The article by Mailloux et al. (1) is informative in defining the immune microenvironment and illustrating the independent prognostic value of effector memory regulatory T cells’ (TregEM) expansion in myelodysplastic syndromes (MDS). However, we wonder: 1) because functional Tregs primarily reside in the bone marrow (2), it might be prudent to use bone marrow samples rather than peripheral blood to analyze Treg subsets (3); 2) the suppression assay performed clearly delineates the high suppressive potential of TregEM, but it is important to demonstrate suppression of tumor-specific responses by cytotoxic T cells by addition of either autologous bone marrow or MDS cell lines as an Ag source and subsequently quantifying CD3+ IFN-γ–producing CFSElow CD8+ T cells (4); 3) the time point from diagnosis at which patient samples were collected would impact disease progression; and 4) the rate of leukemic transformation is critical in determining disease progression.
This study is clearly a step in the right direction in that TregEM expansion may serve as an effective immune marker for patients with MDS that might be used to monitor the response to currently available immunomodulatory therapies such as lenalidomide (5). However, the addition of TregEM expansion has limited utility in improving prognostication already provided by contemporary prognostic models (6), particularly in light of the recent discovery of prognostically relevant mutations in MDS (7).
- Copyright © 2012 by The American Association of Immunologists, Inc.
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