Acute lymphoblastic leukemia (ALL) is the most common cancer in children, adolescents,
and young adults and remains the leading cause of cancer related death among the pediatric
group of patients [1]. Thus finding early predictive biomarkers is still important
to detect children with poor outcomes, for whom quickly altered treatment plans are
vital.
Gamma-delta (γδ) T cells are a recent topic of growing interest in the field of prediction
of a favorable outcome in numerous malignancies. Most of the studies have shown that
the amount of γδ T cells infiltrating solid tumors is a strong biomarker of good prognosis
for cancer patients [2, 3]. On the other hand, there are single reports demonstrating
their pro-tumor role and strong correlation with advanced tumor stages, lymph node
metastasis or poor outcome [4].
To our knowledge, no data have been reported to date on γδ T cell counts among pediatric
patients with acute leukemia at diagnosis. Similarly, no evidence has been presented
previously about lymphocytes and their correlation with already known risk factors
in childhood ALL. Due to these facts, we decided to evaluate these associations to
verify the potential use of selected subsets of γδ T cells (CD3+γδ , CD4+γδ, CD8+γδ)
as a novel and early biomarker of childhood leukemia severity.
This study was approved by the local research ethics committee. All samples were obtained
under written informed consent. Nineteen patients (9 male and 10 female) aged 2 to
18 years were recruited to the study. Diagnosis of acute lymphoblastic B-cell leukemia
was verified via cytological, cytochemical, and immunophenotyping methods. Blood samples
were collected before induction following protocol IA according to ALL IC BFM 2009.
In one of the patients BCR/ABL mutation was detected. At the end of the protocol,
13 of the patients were classified in the intermediate risk (IR) group, 5 in the high
risk (HR) group, and 1 patient in the standard risk (SR) group. Data regarding hematological
parameters were obtained from medical records. Due to the small group of patients,
we could not analyze correlations between γδ T cells and cytogenetic, immunophenotypic,
and central nervous system (CNS) status.
The control group consisted of 19 healthy people, aged 2–18 years (11 male and 8 female).
Children with active infection, acute/chronic diseases, receiving immunosuppressive
therapy or with oncological history were excluded.
Freshly obtained EDTA whole blood was stained using antibody cocktails as follows:
TCRγδ FITC (clone, IMMU510)/TCRαβ PE (clone, IP26A)/CD4 APC (clone, 13B8.2)/CD8 AF700
(clone, B9.11)/CD3 Krome Orange (clone, UCHT1). Samples were then lysed with the Immunoprep
Reagent Kit and TQPrep Workstation, measured with a Navios flow cytometer, and analyzed
with Kaluza software (all from Beckman Coulter, USA). For proper gating fluorescence
the minus one approach was used. First, lymphocytes were gated according to FSc/SSc,
and then CD3+/CD4+ and CD3+/CD8+ T lymphocytes were identified. Finally, for both
T CD4+ and T CD8+ lymphocytes, the percentage of TCRγδ+/TCRαβ– was noted.
Statistical analysis was performed using IBM SPSS 25. Depending on the distribution
of the variable, the nonparametric Mann-Whitney U test, Wilcoxon test, or parametric
Student’s t-test was used to compare the differences between the normal control and
leukemic patient group as well as differences among study groups. The correlation
between γδ and prognostic factors was analyzed by correlation coefficients (Spearman’s,
Pearson’s). A value of p < 0.05 indicated statistical significance.
We evaluated the association of γδ T cells with a series of clinical and hematological
agents. Interestingly, we observed differences in the percentage of CD8+ γδ depending
on age in leukemic patients (R = –0.67, p < 0.00) (Figure 1), but not in healthy controls
(p = 0.58). The same investigation showed no statistically significant differences
in the percentages of CD3+ γδ and CD4+ γδ lymphocytes between leukemic patients and
healthy controls.
Figure 1
Correlation of CD8+ γδ T cells with age among leukemic patients before treatment
We did observe a significant negative correlation between CD8+ γδ T cells at presentation
with a crucial prognostic factor in childhood ALL: minimal residual disease R = –0.53,
p = 0.018 (Figure 2).
Figure 2
Correlation of CD8+ γδ T cells with MRD before treatment
The same investigation showed no significant differences between CD3+ and CD4+ γδ
lymphocytes and the same risk factors.
Due to only 1 patient being classified in the standard risk group, he was excluded
from the evaluation.
The percentage of CD8+ γδ T cells at diagnosis was definitely higher in the IR group
relative to the HR group (median IR = 1.07 vs. median HR = 0.26, p = 0.03) (Figure
3).
Figure 3
CD8+ γδ T cells at diagnosis in the IR group vs. the HR group
Gamma-delta (γδ) T cells are a topic of growing interest due to their prognostic signature
of favorable outcome in numerous cancers [2]. To our knowledge, no data have been
reported to date on γδ T cell counts among pediatric patients with acute leukemia
at diagnosis. Similarly, no evidence has been presented previously about lymphocytes
and their correlation with already known risk factors in childhood ALL. Thus far,
γδ T cell counts have been examined in children with ALL following hematopoietic stem
cell transplantation (HSCT). The results of the study argued in support of a favorable
prognostic role for γδ T cells. γδ T cells have been found with increased frequency
in patients who proceed to become free of disease after HSCT compared to patients
with normal or decreased numbers of γδ T cells [5].
In our study we observed a higher percentage of CD8+ γδ T cells in younger patients.
This correlation was not observed in the control group. Taking into account the fact
that the explanation for the better outcome during the age of 1–6 and worse during
adolescence is still unclear, it could be a good introduction to further research
on lymphocytes’ involvement in the age-related response to leukemia treatment [6].
Apart from that, we found a strong negative correlation between CD8+ γδ T cells and
minimal residual disease (MRD), which is a key prognostic factor reflecting the number
of lymphoblasts in bone marrow on day 15 of treatment. The amount of CD8+ γδ T cells
in peripheral blood was increased in those who achieved a lower percentage of bone
marrow blasts on day 15 of chemotherapy. Additionally, an interesting finding was
definitely the higher percentage of CD8+ γδ T cells in the group of patients allocated
to the IR group relative to the HR group.
In conclusion, our data showed a higher percentage of CD8+ γδ T lymphocytes in patients
with favorable prognostic factors. We suppose that circulating CD8+ γδ T cells may
act as a novel early biomarker of good prognosis in childhood ALL in future.
Conflict of interest
The authors declare no conflict of interest.