Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:39pm-3:51pm
*Purpose: Hepatocellular carcinoma (HCC) recurrence after transplantation is associated with higher tumor grade on explant, failure to respond to DEB-TACE, and pretreatment lymphopenia. We prospectively monitored HCC patients in transplant evaluation to investigate associations between lymphopenia with treatment response and waitlist outcomes.
*Methods: HCC patients undergoing DEB-TACE were prospectively enrolled. Blood was collected before and after DEB-TACE (100-300µm LC Beads with 100mg doxorubicin). Peripheral blood mononuclear cells were analyzed by flow cytometry. Tumor response to DEB-TACE was determined using mRECIST imaging criteria. Intention-to-treat (ITT) endpoint included transplantation or tumor progression. Absolute lymphocyte count (ALC) was monitored from 3 years prior to LRT and on the day of treatment.
*Results: 91 patients with a median age 61, predominantly Caucasian (73%) with Hepatitis C (80%). Prior to DEB-TACE, 47% of patients were lymphopenic (ALC≤1.2k/μL). Pre-treatment ALC and lymphopenia status were associated with failure to respond to DEB-TACE (P=0.028, P=0.004). Overall, 69% of patients that did not respond to treatment were lymphopenic. These patients also exhibited significantly lower albumin (P=0.0017) and higher bilirubin (P=0.02) at the time of treatment. No significant changes were observed in lymphocyte count, albumin, and bilirubin levels between 3 years prior to HCC development, at the time of diagnosis, and day of treatment. Tolerogenic immune populations, myeloid derived suppressor cells (MDSC) and regulatory T cells were significantly elevated in lymphopenic patients (P=0.02 and P=0.001). Sixty patients reached ITT endpoint with 30/60 transplanted and 30/60 waitlist dropout due to tumor progression. In the ITT cohort, 61% of patients with unfavorable response to LRT experienced tumor progression.
*Conclusions: Lymphopenic status remains stable prior to HCC development and may be cirrhosis-driven. Patients presenting with lymphopenia and poor liver synthetic function can identify patients at risk for tumor progression prior to transplantation.
To cite this abstract in AMA style:Nunez K, Sandow T, Hibino M, Cohen A, Thevenot P. Cirrhosis-Driven Immune Dysfunction is Associated with Poor Response to DEB-TACE and Waitlist Dropout in Hepatocellular Carcinoma Patients While Awaiting Liver Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/cirrhosis-driven-immune-dysfunction-is-associated-with-poor-response-to-deb-tace-and-waitlist-dropout-in-hepatocellular-carcinoma-patients-while-awaiting-liver-transplantation/. Accessed March 6, 2021.
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