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Sobia P, Mahomed S, Sivro A, Paul S, Osman F, Harkoo I, Garrett N, Karim QA, Karim SSA, Archary D. Circulating immunoglobulins and transient lymphocytopenia in a sub-study of CAPRISA 012B, testing HIV monoclonal antibodies in a phase 1 trial. Sci Rep 2024; 14:13499. [PMID: 38866888 PMCID: PMC11169379 DOI: 10.1038/s41598-024-63902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 06/03/2024] [Indexed: 06/14/2024] Open
Abstract
Acute, transient lymphocytopenia, not clinically significant was observed in the CAPRISA 012B phase 1 clinical trial following administration of broadly neutralizing antibodies (bnAb)-CAP256V2LS alone or with VRC07-523LS. Lymphocytopenia was assigned upon a > 50% decline in absolute lymphocyte counts following bnAb administration. We posited that systemic immunoglobulins (Igs), and cytokine profiles of eight women who developed lymphocytopenia were different to the 12 women without lymphocytopenia. Plasma Ig subclasses (IgG)/isotypes (IgM/IgA), and 27 cytokines were measured at enrolment (prior to bnAbs) and at days 1, 7, 28, 56 post-bnAb administration. IgG subclasses, IgM and total lymphocyte counts were significantly lower prior to bnAbs in women with gradable lymphocytopenia than those without. Gradable lymphocytopenia compared to non-lymphocytopenia women had significantly higher MIP-1β from enrolment up to day 56. TNF-α was significantly lower in gradable lymphocytopenia compared to non-lymphocytopenia women for enrolment, days 7, 28 and 56 except for day 1. Within the gradable and within the non-lymphocytopenia women, from enrolment to day 1, significantly elevated IL-6, IL-8, IP-10, MCP-1, G-CSF and IL-1RA were found. Additionally, within the gradable lymphocytopenia women, 9 additional cytokines (TNF-α, MIP-1α, MIP-1β, RANTES, Basic FGF, eotaxin, IFN-γ, IL-17A and IL-4) were significantly elevated at day 1 post-bnAbs compared to enrolment. This sub study presents preliminary findings to support the monitoring of baseline immunological markers including lymphocyte counts for assessing the development of transient lymphocytopenia. In high-risk settings conducting clinical trials testing bnAbs for HIV prevention, understanding factors that could amplify rates of lymphocytopenia, even if transient, remain undefined.
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Affiliation(s)
- Parveen Sobia
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
| | - Sharana Mahomed
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
- Department of Medical Microbiology, University of Kwazulu-Natal, Durban, South Africa
| | - Aida Sivro
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
- Department of Medical Microbiology, University of Kwazulu-Natal, Durban, South Africa
- JC Wilt Infectious Disease Research Centre, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Stephane Paul
- GIMAP (EA3064), University of Saint-Etienne/University of Lyon, Saint-Étienne, France
| | - Farzana Osman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
| | - Ishana Harkoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
| | - Nigel Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Salim S Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Derseree Archary
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, 2nd Floor, Doris Duke Medical Research Institute, 719 Umbilo Road, Durban, 4041, South Africa.
- Department of Medical Microbiology, University of Kwazulu-Natal, Durban, South Africa.
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Morimoto M, Yokoya Y, Yoshida K, Kosako H, Hori Y, Mushino T, Tamura S, Ito R, Koyamada R, Yamashita T, Mori S, Mori N, Ohde S. Predictive Model for Occurrence of Febrile Neutropenia after Chemotherapy in Patients with Diffuse Large B-Cell Lymphoma: A Multicenter, Retrospective, Observational Study. Hematol Rep 2024; 16:76-88. [PMID: 38390940 PMCID: PMC10885064 DOI: 10.3390/hematolrep16010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/29/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Febrile neutropenia (FN) is a major concern in patients undergoing chemotherapy for diffuse large B-cell lymphoma (DLBCL); however, the overall risk of FN is difficult to assess. This study aimed to develop a model for predicting the occurrence of FN in patients with DLBCL. In this multicenter, retrospective, observational analysis, a multivariate logistic regression model was used to analyze the association between FN incidence and pretreatment clinical factors. We included adult inpatients and outpatients (aged ≥ 18 years) diagnosed with DLBCL who were treated with chemotherapy. The study examined 246 patients. Considering FN occurring during the first cycle of chemotherapy as the primary outcome, a predictive model with a total score of 5 points was constructed as follows: 1 point each for a positive hepatitis panel, extranodal involvement, and a high level of soluble interleukin-2 receptor and 2 points for lymphopenia. The area under the receiver operating characteristic curve of this model was 0.844 (95% confidence interval: 0.777-0.911). Our predictive model can assess the risk of FN before patients with DLBCL start chemotherapy, leading to better outcomes.
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Affiliation(s)
- Masaya Morimoto
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
- Public Health, St. Luke's International University, Tokyo 104-0044, Japan
| | - Yuma Yokoya
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Kikuaki Yoshida
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Hideki Kosako
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yoshikazu Hori
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Kinan Hospital, Wakayama 646-8588, Japan
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan
- Department of Emergency and Intensive Care Medicine, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Reiko Ito
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Ryosuke Koyamada
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Takuya Yamashita
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Shinichiro Mori
- Department of Hematology/Oncology, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-0044, Japan
| | - Sachiko Ohde
- Public Health, St. Luke's International University, Tokyo 104-0044, Japan
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John L, Miah K, Benner A, Mai EK, Kriegsmann K, Hundemer M, Kaudewitz D, Müller-Tidow C, Jordan K, Goldschmidt H, Raab MS, Giesen N. Impact of novel agent therapies on immune cell subsets and infectious complications in patients with relapsed/refractory multiple myeloma. Front Oncol 2023; 13:1078725. [PMID: 37152008 PMCID: PMC10160457 DOI: 10.3389/fonc.2023.1078725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Infections are a leading cause of morbidity and mortality in patients with multiple myeloma (MM). Methods To examine the effects of modern second-generation novel agent therapy on immune cell subsets, in particular CD4+-T-cells, and infectious complications in patients with relapsed/refractory MM (RRMM), we conducted a prospective cohort study in 112 RRMM patients. Results Substantially decreased CD4+-T-cells <200/µl before initiation of relapse therapy were detected in 27.7% of patients and were associated with a higher number of previous lines of therapy. Relapse therapy with carfilzomib or pomalidomide showed a significant further decrease of CD4+-T-cells. All novel agents led to a significant decrease of B-cell counts. Overall, infections were frequent with 21.3% of patients requiring antibacterial therapy within the first 3 months of relapse therapy, 5.6% requiring hospitalization. However, in the setting of standard antimicrobial prophylaxis in RRMM patients with very low CD4+-T-cells, no significant association of CD4+T-cell count and an increased risk of infection could be detected. Discussion Our findings imply that reduced CD4+-T-cell numbers and infections are common in patients with RRMM. We also demonstrate an association with the number of previous therapies and certain substances suggesting an increased need for personalized prophylaxis strategies for opportunistic infections in this patient cohort.
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Affiliation(s)
- Lukas John
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Molecular Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- *Correspondence: Lukas John,
| | - Kaya Miah
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elias K. Mai
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kriegsmann
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Hundemer
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dorothee Kaudewitz
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Karin Jordan
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Hartmut Goldschmidt
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marc S. Raab
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Molecular Hematology/Oncology, Department of Internal Medicine V, Heidelberg University Hospital, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicola Giesen
- Department of Medicine V - Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
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Balducci L, Falandry C, List A. New Advances in Supportive Care: Chemoprotective Agents as Novel Opportunities in Geriatric Oncology. Curr Oncol Rep 2022; 24:1695-1703. [PMID: 35986858 DOI: 10.1007/s11912-022-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To explore the effectiveness of trilaciclib and ALRN-6924 in the prevention of cancer chemotherapy-induced toxicity in older patients. New chemoprotective agents are necessary because age is the main risk factor for chemotherapy complications that account largely for the poorer outcome of cancer in the elderly. Trilaciclib and ALRN-6924 cause a reversible block of the proliferation of normal cells through cell cycle arrest (CCA). With this mechanism, they may prevent the toxicity of cycle-active cancer treatment including neutropenia, anemia, thrombocytopenia, lymphopenia, mucositis, and alopecia. RECENT FINDINGS Myelopoietic growth factors may prevent neutropenia in the aged, but they may cause severe bone pain, may aggravate thrombocytopenia and anemia, and may cause myelodysplasia and acute leukemia as a late complication. The prevention of thrombocytopenia, anemia, mucositis, and alopecia is unsatisfactory at present. These complications may jeopardize the treatment outcome as they require a reduction of treatment dose/intensity and because many patients find the resulting symptoms intolerable. In three studies of patients with extensive disease small cell lung cancer (ES-SCLC), trilaciclib reduced the severity and duration of neutropenia and thrombocytopenia as well as the need for blood transfusions. In addition, it produced a significant expansion of T-cell clones. Trilaciclib received FDA approval for the prevention of chemotherapy-induced myelosuppression in patients with ES-SCLC. ALRN-6924 is currently studied in phase II study of ES-SCLC. In a phase IB of 38 patients, ALRN-6924 prevented myelosuppression to an extent comparable with trilaciclib. Both drugs proved as effective in patients 65 and older as they were in the younger ones. In an "ex vivo" study, ALRN-6924 protected the epithelial stem cells of hair follicles from taxanes and promised to prevent alopecia. The possibility that CCA of tumor cells may reduce the effectiveness of cycle-active chemotherapy is a major concern. For this reason, the use of trilaciclib, an inhibitor of CDK 4/6, should be limited to tumors with inactivated RB1, and the use of ALRN-6924, an inhibitor of P53, should be limited to tumors with inactivated P53. Chemotherapy-related toxicities limit dose intensity and contribute to significant morbidity and mortality in elderly cancer patients. Trilaciclib and ALRN-6924 are of particular interest to geriatric oncologists because of their novel mechanism of action. Ameliorating chemotherapy-induced toxicities holds the promise of transforming the practice of geriatric oncology by enabling chemotherapeutic regimens that are currently not feasible for this patient population. Specifically, these agents may prevent chemotherapy-induced neutropenia and thrombocytopenia, perhaps the most life-threatening complications of cytotoxic chemotherapy, thereby obviating the need for the use of rescue strategies such as hematopoietic growth factors. In addition, these agents offer the potential for broad tissue protection from other chemotherapy-related toxicities, including mucositis, diarrhea, and alopecia, which historically have been poorly managed. Importantly, by preventing a spectrum of chemotherapy-related toxicities, these agents may permit the administration of chemotherapy at full-dose intensity, prevent functional decline, and grant maintenance of resilience to older cancer patients. As a result, the successful prevention of chemotherapy-induced side effects may not only mitigate the costs of care but also improve patient outcomes and quality of life. Finally, chemoprotective strategies offer the opportunity to apply geriatric principles to clinical trials of cancer treatment. In particular, they may allow the testing of prolongation of "active life expectancy" as a major goal of clinical trials in elderly patients. They may also enable novel and more practical forms of clinical trials. By assessing the risk of chemotherapy-related toxicity with the Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) or the Cancer and Aging Research Group (CARG) instruments, these agents may permit researchers to utilize patients as their own controls and endorse the approval of supportive care drugs based upon the risk profile of individual patients.
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Affiliation(s)
| | - Claire Falandry
- Service de Gériatrie, Centre Hospitaliser Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Laboratoire CarMeN, Inserm U1060, INRA U1397, Université Claude Bernard Lyon, Villeurbanne, France
| | - Alan List
- Precision Bioscience, Durham, NC, USA
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Huang X, Huan Y, Liu L, Ye Q, Guo J, Yan B. Preoperative low absolute lymphocyte count to fibrinogen ratio correlated with poor survival in nonmetastatic colorectal cancer. World J Surg Oncol 2022; 20:309. [PMID: 36153540 PMCID: PMC9508774 DOI: 10.1186/s12957-022-02775-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Preoperative absolute lymphocyte count (LC) and fibrinogen (FIB) are useful prognostic indicators in colorectal cancer (CRC). However, the prognostic value of the LC to FIB ratio (LFR) has never been addressed. Methods A total of 189 nonmetastatic CRC patients after resection were enrolled retrospectively. The significance of the LFR in predicting disease-free survival (DFS) and overall survival (OS) was estimated by receiver operating characteristic curve analysis, and the prognostic efficacy was compared with individual LC and FIB. Patients were assigned to LFR low or high subgroups. Differences in clinicopathological features among these subgroups were calculated, and the survival differences of these subgroups were determined by the Kaplan-Meier analysis. A Cox proportional hazards model was applied to test the risk factors for survival. Results Taking 0.54 as the optimal cutoff point, the LFR had sensitivities of 79.70% and 86.40% and specificities of 52.30% and 51.00% in predicting the DFS and OS, respectively. A total of 109/189 (57.67%) patients were assigned to the LFR low group, and these patients were more likely to be characterized by criteria such as T3 + T4 (P < 0.01), stage 3 (P < 0.01), tumor deposits (P = 0.01), high CEA (P < 0.01), or CA19-9 levels (P = 0.04). And they also displayed worse DFS (log rank = 18.57, P < 0.01) and OS (log rank = 20.40, P < 0.01) than the high LFR group. Finally, the LFR was independently associated with inferior DFS (HR = 0.32, 95% CI: 0.16–0.61, P < 0.01) and OS (HR = 0.23, 95% CI: 0.09–0.55, P < 0.01). Conclusions The LFR is a useful prognostic indicator in nonmetastatic CRC, and patients with a relatively low LFR had poor survival.
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Chen Y, Xu M, Ye Q, Xiang J, Xue T, Yang T, Liu L, Yan B. Irregular delay of adjuvant chemotherapy correlated with poor outcome in stage II-III colorectal cancer. BMC Cancer 2022; 22:670. [PMID: 35715761 PMCID: PMC9206266 DOI: 10.1186/s12885-022-09767-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Adjuvant chemotherapy (ACT) plays an important role in improving the survival of stage II-III colorectal cancer (CRC) patients after curative surgery. However, the prognostic role of irregular delay of ACT (IDacT) for these patients has been less studied. MATERIALS AND METHODS A total of 117 stage II-III CRC patients who underwent radical resection and received at least 3 months ACT were enrolled retrospectively. The significance of IDacT, including total delay (TD) and delay per cycle (DpC), in predicting disease-free survival (DFS) was determined using receiver operating characteristic curve (ROC) analysis. The survival differences between the TD, DpC-short and DpC-long subgroups were tested using Kaplan-Meier analysis, and risk factors for prognosis were determined using a Cox proportional hazards model. RESULTS Using 35.50 and 3.27 days as the optimal cut-off points for TD and DpC, respectively, ROC analysis revealed that TD and DpC had sensitivities of 43.60% and 59.00% and specificities of 83.30% and 62.80%, respectively, in predicting DFS (both P < 0.05). No differences in the clinicopathological parameters were found between the TD, DpC-short or -long subgroups except histological differentiation in different TD subgroups and combined T stages in different DpC subgroups (both P = 0.04). Patients in the TD or DpC-long group exhibited significantly worse survival than in the -short group (TD: Log rank = 9.11, P < 0.01; DpC: Log rank = 6.09, P = 0.01). DpC was an independent risk factor for prognosis (HR = 2.54, 95% CI: 1.32-4.88, P = 0.01). CONCLUSIONS IDacT had a profound effect on the outcome for stage II-III CRC. Although TD and DpC were significant for the prognosis, DpC was more robust, and patients who presented DpC for a long time had a significantly worse DFS.
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Affiliation(s)
- Yuanyuan Chen
- Department of General Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya City, Hainan, P.R. China
| | - Mingyue Xu
- Department of General Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya City, Hainan, P.R. China
| | - Qianwen Ye
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District, Sanya City, Hainan province, 572000, P.R. China
| | - Jia Xiang
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District, Sanya City, Hainan province, 572000, P.R. China
| | - Tianhui Xue
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District, Sanya City, Hainan province, 572000, P.R. China
| | - Tao Yang
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District, Sanya City, Hainan province, 572000, P.R. China
| | - Long Liu
- Department Traditional Chinese Medicine, Tianyou Hospital of Tongji University, No. 528 of Zhennan Road, Putuo District, Shanghai, 200331, P.R. China.
| | - Bing Yan
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, No. 80 of Jianglin Road, Haitang District, Sanya City, Hainan province, 572000, P.R. China.
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Eberst G, Vernerey D, Laheurte C, Meurisse A, Kaulek V, Cuche L, Jacoulet P, Almotlak H, Lahourcade J, Gainet-Brun M, Fabre E, Le Pimpec-Barthes F, Adotevi O, Westeel V. Prognostic value of CD4+ T lymphopenia in non-small cell lung Cancer. BMC Cancer 2022; 22:529. [PMID: 35546670 PMCID: PMC9092669 DOI: 10.1186/s12885-022-09628-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a paucity of data regarding the prognostic influence of peripheral blood CD4+ T lymphopenia in non-small cell lung cancer (NSCLC). Therefore, we investigated the prognostic value of T lymphopenia in NSCLC. MATERIALS Treatment-naive patients with a pathological diagnosis of NSCLC, at clinical stage I to IV were included in the prospective TELOCAP1 study. Lymphocytes count was evaluated in peripheral blood by flow cytometry. CD4+ and CD8+ T lymphopenia were defined as an absolute count of < 500/μL and < 224/μL respectively. The prognostic value of T lymphopenia was analyzed in the whole population, in local/loco-regional (stage I-IIIB) and in advanced (stage IV) NSCLC disease, using the Kaplan-Meier method and Cox regression models for survival curves and multivariate analysis, respectively. RESULTS Between July 2010 and January 2014, 169 evaluable patients with clinical stage I to IV NSCLC were prospectively enrolled. The prevalence of CD4+ and CD8+ T lymphopenia was similar in the study population (around 29%). Patients with CD4+ T lymphopenia showed lower overall survival than those with CD4+ T lymphocytes count > 500/μL (median overall survival (OS) 16.1 versus 21.7 months, hazard ratio (HR): 1.616 [95% CI: 1.1-2.36], p = 0.012). This association with OS was especially marked in local/loco-regional NSCLC stages (median OS, 21.8 versus 72 months, respectively, HR: 1.88 [95% CI: 0.9-3.8], p = 0.035). Multivariate analysis confirmed the worse prognosis associated with CD4+ T lymphopenia in local/loco-regional NSCLC, but not in metastatic patients (HR 2.028 [95% CI = 1.065-3.817] p = 0.02). Restricted cubic spline analysis showed that patients with CD4+ T lymphocytes count ≤500/μL displayed a high risk of death regardless of NSCLC clinical stage. There was no obvious relationship between CD8+ T lymphopenia and clinical outcome. CONCLUSION We identified CD4+ T lymphopenia as an independent prognostic factor in local/loco-regional stages of NSCLC and CD4+ T lymphopenia is also associated with a high risk of death, regardless of NSCLC clinical stage. TRIAL REGISTRATION EUDRACT: 2009-A00642-55.
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Affiliation(s)
- Guillaume Eberst
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France. .,Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France. .,Université de Bourgogne Franche-Comté, EFS BFC, INSERM, UMR1098, RIGHT, Besançon, France.
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France.,Université de Bourgogne Franche-Comté, EFS BFC, INSERM, UMR1098, RIGHT, Besançon, France
| | - Caroline Laheurte
- Université de Bourgogne Franche-Comté, EFS BFC, INSERM, UMR1098, RIGHT, Besançon, France.,INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Biomonitoring Platform, F-25000, Besançon, France
| | - Aurélia Meurisse
- Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France
| | - Vincent Kaulek
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Laurie Cuche
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Pascale Jacoulet
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Hamadi Almotlak
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Jean Lahourcade
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Marie Gainet-Brun
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Elizabeth Fabre
- Department of Medical Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Françoise Le Pimpec-Barthes
- Department of Thoracic surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Olivier Adotevi
- Université de Bourgogne Franche-Comté, EFS BFC, INSERM, UMR1098, RIGHT, Besançon, France.,INSERM CIC-1431, Clinical Investigation Center in Biotherapy, Biomonitoring Platform, F-25000, Besançon, France.,Department of Medical Oncology, University Hospital, Besançon, France
| | - Virginie Westeel
- Chest Disease Department, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.,Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France.,Université de Bourgogne Franche-Comté, EFS BFC, INSERM, UMR1098, RIGHT, Besançon, France
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8
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Huang L, Jiang S, Shi Y. Prognostic significance of baseline neutrophil-lymphocyte ratio in patients with non-small-cell lung cancer: a pooled analysis of open phase III clinical trial data. Future Oncol 2022; 18:1679-1689. [PMID: 35132871 DOI: 10.2217/fon-2021-1304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: This study aimed to assess survival and hematological prognostic indicators of patients with non-small-cell lung cancer (NSCLC). Material & methods: Through the Project Data Sphere portal, two phase III clinical trial datasets were downloaded to analyze survival outcomes and related risk factors. Results: The median progression-free survival and overall survival of 756 patients with stage III-IV NSCLC were 6.2 and 14.2 months, respectively. In multivariate Cox analysis, high baseline neutrophil-lymphocyte ratio (NLR; ≥3.8) was associated with worse progression-free survival (hazard ratio: 1.37; p = 0.0004) and overall survival (hazard ratio: 1.65; p < 0.0001). In addition, it exerted an unfavorable impact on survival across multiple subgroups. Conclusions: NLR, a powerful inflammatory and immunologic indicator, is an independent prognostic indicator in patients with advanced NSCLC.
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Affiliation(s)
- Liling Huang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, China
| | - Shiyu Jiang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, 100021, China
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9
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Long YX, Sun Y, Liu RZ, Zhang MY, Zhao J, Wang YQ, Zhou YW, Cheng K, Chen Y, Zhu CR, Liu JY. Immune-Related Pneumonitis Was Decreased by Addition of Chemotherapy with PD-1/L1 Inhibitors: Systematic Review and Network Meta-Analysis of Randomized Controlled Trials (RCTs). Curr Oncol 2022; 29:267-282. [PMID: 35049699 PMCID: PMC8774972 DOI: 10.3390/curroncol29010025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: Immune-related pneumonitis (IRP) has attracted extensive attention, owing to its increased mortality rate. Conventional chemotherapy (C) has been considered as an immunosuppressive agent and may thus reduce IRP’s risk when used in combination with PD-1/L1 inhibitors. This study aimed to assess the risk of IRP with PD-1/L1 inhibitors plus chemotherapy (I+C) versus PD-1/L1 inhibitors alone (I) in solid cancer treatment. Method: Multiple databases were searched for RCTs before January 2021. This NMA was performed among I+C, I, and C to investigate IRP’s risk. Subgroup analysis was carried out on the basis of different PD-1/L1 inhibitors and cancer types. Results: Thirty-one RCTs (19,624 patients) were included. The I+C group exhibited a lower risk of IRP in any grade (RR, 0.60; 95% CI, 0.38–0.95) and in grade 3–5 (RR, 0.44; 95% CI, 0.21–0.92) as opposed to the I group. The risk of any grade IRP with PD-1 plus chemotherapy was lower than that with PD-1 monotherapy (RR, 0.50; 95% CI, 0.28–0.89), although grade 3–5 IRP was similar. There was no statistically meaningful difference in the risk of any grade IRP between PD-L1 plus chemotherapy and PD-L1 inhibitors monotherapy (RR, 0.95; 95% CI, 0.43–2.09) or grade 3–5 IRP (RR, 0.71;95% CI, 0.24–2.07). In addition, compared with the I group, the I+C group was correlated with a decreased risk in IRP regardless of cancer type, while a substantial difference was only observed in NSCLC patients for grade 3–5 IRP (RR, 0.39; 95% CI, 0.15–0.98). Conclusion: In comparison to PD-1/L1 inhibitor treatment alone, combining chemotherapy with PD-1/L1 inhibitors might reduce the risk of IRP in the general population. Furthermore, PD-1 inhibitors in combination with chemotherapy were correlated with a decreased risk of IRP compared to PD-1 inhibitor treatment alone. In contrast to the I group, the I+C group exhibited a lower risk of IRP, especially for NSCLC patients.
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Affiliation(s)
- Yi-Xiu Long
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Yue Sun
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; (Y.S.); (C.-R.Z.)
| | - Rui-Zhi Liu
- Department of Medicine and Life Science, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China;
| | - Ming-Yi Zhang
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Jing Zhao
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Yu-Qing Wang
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Yu-Wen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Ke Cheng
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Ye Chen
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
| | - Cai-Rong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China; (Y.S.); (C.-R.Z.)
| | - Ji-Yan Liu
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu 610041, China; (Y.-X.L.); (M.-Y.Z.); (J.Z.); (Y.-Q.W.); (Y.-W.Z.); (K.C.); (Y.C.)
- Sichuan Clinical Research Center of Biotherapy, Chengdu 610041, China
- Department of Oncology, The First People’s Hospital of Ziyang, Ziyang 641300, China
- Correspondence: ; Tel.: +86-28-542-3261; Fax: +86-28-8542-3609
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10
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Emile G, Penager S, Levy C, Johnson A, Allouache D, Lequesne J, Hrab I, Segura C, Morel A, Gunzer K, Faveyrial A, Cherifi F, Da Silva A. Baseline lymphopenia as prognostic factor in patients with metastatic breast cancer treated with palbociclib. Oncol Lett 2021; 23:25. [PMID: 34868362 DOI: 10.3892/ol.2021.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
Cyclin-dependent-kinase 4-6 inhibitors (CDK4/6i) have improved the management of hormone receptor (HR)+/human epidermal growth factor receptor (HER)2- metastatic breast cancer (mBC). Currently, there are no valid prognostic factors for response to CDK4/6i. Baseline lymphopenia is reported as a prognostic factor in several types of cancer. The present retrospective study aimed to evaluate the effect of baseline absolute lymphocyte count (ALC) on response to palbociclib. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints were overall survival (OS), best response and safety. A total of 114 patients treated for mBC between 2016 and 2019 were included. Median baseline ALC was 1.4 g/l (range, 0.2-4.3 g/l). A total of 65 (57%) and 49 (43%) patients had baseline ALC values of <1.5 and ≥1.5 g/l, respectively. Patients with baseline lymphopenia exhibited significantly shorter PFS (6 vs. 10 months; P=0.004) and OS (20 vs. 33 months; P=0.02). ALC <1.5 g/l independently predicted worse survival, as indicated by multivariate analysis (P=0.04; hazard ratio, 1.76; 95% confidence interval, 1.02-3.02). Patients with baseline ALC <1.5 g/l had significantly less partial response (14 vs. 22%; P=0.016) and more disease progression (46 vs. 20%; P=0.016) than those with ALC ≥1.5 g/l. ALC is a strong and easy-to-use dosage with prognostic factor for patients with HR+/HER2- mBC treated with palbociclib and endocrine therapy. Lymphopenia may also be a predictive factor of early progression. These data need to be verified in a larger prospective study.
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Affiliation(s)
- George Emile
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Sarah Penager
- Clinical Research Department, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Christelle Levy
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Alison Johnson
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Djelila Allouache
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Justine Lequesne
- Clinical Research Department, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Ioana Hrab
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Carine Segura
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Adeline Morel
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Katarina Gunzer
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Audrey Faveyrial
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Francois Cherifi
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
| | - Angelique Da Silva
- Breast Cancer Unit, François Baclesse Comprehensive Cancer Center, Caen, Calvados, Normandy 14000, France
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11
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Chen F, Ma L, Wang Q, Zhou M, Nong Y, Jing H, Han Y, Liu Y, Hu Y, Yu H, Fu P, Kong F(S. Chemotherapy is a risk factor of lymphopenia before adjuvant radiotherapy in breast cancer. Cancer Rep (Hoboken) 2021; 5:e1525. [PMID: 34390318 PMCID: PMC9327667 DOI: 10.1002/cnr2.1525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lymphopenia can decrease immune function of the host and is a known risk factor for poor prognosis in malignant tumors. Radiation induced lymphopenia was common in patients with breast cancer and was also reported to have a negative effect on long-term outcome. AIMS Lymphopenia may be associated with baseline immune status before radiotherapy (RT). This study aimed to explore the rate and risk factors of lymphopenia before start of the adjuvant RT in patients with breast cancer. METHODS Patients with invasive breast cancer treated from March 2015 to February 2020 and with peripheral lymphocyte counts (PLC) available within 7 days from the beginning of RT were eligible for this study. Data were presented as mean and 95% confidence interval unless otherwise specified. The risk factors of low PLC before RT were identified using univariate and multivariable linear regressions. RESULTS A total of 1012 consecutive patients met the study criteria. The mean PLC before RT commencement was 1.58*109 /L (95%CI: 1.55-1.62*109 /L) with 15.2% (95%CI: 13.1%-17.6%) CTCAE defined lymphopenia, rendering 12.3%, 2.6%, 0.3%, and 0% for grade 1, 2, 3 and 4 respectively. Univariate and multivariable linear regression showed prior chemotherapy was the most significant risk factor (p < .001) for low PLC, while age, menopausal status and lymph node stage were not (all ps > .05). A total of 912 (90.1%, 95%CI: 88.1%-91.9%) patients had chemotherapy before adjuvant RT in this study. In patients with HR+/HER2- breast cancer, 69.0% (95%CI: 63.0%-74.5%) N0 and 98.1% (95%CI: 95.1%-99.5%) N1 had also received chemotherapy. CONCLUSIONS Patients with breast cancer might have lymphopenia from prior chemotherapy at the start of adjuvant RT which could have negative effect on long-term outcome. It is also noted that most of the patients with HR+/HER2-, early-stage breast cancer were treated with aggressive chemotherapy without knowing the risk of chemotherapy induced lymphopenia. Future study on predictive or prognostic multigene assays is warranted to avoid unnecessary chemotherapy and subsequent lymphopenia in patients with low risk breast cancer.
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Affiliation(s)
- Fang Chen
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Lingyu Ma
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Qian Wang
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Manling Zhou
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Yaqing Nong
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Haiman Jing
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Ying Han
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Yaya Liu
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Yulin Hu
- Department of Clinical OncologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Hao Yu
- Biomedical EngineeringShenzhen PolytechnicShenzhenChina
| | - Pingfu Fu
- Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandOhioUSA
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12
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Assaad S, Zrounba P, Cropet C, Blay JY. Mortality of patients with solid and haematological cancers presenting with symptoms of COVID-19 with vs without detectable SARS-COV-2: a French nationwide prospective cohort study. Br J Cancer 2021; 125:658-671. [PMID: 34135471 PMCID: PMC8206183 DOI: 10.1038/s41416-021-01452-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/26/2021] [Accepted: 05/27/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Over 30 million COVID-19 cases have been diagnosed worldwide from late 2019. Among frail persons, cancer patients are at high risk of death from COVID-19. METHODS The French prospective cohort ONCOVID-19 enrolled patients with solid or haematological tumour, receiving anticancer treatment and presenting with clinical symptoms suggestive of COVID-19. COVID-19 was confirmed through detectable SARS-CoV2 by RT-PCR (repeated twice if negative first) and/or specific CT-scan. The study aims to assess the 28-day mortality rate after the first COVID test. RESULTS From March 1st to May 21st 2020, 23 French cancer centres and hospitals enrolled 1230 cancer patients with suspicion of COVID-19, including 1162 (94.5%) matching the inclusion criteria. We identified 425 (36.6%) COVID-19 positive patients including 155 (13.3%) diagnosed with CT-scan only, while 737 (63.4%) patients were COVID-19 negative. Death at day-28 occurred in 116/425 (27.8%) COVID-19 positive patients, and in 118/737 (16.3%) COVID-19 negative patients (p < 0·0001). With a median follow-up of 2.1 (1.6-2.4) months, 310 (26.7%) deaths were reported including 143 (33.6%) in the COVID-19 positive population, and 167 (22.7%) in the COVID-19 negative patients. Male gender, age, metastatic disease, immunosuppressive treatments, lymphopenia, COVID-19 diagnosis and diabetes were independent risk factors for death. CONCLUSION Patients with solid and haematological cancers presenting COVID-19 symptoms with SARS-CoV-2 RT-PCR confirmed or not are both at high-risk of early mortality. COVID-19 is reported as the cause of death in 50% of COVID-19 positive patients with cancer. CLINICAL TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, number NCT04363632.
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Affiliation(s)
- Souad Assaad
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.
| | | | - Claire Cropet
- Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Blay
- Medical Oncology Department, Centre Léon Bérard, Lyon, France.
- Université Claude Bernard, Lyon, France & Unicancer, Paris, France.
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13
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Homkham N, Muangwong P, Pisprasert V, Traisathit P, Jiratrachu R, Chottaweesak P, Chitapanarux I. Dynamic changes in practical inflammation and immunity markers in cancer patients receiving immune-enhancing nutritional supplementation during concurrent chemoradiotherapy. Cancer Biomark 2021; 32:281-291. [PMID: 34151843 PMCID: PMC8673492 DOI: 10.3233/cbm-210086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immune-enhancing nutrition (IMN) strengthens the systematic inflammatory response and the immune system. Neutrophil to lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) are affected during cancer therapies. OBJECTIVE We carried out an analysis of the dynamic changes in NLR and ALC over time in cancer patients with or without IMN supplementation. METHODS 88 cancer patients receiving concurrent chemoradiotherapy (CCRT) were randomized into regular diet group, and regular diet and IMN group.Generalized estimation equation models were used to assess associations between patient's characteristics, IMN, and dynamic changes in NLR and ALC over time. RESULTS NLR and ALC at preCCRT were significantly associated with dynamic changes in NLR (adjusted β= 1.08, 95% confidence interval [CI]: 0.64-1.52) and ALC (adjusted β= 0.41, 95% CI: 0.36-0.46). The magnitudes of the NLR and ALC changes through CCRT were lower in patients receiving IMN, although the differences were not statistically significant except ALC at the end of CCRT in head and neck cancer patients (P= 0.023). CONCLUSION Dynamic negative changes in both markers were demonstrated throughout CCRT. There were non-significant trend in promising changes in both NLR and ALC values in the whole group in IMN supplementation.
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Affiliation(s)
- Nontiya Homkham
- Faculty of Public Health, Thammasat University, Prathumthani, Thailand
| | - Pooriwat Muangwong
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Veeradej Pisprasert
- Division of Clinical Nutrition, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Rungarun Jiratrachu
- Division of Radiation Oncology, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Pattawee Chottaweesak
- Radiotherapy Unit, Radiology Department, Maharat Nakhonratchasima Hospital, Nakhonratchasima, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
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14
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Classen AY, Henze L, von Lilienfeld-Toal M, Maschmeyer G, Sandherr M, Graeff LD, Alakel N, Christopeit M, Krause SW, Mayer K, Neumann S, Cornely OA, Penack O, Weißinger F, Wolf HH, Vehreschild JJ. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematologic malignancies and solid tumors: 2020 updated guidelines of the Infectious Diseases Working Party of the German Society of Hematology and Medical Oncology (AGIHO/DGHO). Ann Hematol 2021; 100:1603-1620. [PMID: 33846857 PMCID: PMC8116237 DOI: 10.1007/s00277-021-04452-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
Hematologic and oncologic patients with chemo- or immunotherapy-related immunosuppression are at substantial risk for bacterial infections and Pneumocystis jirovecii pneumonia (PcP). As bacterial resistances are increasing worldwide and new research reshapes our understanding of the interactions between the human host and bacterial commensals, administration of antibacterial prophylaxis has become a matter of discussion. This guideline constitutes an update of the 2013 published guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). It gives an overview about current strategies for antibacterial prophylaxis in cancer patients while taking into account the impact of antibacterial prophylaxis on the human microbiome and resistance development. Current literature published from January 2012 to August 2020 was searched and evidence-based recommendations were developed by an expert panel. All recommendations were discussed and approved in a consensus conference of the AGIHO prior to publication. As a result, we present a comprehensive update and extension of our guideline for antibacterial and PcP prophylaxis in cancer patients.
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Affiliation(s)
- Annika Y Classen
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Larissa Henze
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Marie von Lilienfeld-Toal
- Department of Hematology and Oncology, Clinic for Internal Medicine II, University Hospital Jena, Jena, Germany
| | - Georg Maschmeyer
- Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Michael Sandherr
- Specialist Clinic for Haematology and Oncology, Medical Care Center Penzberg, Penzberg, Germany
| | - Luisa Durán Graeff
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Nael Alakel
- Department I of Internal Medicine, Hematology and Oncology, University Hospital Dresden, Dresden, Germany
| | - Maximilian Christopeit
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Stefan W Krause
- Department of Medicine 5 - Hematology and Oncology, University Hospital Erlangen, Erlangen, Germany
| | - Karin Mayer
- Medical Clinic III for Oncology, Hematology, Immunooncology and Rheumatology, University Hospital Bonn (UKB), Bonn, Germany
| | - Silke Neumann
- Interdisciplinary Center for Oncology, Wolfsburg, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Olaf Penack
- Medical Department for Hematology, Oncology and Tumor Immunology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Florian Weißinger
- Department for Internal Medicine, Hematology/Oncology, and Palliative Care, Evangelisches Klinikum Bethel v. Bodelschwinghsche Stiftungen Bethel, Bielefeld, Germany
| | - Hans-Heinrich Wolf
- Department IV of Internal Medicine, University Hospital Halle, Halle, Germany
| | - Jörg Janne Vehreschild
- Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, University of Cologne, Herderstr. 52-54, 50931, Cologne, Germany.
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany.
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15
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Puerta-Alcalde P, Ambrosioni J, Chumbita M, Hernández-Meneses M, Garcia-Pouton N, Cardozo C, Moreno-García E, Marco F, Mensa J, Rovira M, Esteve J, Martínez JA, García F, Mallolas J, Soriano A, Miró JM, Garcia-Vidal C. Clinical Characteristics and Outcome of Bloodstream Infections in HIV-Infected Patients with Cancer and Febrile Neutropenia: A Case-Control Study. Infect Dis Ther 2021; 10:955-970. [PMID: 33840061 PMCID: PMC8116456 DOI: 10.1007/s40121-021-00445-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION We aimed to compare the clinical characteristics and outcomes of bloodstream infections (BSI) in cancer patients presenting febrile neutropenia with and without HIV infection, and analyze the prognostic factors for mortality. METHODS BSI episodes in febrile neutropenic patients following chemotherapy were prospectively collected (1997-2018). A case (HIV-infected)-control (non-HIV-infected) sub-analysis was performed (1:2 ratio), matching patients by age, gender, baseline disease, and etiological microorganism. RESULTS From 1755 BSI episodes in neutropenic cancer patients, 60 (3.4%) occurred in those with HIV. HIV characteristics: 51.7% were men who have sex with men; 58.3% had < 200 CD4; 51.7% had a detectable HIV-1 RNA viral load before the BSI episode; 70.0% met AIDS-defining criteria; and 93.3% were on antiretroviral therapy, with a protease inhibitor-based regimen being the most common (53.0%). HIV-infected patients were younger, more frequently male and more commonly presenting chronic liver disease (p < 0.001 for all). BSI due to Enterococcus spp. was significantly more frequent among patients with HIV (p = 0.017) with no differences in other pathogens. HIV-infected patients with cancer presented with shock more frequently (p = 0.014) and had higher mortality (31.7% vs. 18.1%, p = 0.008). In the case-control analysis, cases (HIV-infected) had chronic liver disease (p = 0.003) more frequently, whereas acute leukemia (p = 0.013) and hematopoietic stem-cell transplant (p = 0.023) were more common among controls. There was a non-significant trend for cases to have higher mortality (p = 0.084). However, in multivariate analysis, HIV infection was not associated with mortality (p = 0.196). CONCLUSION HIV-infected patients with cancer developing febrile neutropenia and BSI have different epidemiological and clinical profiles, and experience higher mortality. However, HIV infection by itself was not associated with mortality.
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Affiliation(s)
- Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain.
| | - Juan Ambrosioni
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain.
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Nicole Garcia-Pouton
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Celia Cardozo
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Estela Moreno-García
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Francesc Marco
- Microbiology Department, Centre Diagnòstic Biomèdic, Hospital Clinic, Barcelona, Spain
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - Montserrat Rovira
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Jose A Martínez
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Felipe García
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, Carrer de Villarroel 170, 08036, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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16
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Manuel M, Tredan O, Bachelot T, Clapisson G, Courtier A, Parmentier G, Rabeony T, Grives A, Perez S, Mouret JF, Perol D, Chabaud S, Ray-Coquard I, Labidi-Galy I, Heudel P, Pierga JY, Caux C, Blay JY, Pasqual N, Ménétrier-Caux C. Lymphopenia combined with low TCR diversity (divpenia) predicts poor overall survival in metastatic breast cancer patients. Oncoimmunology 2021; 1:432-440. [PMID: 22754761 PMCID: PMC3382902 DOI: 10.4161/onci.19545] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lymphopenia (< 1Giga/L) detected before initiation of chemotherapy is a predictive factor for death in metastatic solid tumors. Combinatorial T cell repertoire (TCR) diversity was investigated and tested either alone or in combination with lymphopenia as a prognostic factor at diagnosis for overall survival (OS) in metastatic breast cancer (MBC) patients. The combinatorial TCR diversity was measured by semi quantitative multi-N-plex PCR on blood samples before the initiation of the first line chemotherapy in a development (n = 66) and validation (n = 67) MBC patient cohorts. A prognostic score, combining lymphocyte count and TCR diversity was evaluated. Univariate and multivariate analyses of prognostic factors for OS were performed in both cohorts. Lymphopenia and severe restriction of TCR diversity called “divpenia” (diversity ≤ 33%) were independently associated with shorter OS. Lympho-divpenia combining lymphopenia and severe divpenia accurately identified patients with poor OS in both cohorts (7.6 and 10.6 vs 24.5 and 22.9 mo). In multivariate analysis including other prognostic clinical factors, lympho-divpenia was found to be an independent prognostic factor in the pooled cohort (p = 0.005) along with lack of HER2 and hormonal receptors expression (p = 0.011) and anemia (p = 0.009). Lympho-divpenia is a novel prognostic factor that will be used to improve quality of MBC patients’ medical care.
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Affiliation(s)
- Manuarii Manuel
- ImmunID Technologies; CEA; Grenoble, France ; Université Lyon 1; ISPB; Lyon, France ; Team 11; CRCL INSERM U-1052/CNRS 5286; Lyon, France ; LabEx DEVweCAN; Centre Léon Bérard; Lyon, France
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17
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Razavi A, Hamblin MR, Rezaei N. COVID-19 in patients with cancer: Risks and precautions. Am J Emerg Med 2021; 48:357-360. [PMID: 33546958 PMCID: PMC7840397 DOI: 10.1016/j.ajem.2021.01.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a member of the coronavirus family, which causes coronavirus disease 2019 (COVID-19). The phenotype of the disease varies from asymptomatic, to a mild phenotype, through to the severe form of acute respiratory distress syndrome (ARDS), which often leads to death, especially in those with underlying diseases. It has been reported that those who suffer from cancer (especially lung cancer and hematological malignancies) are at higher risk of serious complications and death from COVID-19. Some cancer treatments such as CAR T cell therapy can produce a cytokine storm, which is also a hallmark of severe COVID-19. Therefore, patients receiving CAR T cells are at higher risk if they become infected with COVID-19, and could be treated with anti-cytokine approaches.
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Affiliation(s)
- AzadehSadat Razavi
- Department of Animal Biology, Faculty of Biology Sciences, University of Kharazmi, Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein 2028, South Africa; Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Doornfontein, South Africa
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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18
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Alfano G, Giaroni F, Fontana F, Neri L, Mosconi G, Mussini C, Guaraldi G, Cappelli G. Rituximab in people living with HIV affected by immune-mediated renal diseases: a case-series. Int J STD AIDS 2020; 31:1426-1431. [PMID: 33104497 DOI: 10.1177/0956462420946662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Over the last two decades, rituximab (RTX) has played an important role in the treatment of some lymphoproliferative malignancies and immune-mediated diseases. RTX administration is generally safe and well-tolerated, but side effects including late-onset neutropenia, hypogammaglobulinemia, hepatitis B reactivation and rare cases of progressive multifocal leukoencephalopathy have been observed after its administration. Although there are no absolute contraindications regarding its use in people living with HIV (PLWH), the prescription of this drug has been principally limited in patients with oncohematological diseases. In this report, we described the outcome of four PLWH who underwent RTX therapy after the diagnosis of immune-mediated renal disease. The main RTX-associated adverse effects were leukopenia, late-onset neutropenia and decline of CD4+ and CD8+ T-cell counts. In addition, two of the four patients experienced pneumonia requiring hospitalization within six months from the last RTX infusion. We suggest that RTX should be used with caution in PLWH until further evidence emerges on its safety profile in this vulnerable population.
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Affiliation(s)
- G Alfano
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.,Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - F Giaroni
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - F Fontana
- Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
| | - L Neri
- Nephrology and Dialysis Unit, Hospital of Forlì-Cesena, Forlì-Cesena, Italy
| | - G Mosconi
- Nephrology and Dialysis Unit, Hospital of Forlì-Cesena, Forlì-Cesena, Italy.,Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - C Mussini
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - G Guaraldi
- Clinic of Infectious Diseases, University Hospital of Modena, Modena, Italy
| | - G Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.,Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
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19
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Reid E, Suneja G, Ambinder RF, Ard K, Baiocchi R, Barta SK, Carchman E, Cohen A, Crysler OV, Gupta N, Gustafson C, Hall A, Johung KL, Klopp A, LaCasce AS, Lin C, Mehta A, Menon MP, Morgan D, Nathwani N, Noy A, Ratner L, Rizza S, Rudek MA, Sanchez J, Taylor J, Tomlinson B, Wang CCJ, Yendamuri S, Dwyer MA, Freedman-Cass DA. AIDS-Related Kaposi Sarcoma, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:171-189. [PMID: 30787130 DOI: 10.6004/jnccn.2019.0008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As treatment of HIV has improved, people living with HIV (PLWH) have experienced a decreased risk of AIDS and AIDS-defining cancers (non-Hodgkin's lymphoma, Kaposi sarcoma, and cervical cancer), but the risk of Kaposi sarcoma in PLWH is still elevated about 500-fold compared with the general population in the United States. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for AIDS-Related Kaposi Sarcoma provide diagnosis, treatment, and surveillance recommendations for PLWH who develop limited cutaneous Kaposi sarcoma and for those with advanced cutaneous, oral, visceral, or nodal disease.
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Affiliation(s)
| | | | | | - Kevin Ard
- 4Massachusetts General Hospital Cancer Center
| | - Robert Baiocchi
- 5The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Adam Cohen
- 8Huntsman Cancer Institute at the University of Utah
| | | | | | - Chelsea Gustafson
- 11Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Ann Klopp
- 13The University of Texas MD Anderson Cancer Center
| | | | - Chi Lin
- 15Fred & Pamela Buffett Cancer Center
| | - Amitkumar Mehta
- 16University of Alabama at Birmingham Comprehensive Cancer Center
| | - Manoj P Menon
- 17Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Ariela Noy
- 20Memorial Sloan Kettering Cancer Center
| | - Lee Ratner
- 21Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | - Jeff Taylor
- 24HIV + Aging Research Project - Palm Springs
| | - Benjamin Tomlinson
- 25Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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- 28National Comprehensive Cancer Network
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20
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Miyahara Y, Takashi S, Shimizu Y, Ohtsuka M. The prognostic impact of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) in patients with distal bile duct cancer. World J Surg Oncol 2020; 18:78. [PMID: 32321522 PMCID: PMC7178599 DOI: 10.1186/s12957-020-01847-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Background A growing body of evidence suggests that inflammatory response markers such as the neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) are associated with outcomes of various malignancies. However, no study has reported the prognostic value of NLR and LMR in patients with distal bile duct cancer (DBDC) to date. We investigated the prognostic significance of these inflammatory markers in patients with DBDC who underwent radical resection. Methods The study included 40 patients diagnosed with DBDC who underwent pancreaticoduodenectomy at Narita Red Cross Hospital between January 2000 and December 2017. The cutoff values for these markers were determined by receiver operating characteristic curve analysis. Survival curves are estimated for each group in the study considered separately using the Kaplan-Meier method. The association between overall survival (OS) and the NLR, LMR, and other prognostic factors was investigated using log-rank test and multivariate Cox proportional hazards regression analysis. Results Corresponding to the point with the maximum combined sensitivity and specificity on the ROC curve, the best cutoff value for NLR and LMR was determined to be 3.14 and 4.55, respectively. Most clinicopathological factors were not associated with the NLR and LMR based on these cutoff values. However, serum albumin levels were associated with both the NLR and LMR (P = 0.011 and P = 0.023, respectively), and serum carbohydrate antigen 19-9 (CA 19-9) levels were also associated with the LMR (P = 0.030). Univariate analysis showed that a high NLR (P < 0.001), low LMR (P = 0.002), hypoalbuminemia (P = 0.004), high serum CA 19-9 levels (P = 0.008), and lymph node metastasis (P = 0.033) were significantly associated with poor survival rates. Multivariate analysis showed that a high NLR (hazard ratio 5.799, 95% confidence interval 1.188–28.32, P = 0.030) and a low LMR (hazard ratio 4.837, 95% confidence interval 1.826–2.331, P = 0.025) were independent prognostic factors for OS. Conclusion Both NLR and LMR may serve as significant independent preoperative prognostic indicators of disease in patients with DBDC who undergo radical resection.
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Affiliation(s)
- Yoji Miyahara
- Department of Surgery, Japanese Red Cross Narita Hospital, 90-1 Iida-cho, Narita-shi, Chiba Prefecture, 286-0041, Japan. .,Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba Prefecture, 260-8677, Japan.
| | - Shida Takashi
- Shida Clinic, 1970-1-2 Ne, Shiroi-shi, Chiba Prefecture, 270-1431, Japan
| | - Yoshiaki Shimizu
- Department of Surgery, Japanese Red Cross Narita Hospital, 90-1 Iida-cho, Narita-shi, Chiba Prefecture, 286-0041, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba Prefecture, 260-8677, Japan
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21
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Aagaard T, Reekie J, Jørgensen M, Roen A, Daugaard G, Specht L, Sengeløv H, Mocroft A, Lundgren J, Helleberg M. Mortality and admission to intensive care units after febrile neutropenia in patients with cancer. Cancer Med 2020; 9:3033-3042. [PMID: 32144897 PMCID: PMC7196064 DOI: 10.1002/cam4.2955] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/06/2020] [Accepted: 02/19/2020] [Indexed: 12/13/2022] Open
Abstract
Febrile neutropenia (FN) is a critical complication of chemotherapy associated with increased in‐hospital mortality. However, associations with increased mortality and intensive care unit (ICU) admissions during longer follow‐up are not established. Patients treated with standard first‐line chemotherapy for solid cancers at Rigshospitalet, Denmark in 2010‐2016 were included. Incidence rate ratios (IRR) of all‐cause, infectious and cardiovascular mortality, and ICU admissions after FN were analyzed by Poisson regression. Risk factors at the time of FN were analyzed in the subpopulation of patients with FN; all‐cause mortality was further stratified by the time periods 0‐30, 31‐365, and 366+ days after FN. We included 9018 patients with gastric (14.4%) and breast (13.1%) cancer being the most common, 51.2% had locally advanced or disseminated disease and the patients had a median Charlson Comorbidity Index score of 0 (interquartile range, 0‐0). During follow‐up, 845 (9.4%) experienced FN and 4483 (49.7%) died during 18 775 person‐years of follow‐up. After adjustment, FN was associated with increased risk of all‐cause mortality, infectious mortality, and ICU admissions with IRRs of 1.39 (95% CI, 1.24‐1.56), 1.94 (95% CI, 1.43‐2.62), and 2.28 (95% CI, 1.60‐3.24). Among those with FN, having a positive blood culture and low lymphocytes were associated with excess risk of death and ICU admissions (predominantly the first 30 days after FN), while elevated C‐reactive protein and low hemoglobin predicted mortality the first year after FN. The risk of death varied according to the time since FN; adjusted IRR per additional risk factor present for the time periods 0‐30, 31‐365, and 366+ days after FN were 2.00 (95% CI, 1.45‐2.75), 1.36 (95% CI, 1.17‐1.57), and 1.17 (95% CI, 0.98‐1.41). FN was associated with increased mortality and risk of ICU admissions. An objectively identifiable subgroup of patients among those with FN carried this excess risk.
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Affiliation(s)
- Theis Aagaard
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Joanne Reekie
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Mette Jørgensen
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Ashley Roen
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Gedske Daugaard
- Department of OncologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Lena Specht
- Department of OncologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Henrik Sengeløv
- Department of HaematologyRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Amanda Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME)Institute for Global HealthUniversity College LondonLondonUK
| | - Jens Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Marie Helleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP)RigshospitaletUniversity of CopenhagenCopenhagenDenmark
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22
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Kur DK, Agersnap N, Holländer NH, Pedersen OBV, Friis‐Hansen L. Evaluation of the HemoCue WBC DIFF in leukopenic patient samples. Int J Lab Hematol 2020; 42:256-262. [DOI: 10.1111/ijlh.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dår K. Kur
- Department of Clinical Biochemistry North Zealand Hospital University of Copenhagen Hilleroed Denmark
| | | | - Niels Henrik Holländer
- Department of Oncology and Palliative Units Zealand University Hospital Naestved Denmark
| | - Ole B. Vesterager Pedersen
- Department of Clinical Immunology Zealand University Hospital Naestved Denmark
- Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lennart Friis‐Hansen
- Department of Clinical Biochemistry North Zealand Hospital University of Copenhagen Hilleroed Denmark
- Department of Clinical Biochemistry and Pharmacology Odense University Hospital Odense Denmark
- Institute of Clinical Medicine University of Southern Denmark Odense Denmark
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23
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Focosi D, Tuccori M, Maggi F. Progressive multifocal leukoencephalopathy and anti‐CD20 monoclonal antibodies: What do we know after 20 years of rituximab. Rev Med Virol 2019; 29:e2077. [DOI: 10.1002/rmv.2077] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Daniele Focosi
- North‐Western Tuscany Blood Bank Pisa University Hospital Pisa Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Unit of Adverse Drug Reaction Monitoring Pisa University Hospital Pisa Italy
| | - Fabrizio Maggi
- Department of Translational Research University of Pisa Pisa Italy
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24
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Ménétrier-Caux C, Ray-Coquard I, Blay JY, Caux C. Lymphopenia in Cancer Patients and its Effects on Response to Immunotherapy: an opportunity for combination with Cytokines? J Immunother Cancer 2019; 7:85. [PMID: 30922400 PMCID: PMC6437964 DOI: 10.1186/s40425-019-0549-5] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 12/12/2022] Open
Abstract
Quantitative lymphocyte alterations are frequent in patients with cancer, and strongly impact prognosis and survival. The development of cancers in immunosuppressed patients has demonstrated the contribution of different T cell populations, including CD4+ cells, in the control of cancer occurrence.Whereas absolute numbers of neutrophils, platelets and red blood cells are routinely monitored in clinic following treatments, because of possible short-term complications, absolute lymphocyte counts (ALC), their subpopulations or diversity (phenotype, TCR) are rarely analyzed and never used to choose therapy or as prognostic criteria. The recent identification of immune checkpoint inhibitors (ICPi) as powerful therapeutic agents has revitalized immunotherapy of cancer in a broader group of diseases than anticipated. The status of the immune system is now recognized as an important biomarker for response to these novel treatments. Blood ALC values, along with tumor infiltration by CD8+T cells, and ICPi and ICPi-ligand expression, are likely to be a potential marker of sensitivity to anti-ICPi therapy.In this article, we review the current knowledge on the incidence and significance of lymphopenia in cancer patients, and discuss therapeutic strategies to restore lymphocyte numbers.
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Affiliation(s)
- Christine Ménétrier-Caux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Centre Léon Bérard, F-69008, Lyon, France. .,Innovation in Immuno-monitoring and Immunotherapy Platform (PI3), Centre Léon Bérard, F-69008, Lyon, France.
| | | | - Jean-Yves Blay
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Centre Léon Bérard, F-69008, Lyon, France.,Medical Oncology department, Centre Léon Bérard, F-69008, Lyon, France
| | - Christophe Caux
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Cancer Research Center of Lyon (CRCL), Centre Léon Bérard, F-69008, Lyon, France.,Innovation in Immuno-monitoring and Immunotherapy Platform (PI3), Centre Léon Bérard, F-69008, Lyon, France
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25
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Hirai T, Ogawa R, Yamaga R, Itoh T. Impact of relative dose intensity on bone marrow suppression induced by S-1: retrospective observational study. J Pharm Health Care Sci 2018; 4:30. [PMID: 30524750 PMCID: PMC6276246 DOI: 10.1186/s40780-018-0127-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/07/2018] [Indexed: 11/17/2022] Open
Abstract
Background S-1 (a combination of tegafur, gimeracil, and oteracil) is used to treat various cancers. Bone marrow suppression is a dose-limiting toxicity of S-1. The relationship between relative dose intensity (RDI) and bone marrow suppression has not been investigated. Hence, we aimed to elucidate the threshold for RDI to identify bone marrow suppression induced by S-1. Methods In this retrospective cohort study, patients who initiated S-1 treatment at Tokyo Women’s Medical University, Medical Center East between June 2015 and June 2017 were included. Bone marrow suppression induced by S-1 was assessed using Common Terminology Criteria for Adverse Events version 4.0. The relationships between grade 3 or higher bone marrow suppression induced by S-1 and RDIs (i.e., 70, 75, and 80%) were investigated using the multivariate Cox proportional hazard model. Results We identified 143 patients in this study. The median RDI was 78.8%. Bone marrow suppression induced by S-1 developed in 19 (13.3%) patients. The multivariate Cox proportional hazard model revealed that grade ≥ 2 lymphocytopenia was associated with bone marrow suppression induced by S-1 regardless of the threshold for RDI. In addition, RDI > 75% [hazard ratio (HR) = 1.71, p < 0.05] and RDI > 80% (HR = 1.65, p < 0.05) were associated with bone marrow suppression induced by S-1. Conclusions Reduced dose of S-1 still has the risk of developing bone marrow suppression. Clinicians should assess RDI to identify high risk patients with bone marrow suppression induced by S-1.
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Shimanuki M, Imanishi Y, Sato Y, Nakahara N, Totsuka D, Sato E, Iguchi S, Sato Y, Soma K, Araki Y, Shigetomi S, Yoshida S, Uno K, Ogawa Y, Tominaga T, Ikari Y, Nagayama J, Endo A, Miura K, Tomioka T, Ozawa H, Ogawa K. Pretreatment monocyte counts and neutrophil counts predict the risk for febrile neutropenia in patients undergoing TPF chemotherapy for head and neck squamous cell carcinoma. Oncotarget 2018; 9:18970-18984. [PMID: 29721176 PMCID: PMC5922370 DOI: 10.18632/oncotarget.24863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/07/2018] [Indexed: 01/17/2023] Open
Abstract
Background Febrile neutropenia (FN) is the most serious hematologic toxicity of systemic chemotherapy. However, accurate prediction of FN development has been difficult because the risk varies largely depending on the chemotherapy regimen and various individual factors. Methods We retrospectively analyzed diverse clinical factors including pretreatment hematological parameters to clarify the reliable predictors of FN development during chemotherapy with a docetaxel, cisplatin, and fluorouracil (TPF) regimen in patients with head and neck squamous cell carcinoma. Results Among the 50 patients, grade ≥3 neutropenia, grade 4 neutropenia, and FN developed in 36 (72%), 21 (42%), and 12 (24%) patients, respectively. Multivariate logistic regression revealed that a pretreatment absolute monocyte count (AMC) <370/mm3 is an independent predictor of TPF chemotherapy-induced FN (odds ratio=6.000, p=0.017). The predictive performance of the model combining AMC and absolute neutrophil count (ANC), in which the high-risk group was defined as having an AMC <370/mm3 and/or ANC <3500/mm3, was superior (area under the curve [AUC]=0.745) to that of the model with a cutoff for AMC alone (AUC=0.679). Conclusions On the basis of our results, we recommend primary prophylactic use of granulocyte colony-stimulating factor and/or antibiotics selectively for patients predicted to be at high risk for TPF chemotherapy-induced FN.
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Affiliation(s)
- Marie Shimanuki
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Yoichiro Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Nana Nakahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Daisuke Totsuka
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Emiri Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Sena Iguchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Yasuo Sato
- Department of Otorhinolaryngology, Kyosai Tachikawa Hospital, Tachikawa, Tokyo, Japan
| | - Keiko Soma
- Department of Otorhinolaryngology, Matsumoto Dental University, Matsumoto, Nagano, Japan
| | - Yasutomo Araki
- Department of Otorhinolaryngology-Head and Neck Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Kanagawa, Japan
| | - Seiji Shigetomi
- Department of Otorhinolaryngology, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Satoko Yoshida
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yusuke Ogawa
- Department of Otorhinolaryngology, International University of Health and Welfare Atami Hospital, Atami, Shizuoka, Japan
| | - Takehiro Tominaga
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yuichi Ikari
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Junko Nagayama
- Department of Otorhinolaryngology, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
| | - Ayako Endo
- Department of Otorhinolaryngology, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Koshiro Miura
- Department of Otorhinolaryngology, Kamio Memorial Hospital, Chiyoda, Tokyo, Japan
| | - Takuya Tomioka
- Department of Otorhinolaryngology, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Teo M, Sharial MSNM, McDonnell F, Conlon KC, Ridgway PF, McDermott RS. Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Advanced Pancreatic Ductal Adenocarcinoma: Impact of Baseline Fluctuation and Changes during Chemotherapy. TUMORI JOURNAL 2018; 99:516-22. [DOI: 10.1177/030089161309900413] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Aims and background Inflammation has been implicated in carcinogenesis and progression of pancreatic cancer. The neutrophil-to-lymphocyte ratio is an index of systemic inflammation. We examined the prognostic role of the neutrophil-to-lymphocyte ratio at baseline and the significance of intrapersonal variability of the ratio before and during chemotherapy. Methods and study design Advanced pancreatic adenocarcinoma patients who had received chemotherapy were included. Baseline clinical and biochemical parameters, including the neutrophil-to-lymphocyte ratio, were extracted and analyzed. The neutrophil-to-lymphocyte ratio threshold was determined via recursive partitioning and assessed at diagnosis, prior to chemotherapy and during treatment. Overall survival was estimated via the Kaplan-Meier method and compared between groups with the logrank test. Results Between 2005 and 2011, 85 patients with locally advanced (n = 38) and metastatic disease were identified: 68% with a neutrophil-to-lymphocyte ratio >3 had shorter median overall survival than patients with a neutrophil-to-lymphocyte ratio <3 (3.4 vs 9.4 months, P = 0.001). Pretreatment, 35% of repeat neutrophil-to-lymphocyte ratios crossed the threshold of 3. A persistently elevated neutrophil-to-lymphocyte ratio >3 suggested a worse overall survival than in patients with a decreasing, increasing or persistently low neutrophil-to-lymphocyte ratio (1.9 vs 8.2, 12.3 and 11.7 months, respectively, P <0.001). Twenty-three percent of patients had a >50% decrease in neutrophil-to-lymphocyte ratio following 4 weeks of chemotherapy, with a trend towards improvement in overall survival (12.5 vs 5.0 mo, P = 0.068). Conclusions The baseline neutrophil-to-lymphocyte ratio is a validated marker for a poor prognosis. Multiple assessments of the pre-treatment neutrophil-to-lymphocyte ratio might be required. Reduction in the neutrophil-to-lymphocyte ratio during chemotherapy may be associated with improved survival.
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Affiliation(s)
- MinYuen Teo
- Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | | | - Felicity McDonnell
- Pharmacy Department, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | - Kevin C Conlon
- Professorial Surgical Unit and Department of Upper Gastrointestinal & Hepato-Pancreato-Biliary Surgery, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | - Paul F Ridgway
- Professorial Surgical Unit and Department of Upper Gastrointestinal & Hepato-Pancreato-Biliary Surgery, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
| | - Ray S McDermott
- Department of Medical Oncology, Adelaide & Meath Hospital incorporating National Children's Hospital, Tallaght, Dublin, Ireland
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Pretreatment Neutrophil-to-Lymphocyte Ratio and Lymphocyte Recovery: Independent Prognostic Factors for Survival in Pediatric Sarcomas. J Pediatr Hematol Oncol 2017; 39:538-546. [PMID: 28697168 DOI: 10.1097/mph.0000000000000911] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pretreatment neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) recovery have been shown to be associated with prognosis in several types of cancer in adults. However, evidence in pediatric cancer is scarce. The aim of our study was to evaluate whether pretreatment NLR and lymphocyte recovery are prognostic factors in pediatric sarcomas. MATERIALS AND METHODS Study participants were identified from a retrospective cohort of 100 children with osteosarcoma (n=55), rhabdomyosarcoma (n=22), and Ewing sarcoma (n=23). Data for the hematological variables were obtained from medical records and analyzed with other known prognostic factors in univariate and multivariate analyses. RESULTS In multivariate analysis, NLR>2 was an independent prognostic factor for OS in patients with osteosarcoma (hazard ratio [HR], 2.27, 95% confidence interval [CI], 1.07-5.30; P=0.046) along with metastatic disease and poor histologic response; as well as in patients with rhabdomyosarcoma (HR, 4.76, 95% CI, 1.01-22.24; P=0.0237) along with metastatic disease and risk group. ALC recovery correlated for inferior OS in osteosarcoma (HR, 3.34, 95% CI, 1.37-8.12; P=0.008) and rhabdomyosarcoma (HR, 3.89; 95% CI, 1.01-14.89; P=0.0338). CONCLUSIONS Our study confirms that NLR and ALC recovery are independent prognostic factors for pediatric sarcomas, implying an important role of immune system in survival. Clinical utility of these prognostic biomarkers should be validated in larger pediatric studies.
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Batorov EV, Tikhonova MA, Kryuchkova IV, Sergeevicheva VV, Sizikova SA, Ushakova GY, Batorova DS, Gilevich AV, Ostanin AA, Shevela EY, Chernykh ER. CD4 + memory T cells retain surface expression of CD31 independently of thymic function in patients with lymphoproliferative disorders following autologous hematopoietic stem-cell transplantation. Int J Hematol 2017; 106:108-115. [PMID: 28293817 DOI: 10.1007/s12185-017-2214-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 11/30/2022]
Abstract
High-dose chemotherapy with autologous hematopoietic stem-cell transplantation (AHSCT) causes severe and long-lasting immunodeficiency in patients with lymphoproliferative disorders. The thymus begins to restore the T-cell repertoire approximately from the sixth month post-transplant. We assessed the dynamics of post-transplant recovery of CD4+CD45RA+CD31+ T cells, "recent thymic emigrants" (RTEs), and a poorly described subtype of CD4+CD45RA-CD31+ T cells in 90 patients with lymphoproliferative disorders following high-dose chemotherapy with AHSCT. Relative and absolute counts of CD4+CD31+ naïve and memory T cells were evaluated before AHSCT, at the day of engraftment, and 6- and 12-month post-transplant. The pre-transplant count of CD4+CD45RA+CD31+ T cells was lower than in healthy controls, and did not reach donors' values during the 12-month period. The pre-transplant number of CD4+CD45RA-CD31+ T cells was higher than in healthy controls and was restored rapidly following AHSCT. Post-transplant mediastinal radiotherapy reduced counts of RTEs and elongated recovery period. Non-thymic tissue irradiation did not reduce this subset. The obtained data indicate that homeostatic proliferation may decrease the significance of CD31 expression on CD4+CD45RA+ T cells as a marker of RTEs, and suggest that evaluation of RTEs recovery by flow cytometry requires an accurate gating strategy to exclude CD31+ memory T cells.
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Affiliation(s)
- Egor V Batorov
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation.
| | - Marina A Tikhonova
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Irina V Kryuchkova
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Vera V Sergeevicheva
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Svetlana A Sizikova
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Galina Y Ushakova
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Dariya S Batorova
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Andrey V Gilevich
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Alexander A Ostanin
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Ekaterina Y Shevela
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
| | - Elena R Chernykh
- Research Institute of Fundamental and Clinical Immunology, 14 Yadrintsevskaya St, 630099, Novosibirsk, Russian Federation
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d'Engremont C, Vernerey D, Pointet AL, Simone G, Fein F, Heyd B, Koch S, Vuitton L, Kim S, Jary M, Lamfichek N, Turco C, Lakkis Z, Berger A, Bonnetain F, Taieb J, Bachellier P, Borg C. Additive value of pre-operative and one-month post-operative lymphocyte count for death-risk stratification in patients with resectable pancreatic cancer: a multicentric study. BMC Cancer 2016; 16:823. [PMID: 27782813 PMCID: PMC5080693 DOI: 10.1186/s12885-016-2860-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022] Open
Abstract
Background Pancreatic adenocarcinoma (PDAC) incidence is increasing worldwide. Several studies have shown that lymphopenia was correlated with a poor prognosis but the potential interest to measure lymphopenia in the pre and post-operative setting as well as its added value among conventional prognostic factors was never investigated. Methods Data from two independent cohorts in whom patients underwent resection for pancreatic carcinoma were retrospectively recorded. We examined the association between perioperative findings, pre and post-operative lymphocyte counts and overall survival (OS) in univariate and multivariate analyses. Performance assessment and internal validation of the final model were evaluated with Harrell’s C-index, calibration plot and bootstrap sample procedures. Results Three hundred ninety patients were included in the analysis between 2000 and 2011. Pre and post-operative lymphocyte counts were independent prognostic factors associated with OS in multivariate analysis (p = 0.0128 and p = 0.0764, respectively). The addition of lymphocyte count variable to the conventional parameters identified in multivariate analysis (metastatic lymph node ratio, veinous emboli and adjuvant chemotherapy) significantly improved the model discrimination capacity (bootstrap mean difference = 0.04; 95 % CI, 0.01–0.06). The use of a threshold and combining the categorical (≥1000; <1000) information in pre and post lymphocyte counts permitted the identification of 4 subgroups of patients with different prognosis (p < 0.0001). Finally, the description of patients in long-term remission showed that only 3 of 65 (4.6 %) patients with post-operative lymphocyte count under 1000/mm3 were alive 4 years after surgery contrary to 54 of 236 (22.8 %) patients with a post-operative lymphocyte count above 1000/mm3. Conclusion Pre and post-operative lymphopenia are independent prognostic factors for OS and they have an additive value regarding conventional prognostic factors for death-risk stratification and to predict long-term survival. Lymphopenia should be included as stratification factors in future clinical trial assessing overall survival in pancreatic cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2860-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Dewi Vernerey
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Anne-Laure Pointet
- Department of Gastroenterology and GI oncology, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Gaël Simone
- Department of Digestive Surgery and Liver Transplantation, University hospital of Strasbourg, Strasbourg, France
| | - Francine Fein
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Bruno Heyd
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Stéphane Koch
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Lucine Vuitton
- Department of Gastroenterology, University Hospital of Besançon, Besançon, France
| | - Stefano Kim
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Marine Jary
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France
| | - Najib Lamfichek
- Department of Digestive Surgery, Hospital of Belfort-Montbeliard, Montbeliard, France
| | - Celia Turco
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Zaher Lakkis
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - Anne Berger
- Department of GI Surgery, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Julien Taieb
- Department of Gastroenterology and GI oncology, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | - Philippe Bachellier
- Department of Digestive Surgery and Liver Transplantation, University hospital of Strasbourg, Strasbourg, France
| | - Christophe Borg
- Department of Medical Oncology, University Hospital of Besançon, Besançon, France. .,Centre investigation Clinique en biothérapie, CIC-1431, Besançon, France. .,UMR1098 INSERM/Université de Franche Comté/Etablissement Français du Sang, Besançon, France. .,Department of Oncology, University Hospital of Besançon, 3 Boulevard Alexander Fleming, Besancon, F-25030, France.
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Kou F, Lu Z, Li J, Zhang X, Lu M, Zhou J, Wang X, Gong J, Gao J, Li J, Li Y, Shen L. Pretreatment lymphopenia is an easily detectable predictive and prognostic marker in patients with metastatic esophagus squamous cell carcinoma receiving first-line chemotherapy. Cancer Med 2016; 5:778-86. [PMID: 26814381 PMCID: PMC4864807 DOI: 10.1002/cam4.638] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/22/2015] [Accepted: 12/16/2015] [Indexed: 01/21/2023] Open
Abstract
To explore the influence of pretreatment lymphopenia on the toxicity and efficacy of first‐line chemotherapy in patients with metastatic esophagus squamous cell carcinoma (ESCC). In total, 215 patients were included in this retrospective study. Correlations between pretreatment lymphopenia (lymphocyte count <1 × 109/L) and the occurrence of toxicity and the efficacy of first‐line palliative chemotherapy were investigated. Pretreatment lymphopenia was found in 19.1% of the patients. The overall response rate (ORR) was 35.5% (65 of 183 patients). Patients with pretreatment lymphopenia had a lower ORR to chemotherapy compared with those without lymphopenia (22.2% vs. 38.8%, respectively; P = 0.045). Furthermore, the patients with pretreatment lymphopenia have higher grade 3–4 hematological toxicity than that of patients without pretreatment lymphopenia (19 of 41 patients, 46.3% vs. 54 of 174 patients, 31.0%; P = 0.048). Pretreatment lymphopenia was not correlated with grade 3–4 nonhematological toxicity. Multivariate analysis showed that pretreatment lymphopenia is an independent prognostic factor. Patients with pretreatment lymphopenia had a significantly shorter overall survival time than those without lymphopenia (8.2 months vs. 12.7 months; P = 0.020). This study shows that pretreatment lymphopenia is a good prognostic factor as well as a predictive factor for tumor response and chemotherapy‐related hematological toxicity in metastatic ESCC.
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Affiliation(s)
- Furong Kou
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhihao Lu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jian Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Xiaotian Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Ming Lu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jun Zhou
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Xicheng Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jifang Gong
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jing Gao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Jie Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Yan Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
| | - Lin Shen
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, 100142, China
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Rovati B, Mariucci S, Delfanti S, Grasso D, Tinelli C, Torre C, De Amici M, Pedrazzoli P. Simultaneous detection of circulating immunological parameters and tumor biomarkers in early stage breast cancer patients during adjuvant chemotherapy. Cell Oncol (Dordr) 2016; 39:211-28. [PMID: 26769126 DOI: 10.1007/s13402-015-0264-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chemotherapy-induced immune suppression has mainly been studied in patients with advanced cancer, but the influence of chemotherapy on the immune system in early stage cancer patients has so far not been studied systematically. The aim of the present study was to monitor the immune system during anthracycline- and taxane-based adjuvant chemotherapy in early stage breast cancer patients, to assess the impact of circulating tumor cells on selected immune parameters and to reveal putative angiogenic effects of circulating endothelial cells. METHODS Peripheral blood samples from 20 early stage breast cancer patients were analyzed using a flow cytometric multi-color of antibodies to enumerate lymphocyte and dendritic cell subsets, as well as endothelial and tumor cells. An enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of various serological factors. RESULTS During chemotherapy, all immunological parameters and angiogenesis surrogate biomarkers showed significant decreases. The numbers of circulating tumor cells showed significant inverse correlations with the numbers of T helper cells, a lymphocyte subset directly related to effective anti-tumor responses. Reduced T helper cell numbers may contribute to systemic immunosuppression and, as such, the activation of dormant tumor cells. CONCLUSIONS From our results we conclude that adjuvant chemotherapy suppresses immune function in early stage breast cancer patients. In addition, we conclude that the presence of circulating tumor cells, defined as pan-cytokeratin(+), CD326(+), CD45(-) cells, may serve as an important indicator of a patient's immune status. Further investigations are needed to firmly define circulating tumor cells as a predictor for the success of breast cancer adjuvant chemotherapy.
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Affiliation(s)
- B Rovati
- SC Oncologia e Laboratorio di Citofluorimetria, e Terapie Cellulari, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - S Mariucci
- SC Oncologia e Laboratorio di Citofluorimetria, e Terapie Cellulari, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Delfanti
- SC Oncologia e Laboratorio di Citofluorimetria, e Terapie Cellulari, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Grasso
- SC Oncologia e Laboratorio di Citofluorimetria, e Terapie Cellulari, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Tinelli
- Servizio di Biometria e Statistica Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Torre
- SC Pediatria, Laboratorio di Immuno Allergologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M De Amici
- SC Pediatria, Laboratorio di Immuno Allergologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Pedrazzoli
- SC Oncologia e Laboratorio di Citofluorimetria, e Terapie Cellulari, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Zhou M, Bracci PM, McCoy LS, Hsuang G, Wiemels JL, Rice T, Zheng S, Kelsey KT, Wrensch MR, Wiencke JK. Serum macrophage-derived chemokine/CCL22 levels are associated with glioma risk, CD4 T cell lymphopenia and survival time. Int J Cancer 2015; 137:826-36. [PMID: 25604093 PMCID: PMC4478165 DOI: 10.1002/ijc.29441] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 01/09/2015] [Indexed: 01/07/2023]
Abstract
Defects in antigen presenting cell function have been implicated in glioma immunosuppression. We measured peripheral CCL22, a dendritic cell/macrophage derived T cell trafficking chemokine, in sera from 1,208 glioma cases and 976 controls to assess whether it might provide a biomarker of glioma risk, survival and immune dysfunction. Cluster models were used to examine the relationship between CCL22 and glioma risk. Patient survival was assessed using Cox regression models. We also examined the relationship between CCL22 levels and CD4 cell counts, as well as allergy history and IgE levels. CCL22 levels were significantly lower among glioma cases compared with controls (Mean ± SEM: 1.23 ± 0.03 ng/mL in cases vs. 1.60 ± 0.03 ng/mL in controls, p < 0.0001) and this difference remained significant even after controlling for other covariates in the cluster models (highest quartile versus lowest Odds Ratio = 0.21, p < 0.0001). CD4 cell counts were positively correlated with CCL22 in glioma cases (Spearman r(2) = 0.51, p < 0.01) and were significantly lower in cases compared with controls. Higher CCL22 levels were associated with longer survival in all cases combined and in GBM cases (hazard ratio(allcases) = 0.81; 95% CI: 0.72-0.91, p = 0.0003). CCL22 levels were not associated with IgE level or self-reported allergies. Circulating CCL22 levels are related to both glioma risk and survival duration independent of age, histology, grade and IDH mutation status. CCL22 should be considered a marker of immune status with potential prognostic value.
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Affiliation(s)
- Mi Zhou
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Paige M. Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Lucie S. McCoy
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
| | - George Hsuang
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Joseph L. Wiemels
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Terri Rice
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Shichun Zheng
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Karl T. Kelsey
- Department of Laboratory Medicine and Pathology, Brown University, Providence, RI
| | - Margaret R. Wrensch
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - John K. Wiencke
- Department of Neurological Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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Trédan O, Ménétrier-Caux C, Ray-Coquard I, Garin G, Cropet C, Verronèse E, Bachelot T, Rebattu P, Heudel P, Cassier P, Chabaud S, Croughs T, Dupont P, Cadore A, Clapisson G, Delgado A, Bardin-dit-Courageot C, Rigal C, N'Kodia A, Gilles-Afchain L, Morre M, Pérol D, Blay J, Caux C. ELYPSE-7: a randomized placebo-controlled phase IIa trial with CYT107 exploring the restoration of CD4+ lymphocyte count in lymphopenic metastatic breast cancer patients. Ann Oncol 2015; 26:1353-62. [DOI: 10.1093/annonc/mdv173] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/24/2015] [Indexed: 12/29/2022] Open
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Wiencke JK, Bracci PM, Hsuang G, Zheng S, Hansen H, Wrensch MR, Rice T, Eliot M, Kelsey KT. A comparison of DNA methylation specific droplet digital PCR (ddPCR) and real time qPCR with flow cytometry in characterizing human T cells in peripheral blood. Epigenetics 2015; 9:1360-5. [PMID: 25437051 DOI: 10.4161/15592294.2014.967589] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Quantitating the copy number of demethylated CpG promoter sites of the CD3Z gene can be used to estimate the numbers and proportions of T cells in human blood and tissue. Quantitative methylation specific PCR (qPCR) is useful for studying T cells but requires extensive calibration and is imprecise at low copy numbers. Here we compared the performance of a new digital PCR platform (droplet digital PCR or ddPCR) to qPCR using bisulfite converted DNA from 157 blood specimens obtained from ambulatory care controls and patients with primary glioma. We compared both ddPCR and qPCR with conventional flow cytometry (FACS) evaluation of CD3 positive T cells. Repeated measures on the same blood sample revealed ddPCR to be less variable than qPCR. Both qPCR and ddPCR correlated significantly with FACS evaluation of peripheral blood CD3 counts and CD3/total leukocyte values. However, statistical measures of agreement showed that linear concordance was stronger for ddPCR than for qPCR and the absolute values were closer to FACS for ddPCR. Both qPCR and ddPCR could distinguish clinically significant differences in T cell proportions and performed similarly to FACS. Given the higher precision, greater accuracy, and technical simplicity of ddPCR, this approach appears to be a superior DNA methylation based method than conventional qPCR for the assessment of T cells.
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Affiliation(s)
- John K Wiencke
- a Department of Neurological Surgery ; University of California, San Francisco ; San Francisco , CA USA
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Anazoeze M, Sunday O, Obike I, Awele C, Kenechi M. Comparison of absolute neutrophil to CD4 lymphocyte values as a marker of immunosuppression in cancer patients on cytotoxic chemotherapy. Afr Health Sci 2015; 15:581-9. [PMID: 26124806 DOI: 10.4314/ahs.v15i2.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The absolute neutrophil count (ANC) is currently used to assess immune status of patients on cytotoxic therapy. The CD4 lymphocytes have also been shown to be of importance in protection against opportunistic infections. In people of African descent a low baseline ANC has been recorded and the currently accepted neutropaenic threshold may not be appropriate. OBJECTIVE This study was aimed at comparing the change in ANC to CD4 lymphocyte count in adult cancer patients following chemotherapy. PATIENTS AND METHODS Eighty chemotherapy-naive patients with various malignancies had their ANC and CD4 lymphocyte counts done at days 0 and 12 of the first cycle of various chemotherapeutic regimens. The paired sample t-test was done to assess the significance between these values. Socio-demographic data was obtained using questionnaires. RESULTS ANC and CD4 pre-chemotherapy differed significantly from their post-chemotherapy values (p=0.001) for both parameters). The CD4 count showed significant reduction in patients with Non-Hodgkin's lymphoma (p=0.043), colorectal carcinoma (p=0.037) and other malignancies (p=0.030), while the ANC did not. Patients who had received COPP for Hodgkin's lymphoma also had significant CD4 depletion (p=0.037). CONCLUSION The CD4 lymphocyte count may be a more suitable parameter than ANC, for monitoring immuno-depletion in cancer patients on cytotoxic chemotherapy. Further studies are required to validate these findings, especially in the Negroid population.
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Affiliation(s)
- Madu Anazoeze
- University of Nigeria, Haematology & Immunology ; University of Nigeria Teaching Hospital, Haenatology & Immunology
| | | | | | - Chukwura Awele
- University of Nigeria Teaching Hospital, Enugu, Haematology
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Hoskin PJ, Rojas AM, Peiris SN, Mullassery V, Chong IY. Pre-treatment haemoglobin and peripheral blood lymphocyte count as independent predictors of outcome in carcinoma of cervix. Clin Oncol (R Coll Radiol) 2014; 26:179-84. [PMID: 24439272 DOI: 10.1016/j.clon.2013.11.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/14/2013] [Accepted: 10/17/2013] [Indexed: 10/25/2022]
Abstract
AIMS To evaluate pre-treatment haemoglobin and peripheral blood lymphocyte (PBL) counts as predictors of treatment outcome in cervix carcinoma treated with radical chemoradiation. MATERIALS AND METHODS Pre-treatment PBL counts and haemoglobin concentrations were retrieved from full blood count examinations from 111 patients who received concurrent chemoradiotherapy. Overall survival and relapse-free survival were obtained using the Kaplan-Meier method by ranking the data by median haemoglobin and PBL, singly and then in association. Their independence and significance as predictors of outcome were analysed using the Cox proportional hazard model. RESULTS Survival rates were significantly higher in patients whose haemoglobin level or PBL counts were at or above the corresponding median value. At 5 years, rates of overall survival were 77% versus 41% (P = 0.0003) and 75% versus 42% (P = 0.002), when dichotomised around median haemoglobin and PBL, respectively. In multivariate and univariate analyses, both PBL and haemoglobin were independent and significant predictors for risk of death and relapse. Their predictive power was dramatically enhanced when the data were stratified into four groups by associating patients with haemoglobin ≥ median or < median with those whose PBL was ≥ or < median. CONCLUSION Baseline PBL and haemoglobin seem to be strong, independent predictors of treatment outcome in carcinoma of the cervix, particularly if patient response is ranked using the predictors simultaneously. The hypothesis needs to be tested and, if confirmed, the markers should be used in combination to identify those at greater risk of failure who may benefit from additional therapy, with further validation in prospective trials offering treatment modification.
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Affiliation(s)
- P J Hoskin
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - A M Rojas
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK.
| | - S N Peiris
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - V Mullassery
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - I Y Chong
- Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, UK
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Madu A, Ocheni S, Ibegbulam O, Aguwa E, Madu K. Pattern of CD4 T-lymphocyte Values in Cancer Patients on Cytotoxic Therapy. Ann Med Health Sci Res 2013; 3:498-503. [PMID: 24379998 PMCID: PMC3868113 DOI: 10.4103/2141-9248.122054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Assessment of patients prior to cytotoxic chemotherapy usually includes absolute neutrophils count. Other cellular markers of susceptibility to infection as well as immunocompetence include the T Helper lymphocyte count. In cancer patients, decrease in these lymphocytes has been observed to be associated with decreased overall survival. Aim: To assess the degree of CD4 lymphopenia encountered during cytotoxic chemotherapeutic treatment for cancer and evaluate the differences observed for the various drug combinations. Subjects and Methods: Eighty patients with various histologically diagnosed malignancies had their CD4 lymphocyte counts carried out at days 0 and 12 of the first cycle of their various chemotherapeutic regimens. They were adult patients who had been diagnosed with breast cancer 36/80 cases (45%), non-Hodgkin's lymphoma 8/80 cases (10%), Hodgkin's lymphoma 13/80 cases (16.3%), multiple myeloma 7/80 cases (8.8%), colorectal carcinoma 6/80 cases (7.5%), and other malignancies 10/80 cases (12.5%). CD4 lymphocyte count was done using the Partec Cyflow® 2000 CD4 cell counter, and their socio-demographic data of the patients were assessed using a questionnaire. Results: The mean (sd) CD4 lymphocyte count pre- and post-chemotherapy was observed to be 567 (341) cells/μLand 349 (207) cells/μL while the median values were 454 cells/μLand 349 cells/μL respectively. There were significant differences in CD4 lymphocyte counts after chemotherapy compared to the pre-chemotherapy values. Conclusion: Epirubicin combinations used in breast cancer patients as well as (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) ABVD regimen used in treatment of Hodgkin's lymphoma were found to be significantly less lymphotoxic than other chemotherapeutic combinations. These drugs or their combinations may be less immunotoxic than other known regimen used for these malignancies.
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Affiliation(s)
- Aj Madu
- Department of Hematology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - S Ocheni
- Department of Immunology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Og Ibegbulam
- Department of Immunology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - En Aguwa
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ka Madu
- National Orthopedic Hospital, Enugu, Nigeria
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Lyman GH, Abella E, Pettengell R. Risk factors for febrile neutropenia among patients with cancer receiving chemotherapy: A systematic review. Crit Rev Oncol Hematol 2013; 90:190-9. [PMID: 24434034 DOI: 10.1016/j.critrevonc.2013.12.006] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022] Open
Abstract
Neutropenia with fever (febrile neutropenia [FN]) is a serious consequence of myelosuppressive chemotherapy that usually results in hospitalization and the need for intravenous antibiotics. FN may result in dose reductions, delays, or even discontinuation of chemotherapy, which, in turn, may compromise patient outcomes. It is important to identify which patients are at high risk for developing FN so that patients can receive optimal chemotherapy while their risk for FN is appropriately managed. A systematic review of the literature was performed to gain a comprehensive and updated understanding of FN risk factors. Older age, poor performance status, advanced disease, certain comorbidities, low baseline blood cell counts, low body surface area/body mass index, treatment with myelosuppressive chemotherapies, and specific genetic polymorphisms correlated with the risk of developing FN. Albeit many studies have analyzed FN risk factors, there are several limitations, including the retrospective nature and small sample sizes of most studies.
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Affiliation(s)
- Gary H Lyman
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA.
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Trebouet A, Marchand T, Lemal R, Gyan E, Broussais-Guillaumot F, Guillermin Y, Monjanel H, Salles G, Le Gouill S, Godmer P, Fruchart C, Damaj G, Feugier P, Thieblemont C, Maynadié M, Monnereau A, Troussard X, Rossille D, Lamy T, Houot R. Lymphoma occurring in patients over 90 years of age: characteristics, outcomes, and prognostic factors. A retrospective analysis of 234 cases from the LYSA. Ann Oncol 2013; 24:2612-2618. [PMID: 23970017 DOI: 10.1093/annonc/mdt282] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Lymphoma occurring in patients aged 90 or older is not uncommon, and its incidence is expected to increase over time. Management of these patients is difficult given their underlying fragility and the lack of information regarding this population. PATIENTS AND METHODS We retrospectively analyzed 234 patients diagnosed with lymphoma at the age of 90 years or older (90+) between 1990 and 2012 to describe their characteristics, management, outcomes and prognostic factors. RESULTS The median age was 92 years; 88% were B-cell lymphomas consisting mainly in diffuse large B-cell lymphoma. The median overall survival (OS) was 7.2 months (range, 0-92 months) for the 227 patients with non-Hodgkin Lymphoma (NHL), with a significant difference between aggressive and indolent NHL (5.2 months versus 19.4 months, respectively). We further analyzed 166 NHL patients for whom detailed characteristics were available. Among these patients, 63.5% received a treatment, either local (7.5%) or systemic (56%). Lymphoma was reported as the main cause of death (40%). Treatment administration was associated with improved OS in patients with aggressive (P < 0.001) but not indolent NHL (P = 0.96). In patients with aggressive NHL, hypoalbuminemia appeared as a strong and independent negative prognostic factor. CONCLUSIONS The median OS is short in 90+ patients diagnosed with lymphoma but some patients experience prolonged survival. Lymphoma represents the main cause of death in these patients. Treatment may improve survival of selected patients with aggressive but not indolent NHL. Management of these patients may be guided by prognostic factors identified in this study, notably serum albumin.
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Affiliation(s)
- A Trebouet
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes
| | - T Marchand
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes
| | - R Lemal
- Department of Hematology, Centre Hospitalier Universitaire de Clermont-Ferrand Hôpital Estaing, Université d'Auvergne CREaT - EA 7283, Inserm CIC-501, Clermont-Ferrand
| | - E Gyan
- Department of Hematology, Centre Hospitalier Universitaire de Tours, CIC INSERM U202, Tours
| | | | - Y Guillermin
- Department of Hematology, Centre Léon Bérard, Université Lyon 1, Lyon
| | - H Monjanel
- Department of Hematology, AP-HP, Hôpital Saint Louis, Université Paris 7, INSERM U728, Paris
| | - G Salles
- Department of Hematology, Hospices Civils de Lyon, Université Lyon-1, Pierre-Bénite
| | - S Le Gouill
- Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes
| | - P Godmer
- Department of Hematology, Centre Hospitalier de Bretagne Atlantique, Vannes
| | - C Fruchart
- Department of Hematology, Centre de lutte contre le Cancer François Baclesse, Caen
| | - G Damaj
- Department of Hematology, Centre Hospitalier Universitaire d'Amiens, Amiens
| | - P Feugier
- Department of Hematology, Centre Hospitalier Universitaire de Nancy, Nancy
| | - C Thieblemont
- Department of Hematology, AP-HP, Hôpital Saint Louis, Université Paris 7, INSERM U728, Paris
| | - M Maynadié
- Hematological Cancer Registry of Côte d'Or, UCOG de Bourgogne, EA4184, Université de Bourgogne, Dijon
| | - A Monnereau
- Hematological Cancer Registry of Gironde, Institut Bergonié, Bordeaux
| | - X Troussard
- Hematological Cancer Registry of Basse Normandie, Centre Hospitalier Universitaire de Caen, Caen
| | - D Rossille
- Department of Biology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - T Lamy
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes
| | - R Houot
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, INSERM U917, Rennes.
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Le Jeune C, Bertoli S, Elhamri M, Vergez F, Borel C, Huguet F, Michallet M, Dumontet C, Recher C, Thomas X. Initial absolute lymphocyte count as a prognostic factor for outcome in acute myeloid leukemia. Leuk Lymphoma 2013; 55:855-62. [DOI: 10.3109/10428194.2013.813504] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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What are the molecules involved in regulatory T-cells induction by dendritic cells in cancer? Clin Dev Immunol 2013; 2013:806025. [PMID: 23762097 PMCID: PMC3674660 DOI: 10.1155/2013/806025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 04/22/2013] [Indexed: 01/29/2023]
Abstract
Dendritic cells (DCs) are essential for the maintenance of homeostasis in the organism, and they do that by modulating lymphocyte priming, expansion, and response patterns according to signals they receive from the environment. The induction of suppressive lymphocytes by DCs is essential to hinder the development of autoimmune diseases but can be reverted against homeostasis when in the context of neoplasia. In this setting, the induction of suppressive or regulatory T cells contributes to the establishment of a state of tolerance towards the tumor, allowing it to grow unchecked by an otherwise functional immune system. Besides affecting its local environment, tumor also has been described as potent sources of anti-inflammatory/suppressive factors, which may act systemically, generating defects in the differentiation and maturation of immune cells, far beyond the immediate vicinity of the tumor mass. Cytokines, as IL-10 and TGF-beta, as well as cell surface molecules like PD-L1 and ICOS seem to be significantly involved in the redirection of DCs towards tolerance induction, and recent data suggest that tumor cells may, indeed, modulate distinct DCs subpopulations through the involvement of these molecules. It is to be expected that the identification of such molecules should provide molecular targets for more effective immunotherapeutic approaches to cancer.
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Péron J, Cropet C, Tredan O, Bachelot T, Ray-Coquard I, Clapisson G, Chabaud S, Philip I, Borg C, Cassier P, Labidi Galy I, Sebban C, Perol D, Biron P, Caux C, Menetrier-Caux C, Blay JY. CD4 lymphopenia to identify end-of-life metastatic cancer patients. Eur J Cancer 2013; 49:1080-9. [DOI: 10.1016/j.ejca.2012.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 10/29/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022]
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Trédan O, Manuel M, Clapisson G, Bachelot T, Chabaud S, Bardin-dit-Courageot C, Rigal C, Biota C, Bajard A, Pasqual N, Blay JY, Caux C, Ménétrier-Caux C. Patients with metastatic breast cancer leading to CD4+ T cell lymphopaenia have poor outcome. Eur J Cancer 2012; 49:1673-82. [PMID: 23265706 DOI: 10.1016/j.ejca.2012.11.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low lymphocyte count is a prognostic factor in cancer patients including metastatic breast cancer patients (MBC) but the relative role of each lymphocyte subtype is unclear in MBC. METHODS The impact of lymphocyte subsets was analysed in two prospective MBC patients' cohorts. Cohort A patients (n=103) were included before the first line of chemotherapy and cohort B patients (n=101) were included after at least one line of chemotherapy. Extensive phenotypic analyses were performed on fresh whole blood. Plasma cytokines levels were measured using commercially available Luminex-based multiplex kits. Prognostic value of lymphocyte subsets and circulating cytokines was analysed. RESULTS In both cohorts, severe lymphopaenia (<0.7 Giga/L) correlated with poor overall survival (OS) (median OS: 6.6 months versus 21.7 months in cohort A and 4.5 versus 9 months in cohort B). CD8(+), CD19(+) and CD56(+) T cell counts had no significant prognostic value for OS. After stratification (≤0.2, [0.20-0.45], >0.45 Giga/L), CD4 lymphopaenia appeared to be correlated with poor OS in both cohorts. Furthermore, severe CD4(+) lymphopaenia (≤0.2 Giga/L) was strongly correlated with poor OS in both cohorts (1.2 months versus 24.9 months in cohort A and 5.7 versus 13.1 months in cohort B). In multivariate analysis, after stratification CD4(+) lymphopaenia appeared to be an independent prognostic factor for OS in both cohorts. CD4(+) lymphopaenia correlated with low plasmatic levels of CCL22 that might directly contribute to CD4(+) lymphopaenia. CONCLUSIONS CD4(+) lymphopaenia was associated with reduced OS in MBC patients regardless of the chemotherapy line. Decreased levels of plasmatic CCL22 may contribute to CD4(+) lymphopaenia.
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Affiliation(s)
- Olivier Trédan
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, Lyon 69008, France
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Park J, Kim TM, Hwang JH, Kim NH, Choe PG, Song KH, Kim ES, Park SW, Kim HB, Kim NJ, Park WB, Oh MD. Risk factors for febrile neutropenia during chemotherapy for HIV-related lymphoma. J Korean Med Sci 2012; 27:1468-71. [PMID: 23255844 PMCID: PMC3524424 DOI: 10.3346/jkms.2012.27.12.1468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 09/20/2012] [Indexed: 11/20/2022] Open
Abstract
We evaluated risk factors for neutropenic fever and febrile prolonged neutropenia during vincristine-including chemotherapy to treat HIV-related lymphoma to investigate whether protease inhibitor (PI) treatment is associated with infectious complications due to drug interactions with chemotherapeutic agents. We included all HIV patients who received chemotherapy including vincristine for lymphoma at a single referral center in 1999-2010. Neutropenic fever was defined as absolute neutrophil count < 500 cells/µL with body temperature over 38℃; and prolonged neutropenia was defined if it persisted over 7 days. CODOX-M/IVAC and Stanford regimens were considered high-risk regimens for prolonged neutropenia. We analyzed 48 cycles of chemotherapy in 17 HIV patients with lymphoma. There were 22 neutropenic fever and 12 febrile prolonged neutropenia events. In multivariate analysis, neutropenic fever was associated with old age and low CD4 cell count, but not with PI use or ritonavir-boosted PI use. Low CD4 cell count and high-risk regimens were associated with febrile prolonged neutropenia. Neutropenic fever and febrile prolonged neutropenia is associated with old age, low CD4 cell count, and high-risk regimens, but not PI use, in HIV patients undergoing chemotherapy including vincristine for lymphoma.
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Affiliation(s)
- Jinyong Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nak-Hyun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Chang PH, Yeh KY, Huang JS, Lai CH, Wu TH, Lan YJ, Tsai JCS, Chen EYC, Yang SW, Wang CH. Pretreatment performance status and nutrition are associated with early mortality of locally advanced head and neck cancer patients undergoing concurrent chemoradiation. Eur Arch Otorhinolaryngol 2012. [DOI: 10.1007/s00405-012-2290-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Levine AM, Noy A, Lee JY, Tam W, Ramos JC, Henry DH, Parekh S, Reid EG, Mitsuyasu R, Cooley T, Dezube BJ, Ratner L, Cesarman E, Tulpule A. Pegylated liposomal doxorubicin, rituximab, cyclophosphamide, vincristine, and prednisone in AIDS-related lymphoma: AIDS Malignancy Consortium Study 047. J Clin Oncol 2012; 31:58-64. [PMID: 23169503 DOI: 10.1200/jco.2012.42.4648] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Infusional chemotherapy is efficacious in patients with AIDS-related lymphoma, but it may be difficult to administer. We studied standard agents with rituximab plus pegylated liposomal doxorubicin (DR-COP) in an attempt to provide a more practical approach to therapy while ascertaining rates of response, potential infectious complications, and prognostic role of biologic markers. PATIENTS AND METHODS We conducted a prospective, multi-institutional phase II trial, employing (day 1) pegylated liposomal doxorubicin 40 mg/m(2), rituximab 375 mg/m(2), cyclophosphamide 750 mg/m(2), vincristine 1.4 mg/m(2) (not > 2 mg), and prednisone 100 mg orally on days 1 through 5, with concomitant antiretroviral therapy. RESULTS In 40 evaluable patients, median CD4 cells was 114/μL (range, 5 to 1,026/μL), and median HIV-1 viral load (VL) was 25,000 copies/mL. High or intermediate/high age-adjusted International Prognostic Index was present in 28%. Overall response was 67.5%, with complete remission in 47.5% (95% CI, 31.5 to 63.9). Of 19 complete responders, 84% had extranodal disease, 47% had CD4 < 100/μL, and 47% had VL > 50,000 copies/mL; one relapsed. With 25.5-month median follow-up, 62% (95% CI, 44 to 75) of patients remain alive. Sixteen patients (40%) experienced 22 infections, with grade 4 in only two (5%). No patient died as a result of infection during treatment; one had opportunistic infection. CONCLUSION Profound immunodeficiency and high HIV-1 viral load do not preclude attainment of complete response after DR-COP with highly active antiretroviral therapy. The regimen is tolerable, and use of rituximab was not associated with death as a result of infection during treatment. This approach may be useful in patients in whom the more intensive infusional regimens are impractical.
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Li ZM, Huang JJ, Xia Y, Sun J, Huang Y, Wang Y, Zhu YJ, Li YJ, Zhao W, Wei WX, Lin TY, Huang HQ, Jiang WQ. Blood lymphocyte-to-monocyte ratio identifies high-risk patients in diffuse large B-cell lymphoma treated with R-CHOP. PLoS One 2012; 7:e41658. [PMID: 22911837 PMCID: PMC3402437 DOI: 10.1371/journal.pone.0041658] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/27/2012] [Indexed: 11/18/2022] Open
Abstract
Background Recent research has shown a correlation between immune microenvironment and lymphoma biology. This study aims to investigate the prognostic significance of the immunologically relevant lymphocyte-to-monocyte ratio (LMR), in diffuse large B-cell lymphoma (DLBCL) in the rituximab era. Methodology/Principal Findings We analyzed retrospective data from 438 newly diagnosed DLBCL patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. We randomly selected 200 patients (training set) to generate a cutoff value for LMR by receiver operating characteristic (ROC) curve analysis. LMR was then analyzed in a testing set (n = 238) and in all patients (n = 438) for validation. The LMR cutoff value for survival analysis determined by ROC curve in the training set was 2.6. Patients with low LMR tended to have more adverse clinical characteristics. Low LMR at diagnosis was associated with worse survival in DLBCL, and could also identify high-risk patients in the low-risk IPI category. Multivariate analysis identified LMR as an independent prognostic factor of survival in the testing set and in all patients. Conclusions/Significance Baseline LMR, a surrogate biomarker of the immune microenvironment, is an effective prognostic factor in DLBCL patients treated with R-CHOP therapy. Future prospective studies are required to confirm our findings.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Kaplan-Meier Estimate
- Leukocyte Count
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Monocytes/pathology
- Multivariate Analysis
- Prednisone/therapeutic use
- Prognosis
- Proportional Hazards Models
- ROC Curve
- Risk Factors
- Rituximab
- Treatment Outcome
- Vincristine/therapeutic use
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Affiliation(s)
- Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Guangzhou, China.
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Jenkins P, Scaife J, Freeman S. Validation of a predictive model that identifies patients at high risk of developing febrile neutropaenia following chemotherapy for breast cancer. Ann Oncol 2012; 23:1766-71. [DOI: 10.1093/annonc/mdr493] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morre M, Beq S. Interleukin-7 and immune reconstitution in cancer patients: a new paradigm for dramatically increasing overall survival. Target Oncol 2012; 7:55-68. [PMID: 22383042 PMCID: PMC3304058 DOI: 10.1007/s11523-012-0210-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 01/16/2012] [Indexed: 12/27/2022]
Abstract
Although great effort is being expended in the development of cancer immunotherapies, it is surprising that global lymphopenia and its various dimensions are not being systematically assessed in cancer patients. The incident pathologies associated with various immunosuppressed conditions such as those found in HIV infection have taught us that measuring various T cell populations including CD4 provides the clinician with a reliable measure for gauging the risk of cancer and opportunistic infections. Importantly, recent data emphasize the key link between lymphocyte T cell counts and overall survival in cancer patients receiving chemotherapy. Treatment of immunocompromised patients with interleukin-7 (IL-7), a critical growth and homeostatic factor for T cells, has been shown to produce a compelling profile of T cell reconstitution. The clinical results of this investigational therapy confirm data obtained from numerous preclinical studies and demonstrate the long-term stability of this immune reconstitution, not only on CD4 but also on CD8 T cells, involving recent thymic emigrants as well as naive, memory, and central memory T cells. Furthermore, IL-7 therapy also contributes to restoration of a broadened diversity of the T cell repertoire as well as to migration of these cells to lymph nodes and tissues. All these properties support the initiation of new clinical studies aimed at reconstituting the immune system of cancer patients before or immediately after chemotherapy in order to demonstrate a potentially profound increase in overall survival.
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Affiliation(s)
- Michel Morre
- Cytheris S.A., 175 rue Jean Jacques Rousseau, 92130, Issy-Les-Moulineaux, France.
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