Cellular immune profiling after sequential clofarabine and lenalidomide for high risk myelodysplastic syndromes and acute myeloid leukemia Prachi Jain,

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Cellular immune profiling after sequential clofarabine and lenalidomide for high risk myelodysplastic syndromes and acute myeloid leukemia Prachi Jain, Jeffrey Klotz, Neil Dunavin, Kit Lu, Eleftheria Koklanaris, Debbie Draper, Jeanine Superata, Fariba Chinian, Quan Yu, Keyvan Keyvanfar, Susan Wong, Pawel Muranski, A. John Barrett, Sawa Ito, Minoo Battiwalla Leukemia Research Reports Volume 7, Pages 40-44 (January 2017) DOI: 10.1016/j.lrr.2017.04.003 Copyright © 2017 Terms and Conditions

Fig. 1 Lympho-depleting effect of clofarabine. A. PBMC samples (n=4), were collected pre clofarabine(pre-clo) and 28–42 days post clofarabine(post clo). Analysis of post clofarabine samples showed persistently low (UPN1 and UPN2, stable disease) and decreased (UPN3, partial response) absolute lymphocyte counts. In contrast absolute lymphocyte count was increased in UPN4 (refractory disease). B. All lineages of lymphocytes, CD4 T cells, CD8 T cells, NK cells and B cells were decreased in subjects with stable disease (SD) and partial responder (PR),however CD4 T cells, CD8 T cells, and NK cells were increased in subject with resistant disease (RD). Leukemia Research Reports 2017 7, 40-44DOI: (10.1016/j.lrr.2017.04.003) Copyright © 2017 Terms and Conditions

Fig. 2 Restoration of NK cell repertoires after clofarbine treatment. A.CD56brightNK cells were increased in all subjects. B. CD56dimNK cells were unchanged or decreased in subjects with stable disease and partial responder. In contrast, CD56dimNK cells were increased in subject with refractory disease. C. CD56dimCD57+NK cells were increased in only subject with refractory disease (UPN4). D. CD56dimLIR1+NK cells were increased in only subject with refractory disease (UPN4). Leukemia Research Reports 2017 7, 40-44DOI: (10.1016/j.lrr.2017.04.003) Copyright © 2017 Terms and Conditions

Fig. 3 Trend in absolute lymphocyte count (ALC), absolute monocyte count (AMC), PD1+CD4 T cells, and CD57+LIR+NK cells through the study period. A. Peripheral blood counts in UPN1 showed lympho-depletion post clofarabine with stable recovery of lymphocytes and monocyte counts during lenalidomide therapy. In addition, steady decline in absolute number of PD1+CD T cells was found through the lenalidomide therapy. B. In UPN2, lenalidomide therapy was delayed due to neutropenia. There was a reciprocal rise in absolute number of PD1+CD4 T cells after lenalidomide therapy. Leukemia Research Reports 2017 7, 40-44DOI: (10.1016/j.lrr.2017.04.003) Copyright © 2017 Terms and Conditions