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Haematologica. 2019 Feb;104(2):338-346. doi: 10.3324/haematol.2018.200105. Epub 2018 Sep 20.

T-cell inflamed tumor microenvironment predicts favorable prognosis in primary testicular lymphoma.

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Research Program Unit, Medical Faculty, University of Helsinki, Finland.
Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Finland.
Department of Oncology, Tampere University Hospital, Finland.
Hematology Research Unit Helsinki, Department of Clinical Chemistry and Hematology, University of Helsinki, Finland.
Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland.
Department of Pathology, Helsinki University Hospital, Finland.
University of Tampere, Faculty of Medicine and Life Sciences, Finland.
Science for Life Laboratory, Karolinska Institutet, Department of Oncology and Pathology, Solna, Sweden.
Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Finland.
Research Program Unit, Medical Faculty, University of Helsinki, Finland


Primary testicular lymphoma is a rare lymphoid malignancy, most often, histologically, representing diffuse large B-cell lymphoma. The tumor microenvironment and limited immune surveillance have a major impact on diffuse large B-cell lymphoma pathogenesis and survival, but the impact on primary testicular lymphoma is unknown. Here, the purpose of the study was to characterize the tumor microenvironment in primary testicular lymphoma, and associate the findings with outcome. We profiled the expression of 730 immune response genes in 60 primary testicular lymphomas utilizing the Nanostring platform, and used multiplex immunohistochemistry to characterize the immune cell phenotypes in the tumor tissue. We identified a gene signature enriched for T-lymphocyte markers differentially expressed between the patients. Low expression of the signature predicted poor outcome independently of the International Prognostic Index (progression-free survival: HR=2.810, 95%CI: 1.228-6.431, P=0.014; overall survival: HR=3.267, 95%CI: 1.406-7.590, P=0.006). The T-lymphocyte signature was associated with outcome also in an independent diffuse large B-cell lymphoma cohort (n=96). Multiplex immunohistochemistry revealed that poor survival of primary testicular lymphoma patients correlated with low percentage of CD3+CD4+ and CD3+CD8+ tumor-infiltrating lymphocytes (P<0.001). Importantly, patients with a high T-cell inflamed tumor microenvironment had a better response to rituximab-based immunochemotherapy, as compared to other patients. Furthermore, loss of membrane-associated human-leukocyte antigen complexes was frequent and correlated with low T-cell infiltration. Our results demonstrate that a T-cell inflamed tumor microenvironment associates with favorable survival in primary testicular lymphoma. This further highlights the importance of immune escape as a mechanism of treatment failure.

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