Receiver operating characteristic curve analysis of circulating blood dendritic cell precursors and T cells predicts response to extracorporeal photopheresis in patients with chronic graft-versus-host disease

• Authors: Mojtaba Akhtari, Emory University; Cynthia R Giver, Emory University; Zahir Ali, Emory University; Christopher R Flowers, Emory University; Charise Gleason, Emory University; Christopher D. Hillyer, Emory University; Jonathan Kaufman, Emory University; H Jean Khoury, Emory University; Amelia A Langston, Emory University; Mary Jo Lechowicz, Emory University; Sagar Lonial, Emory University; Heather M. Renfroe, Emory University; John D Roback, Emory University; Mourad Tighiouart, Emory University; Louette Vaughn, Emory University; Edmund K Waller, Emory University
• Journal Title: Transfusion
• Volume: Volume 50, Number 11
• Publisher: Wiley | 2010-11, Pages 2424-2431
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/j.1537-2995.2010.02712.x
• Subjects: Health Sciences, Oncology; Health Sciences, Pathology

Abstract

BACKGROUND One proposed mechanism of extracorporeal photopheresis (ECP) in reducing chronic graft-versus-host disease (cGVHD) is alteration in numbers of circulating dendritic cells (DCs). This hypothesis was tested by correlating numbers of DC precursors and T cells in the blood before and during ECP therapy with response of cGVHD. STUDY DESIGN AND METHODS Twenty-five patients with cGVHD were treated with ECP. Data were collected with emphasis on blood cellular markers, clinical response to ECP, and overall survival. RESULTS Fourteen patients (56%) responded and had better 2-year survival than nonresponders (88% vs. 18%, p = 0.003). Responders had higher baseline circulating myeloid DC (mDC) and plasmacytoid DC precursors and CD4+ and CD8+ T cells compared with nonresponders. Receiver operating characteristic curve analyses showed that the best baseline cutoff values to predict response to ECP were mDC counts of 3.7 cells/µL (79% sensitivity, 82% specificity) and CD4+ T-cell counts of 104 cells/µL (71% sensitivity, 82% specificity). CD4+ T cells declined in responders over time, but not in nonresponders, and no significant changes were seen in CD8 T-cell or DC numbers over a 12-month period in responder or nonresponder groups. CONCLUSIONS Higher baseline numbers of circulating DCs and T cells may predict clinical response to ECP in patients with cGVHD.