Session Item

Soluble biomarker testing has a prognostic potential in several hematological malignancies. Here, we examined the level of selected biomarkers in mycosis fungoides (MF), Sézary syndrome (SS) patients and their correlation with treatment outcomes in the S-MISR prospective study (Soluble-biomarkers for Mycosis fungoides and Sézary syndrome patients during and after Radiotherapy).

MF/SS patients received total skin electron beam therapy between 2019 and 2022 at our institute were prospectively recruited (The local ethics committee approved the study protocol). Soluble programmed death-ligand 1 (sPD-L1), soluble CD30 (sCD30), soluble thymus and activation-related chemokine (sTARC), and soluble cytotoxic T lymphocyte-associated antigen-4 (sCTLA-4) were determined before and after treatment with radiotherapy. Disease burden was evaluated with the median modified severity weighted assessment tool (mSWAT). ROC curve analysis was used evaluate the predicting accuracy of different biomarkers and the Youden's index was used determine the optimal biomarkers’ cut-off point.  The data has been analyzed according to REMARK guidelines.

252 serum samples of sixty-three patients with MF/SS were collected and evaluated by immunoassay. Sixty-three (100%), 48 (76%), and 41 (65%) patients had baseline, post-radiation, and last follow-up samples, respectively. The median follow-up for this analysis was 12 months. The median age was 63 years (range: 38-87). The patient population consisted of 52 (83%) MF and 11 (17%) SS patients. The baseline concentrations of sPD-L1, sCD30, and sTARC biomarkers are significantly higher in MF/SS patients than in healthy individuals. Low baseline sPD-L1 and sCD30 levels were associated with higher response rates (P<0.05). At the end of treatment. The level of sPD-L1, sCD30, and sTARC concentrations was associated with the clinical outcome (Figure 1). In a Cox proportional hazard model, CLIC-risk group, ECOG score, baseline WBC count, CRP level, posttherapy level of sPD-L1, sCD30, sTARC, sCTLA-4, sIL-2R: soluble interleukin 2 receptor, interleukin 6, and clinical response to radiotherapy were included. In the multivariate analysis, the posttherapy sPD-L1 and sCD30 levels were associated with progression-free survival (PFS). At the same time point, the sTARC level and ECOG score proved to be significant determinants of overall survival (OS).

Abbreviations: complete remission (CR), very good partial response (VGPR), partial remission, stable disease (SD), and disease progression (PD).

Figure 1: The level of soluble biomarkers’ concentrations in healthy individuals and according to posttherapy outcome in treated patients (N=63).

Baseline sPD-L1 and sCD30 have to be considered as a promising predictive biomarker in MF/SS. sCD30, sTARC values reduced significantly following successful
treatment and significantly increased upon progression or relapse. Posttherapy sPD-L1, sCD30, and sTARC could identify patients with shorter survivals.