Elevated TCR-αβ⁺ double-negative T cells in pediatric patients with acquired aplastic anemia

The pathophysiology of acquired aplastic anemia (aAA) is most associated with T cell mediated immune dysfunction, but the role of CD4^- CD8^- double negative T cells (DNTs) in pediatric patients with aAA is unclear. In this study, we aimed to investigate the proportion of TCR-αβ⁺ DNTs in pediatric patients with aAA and correlation with the response to immunosuppressive therapy (IST).

Assessment of DNTs from peripheral blood was done by sensitive multi-color flow cytometry. The potential clinical value of TCR-αβ⁺ DNTs was then assessed by the receiver operating characteristic (ROC) curves.

The retrospective study evaluated 164 pediatric patients with aAA and 105 healthy donors (HD). Our data showed higher proportion of TCR-αβ⁺ DNTs in total lymphocytes [1.04% (0.79%-1.40%) vs 0.69% (0.47%-0.87%), p < 0.001] and CD3⁺ T cells [1.52% (1.10%-1.96%) vs 1.10% (0.70%-1.40%), p < 0.001] in aAA compared to HD. Patients with SAA/VSAA achieving complete response (CR) after IST had a higher proportion of TCR-αβ⁺ DNTs at initial diagnosis, than those not achieving CR for total (1.21%±0.39 vs 0.78%±0.38, p < 0.05) and CD3⁺ T cells (1.74%±0.53 vs 1.15%±0.59, p < 0.05). The ROC analysis showed areas under the curves (AUCs) for TCR-αβ⁺ DNT proportion in lymphocytes and CD3⁺ T cells were 0.756 (cutoff value 1.33, p < 0.05) and 0.758 (cutoff value 1.38, p < 0.05), respectively. And the complete response rate was higher in TCR-αβ⁺ DNT proportion high group than in TCR-αβ⁺ DNT proportion low group at baseline (p < 0.001).

Our observations suggest that elevated TCR-αβ⁺ DNTs seems to play a role in the pathogenesis of aAA, and it was involve in immune response to IST.