T-helper phenotypes in the blood of myeloma patients on ECOG phase III trials E9486/E3A93

T-helper blood populations are frequently altered in multiple myeloma (MM), We measured the numbers of naive and activated cell subsets in the blood of a cohort of both previously untreated and treated MM patients. Two-colour now cytometry to detect total CD4(+), CD4(+), CD45RA(+) (naive) and CD4(+), CD45RO(+) (activated) subsets was then used to quantify the T-cell subsets in controls and MM patients. Previously treated MM patients either on or off treatment (n=105) had significantly reduced (P<0.0001) total CD4 and naive/activated cells than controls. Previously treated MM patients sampled for naive/activated cells while currently off therapy (n=45) had no difference in the levels of CD4 and naive/activated cells compared to the currently treated patients (n=60). However, newly diagnosed patients (n=58) had a significantly reduced total CD4 (P=0.023) and activated CD4 (P=0.004), but not naive CD4 subsets, compared to controls. CD19(+) cell levels above 125/mu l were positively associated with higher T-helper cell levels. There was a strong positive association for better overall survival for patients with >395 CD4 cells/mu l (P=0.0001). These data indicate that MM patients at diagnosis have altered T-helper subsets, with a selective reduction in activated but not naive cells. Subsequent chemotherapy or the disease process contributes to a further reduction in CD4 cells. Importantly, the association of higher CD19(+) cell levels with higher T helper cells indicates that certain myeloma patients can be identified with a more quantitatively intact immune system.