Originally published as JCO Early Release 10.1200/JCO.2007.10.7219 on April 30 2007

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Prognostic Significance of Immune Subset Measurement in Individuals With AIDS-Associated Kaposi's Sarcoma

Justin Stebbing, Adam Sanitt, Alastair Teague, Tom Powles, Mark Nelson, Brian Gazzard, Mark Bower

From the Imperial College of Science, Medicine, and Technology, Departments of Oncology and HIV Medicine, The Chelsea and Westminster Hospital, London, United Kingdom

Address reprint requests to Justin Stebbing, MA, MRCP, MRCPath, PhD, Imperial College of Science, Medicine, and Technology, Charing Cross Hospital, Department of Oncology, First Floor, East Wing, Fulham Palace Rd, London W6 8RF, United Kingdom; e-mail: j.stebbing{at}imperial.ac.uk

Purpose A prognostic index for AIDS-associated Kaposi's sarcoma (KS) diagnosed in the era of highly active antiretroviral therapy (HAART) was based on routine clinical and laboratory characteristics. Because immune subset measurement is often performed in HIV-positive individuals, we examined whether these were predictive of mortality independently of the prognostic index, or could predict time to progression of KS.

Patients and Methods We performed univariate and multivariate Cox regression analyses on a data set of 326 individuals with AIDS-associated KS to identify immune subset covariates predictive of overall survival and time to progression. Adaptive (CD8 T cell and CD19 B cell) and innate (CD16/56 natural-killer cell) immune parameters were studied by flow cytometry.

Results In univariate analyses, all three immune subsets had significant effects on overall survival (P < .025). In multivariate analyses including the prognostic index, only CD8 counts remained significant (P = .026), although its effect on the overall prognostic index is small. An increase of 100 cells/mm³ in the CD8 count confers a 5% improvement in overall survival. Individuals with a higher CD8 count did not have an increased time to progression. Patients who were already on HAART at the time of KS diagnosis did not have a shorter time to progression than those who were antiretroviral naïve at KS diagnosis.

Conclusion The CD8 count appears to provide independent prognostic information in individuals with AIDS-associated KS. Measurement of the CD8 count is clinically useful in patients with KS.

published online ahead of print at www.jco.org on April 30, 2007

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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