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DUSP22 AND TP63 REARRANGEMENTS PREDICT OUTCOME OF ALK‐NEGATIVE ANAPLASTIC LARGE CELL LYMPHOMA: A DANISH COHORT STUDY

useful information for assessing prognosis. Meanwhile, data of the role of specific circulating lymphocyte subsets as host immune factor in the progression of ENKTL is limited. This study aims to investigate the clinical correlation and distribution of circulating absolute CD4 T cell counts (ACD4C) in ENKTL. Methods: We retrospectively searched the medical records of 88 patients with untreated ENKTL diagnosed at the Department of Hematology at the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) from August 1, 2009 to May 31, 2016. The distribution and prognostic value of ACD4C at diagnosis was analyzed. Results: The result showed that low ACD4C at diagnosis was significantly associated with stage III/IV (P = 0.001), B symptoms (P = 0.020), elevated serum lactate dehydrogenase (LDH) (P < 0.001), regional lymphadenopathy (P = 0.015), high‐intermediate and high‐risk International Prognosis Index (IPI) (P < 0.001) and Korean Prognostic Index (KPI) (P < 0.001). As well, we also found that low ACD4C have significant link to decreasing monocytes (P = 0.001), anemia (P = 0.049) and thrombocytopenia (P = 0.014). There were significant differences in both overall survival (OS) (P < 0.001) and progression‐ free survival (PFS) (P < 0.001) between ACD4C < 0.3 × 10/L cohort and ACD4C ≥ 0.3 × 10/L cohort (Fig. A and B). With the median follow‐up time of 33 months, patients who had ACD4C < 0.30 × 10/L had worse survival with the 3‐year OS of 36.9% versus 81.2% in patients with high ACD4C, and the 3‐year PFS of 32.1% versus 67.0%. The 5‐year OS and PFS were 36.9% vs. 62.8% and 24.1% vs. 67.0% between ACD4C < 0.3 × 10/L cohort and ACD4C0.3 × 10/L cohort, respectively. The median OS time was 14 months, and the median PFS was 5.5 months in low ACD4C cohort, while the median OS and PFS were not reached in ACD4C ≥ 0.3 × 109/L cohort. In univariate analysis, the results also demonstrated that B symptoms, poor PS, stage III/IV, primary extranasal presentation, regional lymphadenopathy, anemia, high and intermediate‐high risk IPI and KPI were related with worse OS and PFS. Moreover, the multivariate Cox analysis identified the ACD4C as an independent predictor for OS (P = 0.029; relative risk, 2.632; 95% CI 1.104–6.276) and PFS (P = 0.010; relative risk, 2.719; 95% CI 1.264–5.849). Conclusions: This retrospective study demonstrated that low ACD4C as important immune factor was associated with poorer survival and could act as a negative predictor for patients with ENKTL. It was supposed that ACD4C play an important role in the pathogenesis and progression of ENKTL.