Journal of Clinical Oncology, Vol 14, 1690-1696, Copyright © 1996 by American Society of Clinical Oncology
The CD4+/CD8+ ratio as a prognostic factor in patients with metastatic melanoma receiving chemoimmunotherapy
M Hernberg, T Muhonen, JP Turunen, M Hahka-Kemppinen and S Pyrhonen
Department of Oncology, Helsinki University, Central Hospital, Finland.
PURPOSE: As reported earlier, a chemotherapy regimen that consisted of
dacarbazine, vincristine, lomustine, and bleomycin (DOBC) combined with
natural leukocyte interferon (IFN) has been administered with favorable
results to patients with metastatic melanoma. In this study, lymphocyte
subsets (CD4+ and CD8+) were analyzed before and during treatment to
elucidate if alterations in the CD4+/CD8+ ratio had any prognostic value.
MATERIALS AND METHODS: Blood samples were systematically obtained from 54
patients with metastatic melanoma who received this chemoimmunotherapy. The
frequencies of peripheral-blood lymphocyte subsets were monitored by flow
cytometry using the monoclonal antibodies OKT4 (CD4+, T-helper cells) and
OKT8 (CD8+, T-suppressor cells). RESULTS: Twenty-seven patients had a
constantly increasing ratio, while the remaining 27 patients had a
fluctuating or constantly decreasing ratio. The former group had a median
survival time of 11.8 months, as compared with 6.5 months for the latter (P
= .008, log-rank test). This difference was generated among patients who
had an objective response. Responding patients with a constantly increasing
ratio had a median survival time of 21.7 months, as compared with 10.2
months for patients with no constant increase in the ratio (P = .038,
log-rank test). In nonresponders, no difference in survival was observed
between the two groups. CONCLUSION: The monitoring of early changes in the
CD4+/CD8+ ratio can provide valuable information that predicts the
prognosis of metastatic melanoma patients receiving chemoimmunotherapy.