Lymphocyte subpopulations: a potential predictor of a response in patients with immune thrombocytopenia

ABSTRACT

Objectives

Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder caused by increased platelet destruction and altered production. Despite the well-described pathophysiological background of immune dysregulation, current treatment guidelines consist of monotherapy with different drugs, with no tool to predict which patient is more suitable for each therapeutic modality.

Methods

In our study, we attempted to determine differences in the immune setting, comparing the patients’ responses to administered therapy. During 12-month follow-up, we assessed blood count, antiplatelet autoantibodies, and T lymphocyte subsets in peripheral blood in 35 patients with ITP (newly diagnosed or relapsed disease).

Results

Our data show that the value of antiplatelet autoantibodies, the percentage of cytotoxic T lymphocytes, and the immunoregulatory index (IRI, CD4+ / CD8+ T cell ratio) differ significantly by treatment response. Responders have a higher IRI (median 2.1 vs. 1.5 in non-responders, P = 0.04), higher antiplatelet autoantibodies (median 58 vs. 20% in non-responders, P = 0.01) and lower relative CD8+ T cells count (P = 0.02) before treatment.

Discussion

The results suggest that immunological parameters (antiplatelet autoantibodies, relative CD8+ T cell count and IRI) could be used as prognostic tools for a worse clinical outcome in patients with ITP.

Conclusion

These biomarkers could be utilized for stratification and eventually selection of treatment preferring combination therapy.

KEYWORDS:

• Immune thrombocytopenia
• lymphocyte subpopulations
• antiplatelet autoantibodies
• immunoregulatory index

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

All authors contributed to the conception and design. Material preparation, data collection, and analysis were performed by OS, KJ, LKK, and MG. The first draught of the manuscript was written by KŽ, OS and MK and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Conflict of interest

KŽ, OS, KJ, LKK, MG, MAP, JD and DN have no financial and nonfinancial interests to disclose. MK received speaker and consultant honoraria from the pharmaceutical companies Novartis and Amgen.

Informed Consent

Informed consent was obtained from all subjects involved in the study.

Data availability

Data supporting the findings of this study are available from the corresponding author on a reasonable request.

Additional information

Funding

This work was supported by Ministerstvo Zdravotnictví Ceské Republiky [grant number: 00179906]; Cooperatio research program - area ONCO.