The prospective prognostic value of the immune checkpoint BTLA expression in adult acute myeloid leukemia patients

Abstract

Background: One of the crucial functions of the immune system is to prevent tumorigenesis, yet cancer occurs when malignant cells manage to evade immune surveillance via multiple strategies. Accordingly, this study aimed at assessing the potential signifcance of the novel immune checkpoint B and T lymphocyte attenuator (BTLA) as a prog‑ nostic marker in acute myeloid leukemia (AML), in addition to how it relates to response to treatment and patients’ survival. Thus, mRNA expression of BTLA was investigated on peripheral blood in 60 AML patients and 15 healthy controls. Results: BTLA expression was found to be signifcantly elevated (p=0.024) in the tested AML cases in comparison with healthy controls. Moreover, BTLA was over-expressed in the CD13, CD33, and HLA-DR positive cases as compared to their negative counterparts (p=0.003; p<0.001, and p=0.001, respectively), and cases showing BTLA over-expres‑ sion had signifcantly poorer overall survival times (p=0.001) as confrmed by Kaplan–Meier survival analysis. Conclusion: These observations suggest that BTLA over-expression may be associated with reduced immunity against tumors and could be recommended as a promising biomarker for unfavorable prognosis in AML. Keywords: Immune checkpoints, T-cells, B and T lymphocyte attenuator (BTLA), Acute myeloid leukemia