Andrea Lisco, United States of America

National Institutes of Health National Institute of Allergy and Infectious Diseases

Presenter of 1 Presentation

E-Poster Discussion Malignancy and PID

SPECTRUM OF MALIGNANCIES IN IDIOPATHIC CD4 LYMPHOPENIA REVEALS AN ASSOCIATION WITH HPV INFECTION AND WITH LOWER CD4 AND CD8 T CELL COUNTS

Lecture Time
13:22 - 13:29
Room
Station 2
Date
19.09.2019, Thursday
Session Time
13:15 - 14:20
Presentation Topic
Malignancy and PID

Abstract

Background and Aims

Idiopathic-CD4-lymphopenia (ICL, CD4-T-cells<300μL without known cause), is a heterogenous clinical syndrome characterized by an increased risk of opportunistic infections. We hypothesized that ICL would also be associated with an increased risk of malignancies.

Methods

The prevalence of solid-organ-cancers and lymphoproliferative-disorders was evaluated in the NIH-ICL-cohort and compared with age-adjusted-rates from the Surveillance-Epidemiology-and-End-Results-database (SEER). T- and NK-cells immunophenotyping was performed in healthy-subjects (HC), ICL-patients with (ICL-CA) or without (ICL-nCA) malignancies.

Results

30 solid-organ-cancers and 3 lymphoproliferative-disorders were identified in 22 of the 90 ICL patients (24%): 6 ICL-CA had synchronous/metachronous malignancies. Squamous-cell carcinomas [SCC-skin, -anogenital, -head/neck] were the most common malignancies (n=14) in addition to other non-melanoma-skin-cancers (NMSC) [basal-cell-carcinoma (n=8), verrucous-carcinoma (n=3) and Kaposi`s sarcoma]. Papillary-thyroid-cancer, breast-lobular-adenocarcinoma, soft-tissue-sarcoma and thymoma were other solid-organ cancers identified. ICL had higher prevalence of malignancies (even excluding NMSC not recorded in SEER) compared to the general population (14.4% vs 3.6%, p<0.001). ICL-CA had higher prevalence of HPV-related-diseases (59 vs 26%, p<0.05), but not of other opportunistic infections compared to ICL-nCA (45% vs 44%). Although age (45 vs 44 years) and follow-up (5 years) were similar, the CD4- and CD8-T-cells were lower in ICL-CA compared to ICL-nCA (39 vs 104cells/μL; 63 vs 169cells/μL respectively, p<0.01). ICL-CA had a lower proportion of effector-memory-CD4-T-cells expressing the skin-homing receptor CLA but not the gut-homing receptor CCR9, compared to ICL-nCA. ICL-CA had also a lower proportion of CLA+CD56dim-NK-cells compared to HC.

Conclusions

The increased prevalence of malignancies and HPV-related-diseases in ICL is associated with lower numbers and altered trafficking of CD4- and CD8-T-cells.

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