The prognostic significance of CD11bCX3CR1 monocytes in patients with newly diagnosed diffuse large B-cell lymphoma.

Despite their critical roles in angiogenesis and host immunosuppression within the tumor microenvironment, the prognostic significance of myeloid-lineage cells expressing CD11b and CX3CR1 in diffuse large B-cell lymphoma (DLBCL) has not been well studied. We prospectively enrolled newly-diagnosed DLBCL patients at two Korean institutions between May 2011 and Aug 2015. CD11bCX3CR1 cells were analyzed by flow cytometry using peripheral blood (PB) and bone marrow (BM) aspirate samples before treatments. Eighty-nine patients (52 males) were enrolled. The median age was 65 years (range, 19-88 years). Thirty-seven patients (42%) were classified as high-intermediate or high risk according to the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI). Patients were categorized into either high or low PB-/BM-CD11bCX3CR1 monocyte group according to the cutoffs identified by the receiver-operating-characteristics analysis (PB, 3.68%; BM, 3.45%). The high PB-CD11bCX3CR1 monocyte group was significantly associated with high-intermediate and high risk NCCN-IPI group ( = 0.004). With a median follow-up of 27.7 months (range, 1.7-60.4 months), the low PB-CD11bCX3CR1 monocyte group showed significantly better overall survival (OS) than the high PB-CD11bCX3CR1 monocyte group (3-year, 92.3% 51.2%, respectively; < 0.001). In contrast, no significant difference was observed between the high and low BM-CD11bCX3CR1 monocyte groups. Among patients with high-intermediate to high risk NCCN-IPI, the high PB-CD11bCX3CR1 monocyte group showed significantly worse OS than the low PB-CD11bCX3CR1 monocyte group (3-year, 29.3% 80.2%, respectively; = 0.008). Taken together, PB-CD11bCX3CR1 monocyte percentage correlates with the NCCN-IPI risk stratification, which enables identification of subgroups with extremely poor clinical outcomes.