM. Paradoxically, higher mean intensities of IFN gamma in the tumors were associated with shorter OS. These findings suggest that survival may be enhanced by increasing proliferation of tumor-reactive CD8(+) T cells and that approaches may be needed to promote CD8(+) T cell dominance in GBM, and to interfere with the immunoregulatory effects of IFN gamma in the tumor microenvironment.