Increased Survival From Stage IV Melanoma Associated With Fewer Regulatory T Cells

BackgroundMelanoma often elicits a profound immune response, and this response has been exploited by various immune therapies. These immunotherapies ultimately fail, however, and advanced melanoma is uniformly fatal, suggesting the development of an immune escape mechanism. In this study, markers of immune escape including regulatory T cells (Tregs), dendritic cells (DCs), and TGF-β were evaluated in 14 Stage IV melanoma patients and correlated with survival.Materials and methodsPeripheral blood mononuclear cells were isolated from Stage IV melanoma patients and analyzed for Tregs and DCs by flow cytometry using fluorescent CD3, CD4, CD25, Lin, HLA-DR, CD11c, and CD123 antibodies. Serum TGF-β levels were evaluated by ELISA from these patients. Clinical data were extracted from the patients' medical records.ResultsStage IV melanoma patients with shorter survival (less than 24 mo) had a significantly higher proportion of Tregs than those with longer survival (15% versus 8%, respectively, P = 0.004). The numbers of DCs and the serum TGF-β levels were not significantly different in these two groups. There was an inverse relationship between the percentage of Tregs and survival, although this did not reach statistical significance (r = −0.35, P = 0.22). There was also an inverse relationship between peripheral Tregs and DCs. When patients were divided into groups of greater than or less than 7% Tregs, the number of total DCs was higher in the patients with fewer Tregs than in those with more Tregs, but this did not reach statistical significance (16,535 versus 12,126 total DCs/mL, P = 0.52).ConclusionsIn Stage IV melanoma patients, a high percentage of Tregs appears to be associated with shorter survival. The inverse relationship of the number of DCs and Tregs in these patients may provide an insight to the origin of this observation.