1
|
Rostami M, Yelghi O, Moghaddam ZK, Zeraatchi A, Rezaeejam H, Sadeghi A. Effectiveness of oral famotidine in reducing the hematologic complications of radiotherapy in patients with esophageal and cardia cancers: a randomized controlled trial. Radiat Oncol 2023; 18:83. [PMID: 37210511 DOI: 10.1186/s13014-023-02281-w] [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: 01/29/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Chemoradiotherapy complications has always been of great concern to both clinicians and patients during the course of treatment. The purpose of the present study was to examine the effectiveness of oral famotidine on the reduction of hematologic complications of patients with esophageal and gastric cardia cancers undergoing radiotherapy. METHODS A single-blind controlled trial was conducted on 60 patients with esophageal and cardia cancers, who were undergoing chemoradiotherapy. Patients were randomly assigned to 2 groups with 30 patients to receive either 40 mg of oral famotidine (daily and 4 h before each session) or placebo. Complete blood count with differential, platelet counts, and hemoglobin levels were obtained weekly during treatment. The main outcome variables were lymphocytopenia, granulocytopenia, thrombocytopenia, and anemia. RESULTS The findings indicated a significant effect of famotidine on reduction of thrombocytopenia among intervention group compared to control group (P < 0.0001). Even so, the effect of intervention was not significant for other outcome variables (All, P ≥ 0.05). The lymphocyte (P = 0.007) and platelet (P = 0.004) counts were also significantly greater in famotidine group in comparison with placebo group at the end of the study. CONCLUSION As evidenced by the findings of the current study, famotidine might be recommended as an effective radioprotective agent among patients with esophageal and gastric cardia cancers to prevent Leukocyte and platelet reduction to some extent. Trial registration This study was prospectively registered at irct.ir (Iranian Registry of Clinical Trials) with the code IRCT20170728035349N1, 2020-08-19.
Collapse
Affiliation(s)
- Mina Rostami
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Omid Yelghi
- Department of Radiation Oncology, School of Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Zhaleh Karimi Moghaddam
- Department of Radiation Oncology, School of Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Alireza Zeraatchi
- Department of Emergency Medicine, School of Medicine, Valiasr-e-Asr Hospital, Ayatollah Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hamed Rezaeejam
- Department of Radiology Technology, School of Paramedical Sciences, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Sadeghi
- Department of Internal Medicine, School of Medicine, Vali-e-Asr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
2
|
Whole Blood Transcriptional Fingerprints of High-Grade Glioma and Longitudinal Tumor Evolution under Carbon Ion Radiotherapy. Cancers (Basel) 2022; 14:cancers14030684. [PMID: 35158950 PMCID: PMC8833402 DOI: 10.3390/cancers14030684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Particle therapy with carbon ions is a promising novel option for the treatment of recurrent high-grade glioma (rHGG). Lack of initial and sequential biopsies limits the investigation of rHGG evolution under therapy. We hypothesized that peripheral blood transcriptome derived from liquid biopsies (lbx) as a minimal invasive method may provide a useful decision support for identification of glioma grade and provide novel means for longitudinal molecular monitoring of tumor evolution under carbon ion irradiation (CIR). We demonstrate feasibility and report patient, tumor and treatment fingerprints in whole blood transcriptomes of rHGG patients with pre-CIR and three post-CIR time points. Abstract Purpose: To assess the value of whole blood transcriptome data from liquid biopsy (lbx) in recurrent high-grade glioma (rHGG) patients for longitudinal molecular monitoring of tumor evolution under carbon ion irradiation (CIR). Methods: Whole blood transcriptome (WBT) analysis (Illumina HumanHT-12 Expression BeadChips) was performed in 14 patients with rHGG pre re-irradiation (reRT) with CIR and 3, 6 and 9 weeks post-CIR (reRT grade III:5, 36%, IV:9, 64%). Patients were irradiated with 30, 33, 36 GyRBE (n = 5, 6, 3) in 3GyRBE per fraction. Results: WTB analysis showed stable correlation with treatment characteristics and patients tumor grade, indicating a preserved tumor origin specific as well as dynamic transcriptional fingerprints of peripheral blood cells. Initial histopathologic tumor grade was indirectly associated with TMEM173 (STING), DNA-repair (ATM, POLD4) and hypoxia related genes. DNA-repair, chromatin remodeling (LIG1, SMARCD1) and immune response (FLT3LG) pathways were affected post-CIR. Longitudinal WTB fingerprints identified two distinct trajectories of rHGG evolution, characterized by differential and prognostic CRISPLD2 expression pre-CIR. Conclusions: Lbx based WTB analysis holds the potential for molecular stratification of rHGG patients and therapy monitoring. We demonstrate the feasibility of the peripheral blood transcriptome as a sentinel organ for identification of patient, tumor characteristics and CIR specific fingerprints in rHGG.
Collapse
|
3
|
Marcus D, Lieverse RIY, Klein C, Abdollahi A, Lambin P, Dubois LJ, Yaromina A. Charged Particle and Conventional Radiotherapy: Current Implications as Partner for Immunotherapy. Cancers (Basel) 2021; 13:1468. [PMID: 33806808 PMCID: PMC8005048 DOI: 10.3390/cancers13061468] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
Radiotherapy (RT) has been shown to interfere with inflammatory signals and to enhance tumor immunogenicity via, e.g., immunogenic cell death, thereby potentially augmenting the therapeutic efficacy of immunotherapy. Conventional RT consists predominantly of high energy photon beams. Hypofractionated RT regimens administered, e.g., by stereotactic body radiation therapy (SBRT), are increasingly investigated in combination with cancer immunotherapy within clinical trials. Despite intensive preclinical studies, the optimal dose per fraction and dose schemes for elaboration of RT induced immunogenic potential remain inconclusive. Compared to the scenario of combined immune checkpoint inhibition (ICI) and RT, multimodal therapies utilizing other immunotherapy principles such as adoptive transfer of immune cells, vaccination strategies, targeted immune-cytokines and agonists are underrepresented in both preclinical and clinical settings. Despite the clinical success of ICI and RT combination, e.g., prolonging overall survival in locally advanced lung cancer, curative outcomes are still not achieved for most cancer entities studied. Charged particle RT (PRT) has gained interest as it may enhance tumor immunogenicity compared to conventional RT due to its unique biological and physical properties. However, whether PRT in combination with immune therapy will elicit superior antitumor effects both locally and systemically needs to be further investigated. In this review, the immunological effects of RT in the tumor microenvironment are summarized to understand their implications for immunotherapy combinations. Attention will be given to the various immunotherapeutic interventions that have been co-administered with RT so far. Furthermore, the theoretical basis and first evidences supporting a favorable immunogenicity profile of PRT will be examined.
Collapse
Affiliation(s)
- Damiënne Marcus
- The M-Lab, Department of Precision Medicine, GROW–School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (D.M.); (R.I.Y.L.); (P.L.); (L.J.D.)
| | - Relinde I. Y. Lieverse
- The M-Lab, Department of Precision Medicine, GROW–School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (D.M.); (R.I.Y.L.); (P.L.); (L.J.D.)
| | - Carmen Klein
- German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Clinical Cooperation Unit Translational Radiation Oncology, Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; (C.K.); (A.A.)
- Heidelberg Ion-Beam Therapy Center (HIT), Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg University and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 222, 69120 Heidelberg, Germany
| | - Amir Abdollahi
- German Cancer Consortium (DKTK) Core-Center Heidelberg, National Center for Tumor Diseases (NCT), Clinical Cooperation Unit Translational Radiation Oncology, Heidelberg University Hospital (UKHD) and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany; (C.K.); (A.A.)
- Heidelberg Ion-Beam Therapy Center (HIT), Division of Molecular and Translational Radiation Oncology, Heidelberg Faculty of Medicine (MFHD) and Heidelberg University Hospital (UKHD), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg University and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 222, 69120 Heidelberg, Germany
| | - Philippe Lambin
- The M-Lab, Department of Precision Medicine, GROW–School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (D.M.); (R.I.Y.L.); (P.L.); (L.J.D.)
| | - Ludwig J. Dubois
- The M-Lab, Department of Precision Medicine, GROW–School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (D.M.); (R.I.Y.L.); (P.L.); (L.J.D.)
| | - Ala Yaromina
- The M-Lab, Department of Precision Medicine, GROW–School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (D.M.); (R.I.Y.L.); (P.L.); (L.J.D.)
| |
Collapse
|
4
|
Meneveau MO, Petroni GR, Varhegyi NE, Hulse JC, Schroen AT, Brenin DR, Janowski EM, Berger AC, Lazar MA, Simone NL, Showalter TN, Showalter SL. Toxicity and cosmetic outcomes after treatment with a novel form of breast IORT. Brachytherapy 2020; 19:679-684. [PMID: 32571746 DOI: 10.1016/j.brachy.2020.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Intraoperative radiation therapy (IORT), a form of accelerated partial breast irradiation (APBI), is an appealing alternative to postoperative whole breast irradiation for early-stage breast cancer. The purpose of this study was to examine the toxicity and cosmetic outcomes of patients treated with a novel form of breast IORT (precision breast IORT; PB-IORT), that delivers a targeted, higher dose of radiation than conventional IORT. METHODS AND MATERIALS The first 204 patients treated with PB-IORT in a Phase II clinical trial (NCT02400658) with 12 months of followup were included. Trial inclusion criteria were age ≥45 years, invasive or in situ breast cancer, tumor size ≤3 cm, and node negative. Toxicity and cosmetic scoring were performed at 6 and 12 months. RESULTS 98 patients (48%; 95% CI, 41-55%) experienced toxicity. Seven Grade 3 toxicities occurred (3.4%; 95% CI, 1.4-6.9%). Most patients (95%) had excellent or good cosmetic outcomes (95% CI, 91-98%) at 12 months. Most patients (94%) had little or no pigmentation change (95% CI, 90-97%), 88% little to no size change (95% CI, 82-92%), and 87% experienced minimal shape change (95% CI, 82-92%). CONCLUSIONS Overall, Grade 3+ toxicity was rare and cosmetic outcomes were excellent. Severe toxicity with PB-IORT is similar to that reported in the TARGIT trial (3.3% rate of major toxicity) but lower than APBI (NSABP-39, 10.1% Grade 3/4 toxicities). We propose that the toxicity of PB-IORT compared with TARGIT and NSABP-39 is related to the radiation dose and delivery schedule. PB-IORT offers low-toxicity and good cosmetic outcomes when compared with other forms of APBI.
Collapse
Affiliation(s)
- Max O Meneveau
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA.
| | - Gina R Petroni
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA
| | - Nikole E Varhegyi
- Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA
| | - John C Hulse
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - David R Brenin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Einsley M Janowski
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Adam C Berger
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Melissa A Lazar
- Department of Surgery, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Shayna L Showalter
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| |
Collapse
|
5
|
Calkins KL, Chander G, Joshu CE, Visvanathan K, Fojo AT, Lesko CR, Moore RD, Lau B. Immune Status and Associated Mortality After Cancer Treatment Among Individuals With HIV in the Antiretroviral Therapy Era. JAMA Oncol 2020; 6:227-235. [PMID: 31804663 PMCID: PMC6902188 DOI: 10.1001/jamaoncol.2019.4648] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
Importance Immunologic decline associated with cancer treatment in people with HIV is not well characterized. Quantifying excess mortality associated with cancer treatment-related immunosuppression may help inform cancer treatment guidelines for persons with HIV. Objective To estimate the association between cancer treatment and CD4 count and HIV RNA level in persons with HIV and between posttreatment CD4 count and HIV RNA trajectories and all-cause mortality. Design, Setting, and Participants This observational cohort study included 196 adults with HIV who had an incident first cancer and available cancer treatment data while in the care of The Johns Hopkins HIV Clinic from January 1, 1997, through March 1, 2016. The study hypothesized that chemotherapy and/or radiotherapy in people with HIV would increase HIV RNA levels owing to treatment tolerability issues and would be associated with a larger initial decline in CD4 count and slower CD4 recovery compared with surgery or other treatment. An additional hypothesis was that these CD4 count declines would be associated with higher mortality independent of baseline CD4 count, antiretroviral therapy use, and risk due to the underlying cancer. Data were analyzed from December 1, 2017, through April 1, 2018. Exposures Initial cancer treatment category (chemotherapy and/or radiotherapy vs surgery or other treatment). Main Outcomes and Measures Post-cancer treatment longitudinal CD4 count, longitudinal HIV RNA level, and all-cause mortality. Results Among the 196 participants (135 [68.9%] male; median age, 50 [interquartile range, 43-55] years), chemotherapy and/or radiotherapy decreased initial CD4 count by 203 cells/μL (95% CI, 92-306 cells/μL) among those with a baseline CD4 count of greater than 500 cells/μL. The decline for those with a baseline CD4 count of no greater than 350 cells/μL was 45 cells/μL (interaction estimate, 158 cells/μL; 95% CI, 31-276 cells/μL). Chemotherapy and/or radiotherapy had no detrimental association with HIV RNA levels. After initial cancer treatment, every 100 cells/μL decrease in CD4 count resulted in a 27% increase in mortality (hazard ratio, 1.27; 95% CI, 1.08-1.53), adjusting for HIV RNA level. No significant increase in mortality was associated with a unit increase in log10 HIV RNA after adjusting for CD4 count (hazard ratio, 1.24; 95% CI, 0.94-1.65). Conclusions and Relevance In this study, chemotherapy and/or radiotherapy was associated with significantly reduced initial CD4 count in adults with HIV compared with surgery or other treatment. Lower CD4 count after cancer treatment was associated with an increased hazard of mortality. Further research is necessary on the immunosuppressive effects of cancer treatment in adults with HIV and whether health care professionals must consider the balance of cancer treatment efficacy against the potential cost of further immunosuppression. Monitoring of immune status may also be helpful given the decrease in CD4 count after treatment and the already immunocompromised state of patients with HIV.
Collapse
Affiliation(s)
- Keri L. Calkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Geetanjali Chander
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Corinne E. Joshu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medical Oncology, The Johns Hopkins University, Baltimore, Maryland
| | - Anthony T. Fojo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Catherine R. Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Richard D. Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- School of Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
6
|
Ye LL, Fan XW, Hu CS, He XY, Wang XS, Shen CY, Xu TT, Ying HM. Dosimetry of the brain and hypothalamus predicting acute lymphopenia and the survival of glioma patients with postoperative radiotherapy. Cancer Med 2019; 8:2759-2768. [PMID: 30983159 PMCID: PMC6558490 DOI: 10.1002/cam4.2159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 01/20/2023] Open
Abstract
Background The aim of this study was to investigate dosimetric factors for predicting acute lymphopenia and the survival of glioma patients with postoperative intensity‐modulated radiotherapy (IMRT). Methods A total of 148 glioma patients were reviewed. Acute lymphopenia was defined as a peripheral lymphocyte count (PLC) lower than 1.0 × 109/L during radiotherapy with a normal level at pretreatment. PLCs with the corresponding dates and dose volume histogram parameters were collected. Univariate and multivariate Cox regression analyses were constructed to assess the significance of risk factors associated with lymphopenia and overall survival (OS). Results Sixty‐nine (46.6%) patients developed lymphopenia during radiotherapy. Multivariate analyses revealed that the risk increased with the maximal dose of the hypothalamus (HT Dmax) ≥56 Gy (58.9% vs 28.5%, P = 0.002), minimal dose of the whole brain (WB Dmin) ≥2 Gy (54.3% vs 33.9%, P = 0.006), or mean dose of the WB (WB Dmean) ≥34 Gy (56.0% vs 37.0%, P = 0.022). Patients with older age, high‐grade glioma, development of lymphopenia, high HT Dmax, WB Dmin, and WB Dmean had significantly inferior OS in the multivariate analyses. Conclusions HT Dmax, WB Dmin, and WB Dmean are promising indicators of lymphopenia and the survival of glioma patients undergoing postoperative IMRT. The necessity and feasibility of dosimetric constraints for HT and WB is warranted with further investigation.
Collapse
Affiliation(s)
- Lu-Lu Ye
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Xing-Wen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Chao-Su Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Xia-Yun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Xiao-Shen Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Chun-Ying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Ting-Ting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| | - Hong-Mei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R China
| |
Collapse
|
7
|
Schad MD, Dutta SW, Muller DM, Wijesooriya K, Showalter TN. Radiation-related Lymphopenia after Pelvic Nodal Irradiation for Prostate Cancer. Adv Radiat Oncol 2019; 4:323-330. [PMID: 31011677 PMCID: PMC6460292 DOI: 10.1016/j.adro.2019.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/23/2018] [Accepted: 01/16/2019] [Indexed: 01/11/2023] Open
Abstract
Purpose Given the uncertainty with regard to the effectiveness of pelvic nodal irradiation (PNI) for prostate cancer, we aimed to determine whether patients with prostate cancer who are treated with PNI are at a higher risk of developing radiation-related lymphopenia (RRL). Methods and materials The electronic charts of 886 consecutive patients treated with radiation therapy for prostate cancer between 2006 and 2018 at our institution were retrospectively analyzed. Qualifying patients were those with total lymphocyte counts within 1 year before and 3 to 24 months after the start of radiation therapy. Lymphopenia was the primary outcome, and overall survival and biochemical progression-free survival were secondary outcomes. Results Thirty-six patients with and 95 patients without PNI qualified for inclusion. In the PNI cohort, 61.1% of patients developed RRL (median follow-up total lymphocyte count < 1000 cells/μL) versus 26.3% of non-PNI patients (P < .001). On univariate analysis, initial prostate-specific antigen level, baseline lymphopenia, treatment modality, PNI status, increased planned target volume, and androgen deprivation therapy administration were all significant predictors of RRL (P < .05). On multivariate analysis, PNI status was a significant predictor of RRL (hazard ratio [HR], 3.42; 95% confidence interval [CI], 1.22-9.61; P < .001), as were initial prostate-specific antigen values (HR, 1.05; 95% CI, 1.00-1.11; P = .006) and baseline lymphopenia (HR, 8.32; 95% CI, 2.19-31.6; P = .007). RRL was not predictive for biochemical progression-free survival, distant metastasis, or overall survival on multivariate analysis, but the number of events was likely insufficient for these analyses. Conclusions The higher risk of RRL among patients with PNI comports with other papers that show that increased treatment volumes are associated with higher rates of RRL. Mounting evidence for the adverse effects of RRL on clinical outcomes supports the significance of our findings and suggests that further studies are needed on RRL as a potential harm of PNI that may affect the interpretation of results from clinical trials of PNI.
Collapse
Affiliation(s)
| | | | | | | | - Timothy N. Showalter
- Corresponding author. Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, P.O. Box 800383, Charlottesville, VA 22908.
| |
Collapse
|
8
|
Chua KLM, Yeo ELL, Shihabudeen WA, Tan SH, Shwe TT, Ong EHW, Lam PYP, Soo KC, Soong YL, Fong KW, Tan TWK, Wee JTS, Chua MLK. Intra-patient and inter-patient comparisons of DNA damage response biomarkers in Nasopharynx Cancer (NPC): analysis of NCC0901 randomised controlled trial of induction chemotherapy in locally advanced NPC. BMC Cancer 2018; 18:1095. [PMID: 30419858 PMCID: PMC6233280 DOI: 10.1186/s12885-018-5005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inter-patient heterogeneity in radiation-induced DNA damage responses is proposed to reflect intrinsic variations in tumour and normal tissue radiation sensitivity, but the prediction of phenotype by a molecular biomarker is influenced by clinical confounders and assay reproducibility. Here, we characterised the intrapatient and inter-patient heterogeneity in biomarkers of DNA damage and repair and radiation-induced apoptosis. METHODS We enrolled 85 of 172 patients with locally advanced nasopharynx cancer from a randomised controlled phase II/III trial of induction chemotherapy added to chemo-radiotherapy. G0 blood lymphocytes were harvested from these patients, and irradiated with 1, 4, and 8 Gy ex vivo. DNA damage induction (1 Gy 0.5 h) and repair (4 Gy 24 h) were assessed by duplicate γH2AX foci assays in 50-100 cells. Duplicate FLICA assays performed at 48 h post-8 Gy were employed as surrogate of radiation-induced apoptosis; %FLICA-positive cells were quantified by flow cytometry. RESULTS We observed limited intrapatient variation in γH2AX foci and %FLICA readouts; median difference of duplicate foci scores was - 0.37 (IQR = - 1.256-0.800) for 1 Gy 0.5 h and 0.09 (IQR = - 0.685-0.792) for 4 Gy 24 h; ICC of ≥0.80 was observed for duplicate %FLICA0Gy and %FLICA8Gy assays of CD4+ and CD8+ T lymphocytes. As expected, we observed wide inter-patient heterogeneity in both assays that was independent of intrapatient variation and clinical covariates, with the exception of age, which was inversely correlated with %FLICAbackground-corrected (Spearman R = - 0.406, P < 0.001 [CD4+]; R = - 0.220, P = 0.04 [CD8+]). Lastly, an exploratory case-control analysis indicates increased levels of γH2AX foci at 4 Gy 24 h in patients with severe late radiotherapy-induced xerostomia (P = 0.05). CONCLUSION Here, we confirmed the technical reproducibility of DNA damage response assays for clinical implementation as biomarkers of clinical radiosensitivity in nasopharynx cancer patients.
Collapse
Affiliation(s)
- Kevin Lee Min Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Eugenia Li Ling Yeo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Waseem Ahamed Shihabudeen
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore, Singapore
| | - Than Than Shwe
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Enya Hui Wen Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
| | - Paula Yeng Po Lam
- Division of Cellular and Molecular Research, National Cancer Centre, Singapore, Singapore
| | - Khee Chee Soo
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Division of Surgical Oncology, National Cancer Centre, Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Terence Wee Kiat Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Joseph Tien Seng Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| | - Melvin Lee Kiang Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610 Singapore
- Division of Medical Sciences, National Cancer Centre, Singapore, Singapore
- Oncology Academic Program, Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
9
|
The absolute lymphocyte count can predict the overall survival of patients with non-small cell lung cancer on nivolumab: a clinical study. Clin Transl Oncol 2018; 21:206-212. [PMID: 29948974 DOI: 10.1007/s12094-018-1908-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The neutrophil-to-lymphocyte (ANC/ALC) ratio is associated with worse prognosis in patients with NSCLC on immunotherapies, but the role of ALC remains unclear. The previous radiation therapy causes lymphopenia, and given approaches of combining radiation with immunotherapies, it is critical to better understand the impact of peripheral lymphocytes. PATIENTS AND METHODS We evaluated retrospectively 22 patients with advanced NSCLC treated with nivolumab at Boston Medical Center from January 2014 to September 2016 and correlated the peripheral blood counts with the overall survival (OS) and overall time on treatment. We assessed the effect of the previous radiation on peripheral blood counts and clinical outcomes. RESULTS Baseline ALC and ANC/ALC ratios are positively and negatively correlated, respectively, with the OS on nivolumab. The ALC and ALC/WBC ratios at 6 weeks on treatment are positively associated with the OS. Kaplan-Meier analysis at baseline and at 6 weeks showed significantly increased OS in the group of patients with the highest ALC. The previous radiation therapy was positively correlated with the ANC and negatively correlated with the ALC/WBC ratio at 8 weeks after the initiation of nivolumab. CONCLUSION Our finding that ALC at baseline and at 6 weeks on treatment is positively correlated with the OS provides an easily obtained predictive marker. Our result that the previous radiation is associated with higher ANC and lower ALC during treatment supports that the combination of radiation therapy with immunotherapy should be carefully applied and potentially peripheral blood counts can be utilized to stratify patients for this approach.
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW The immunomodulatory effects of ionizing radiation have long been recognized; however, so far these have not been fully exploited in clinical practice. We review the rationale to combine radiation with immune checkpoint inhibitors, which are used in standard practice. RECENT FINDINGS Preclinical research suggests a synergy between radiotherapy and these immune checkpoint inhibitors. Whether or not this benefit translates into a clinical benefit is currently subject of ongoing research. SUMMARY It is highly rational to combine radiation with immune therapy as in preclinical models and in proof of concept trials in humans it clearly can increase the antitumor immunity when given together with other immune interventions.
Collapse
|
11
|
Tan JT, Yang Y, Mao NQ, Liu DS, Huang DM, Pan H, Xie T, Pan Q, Yang L, Zhong JH, Zuo CT. Effect of neoadjuvant chemoradiotherapy on perioperative immune function of patients with locally advanced esophageal cancer. Dis Esophagus 2017; 30:1-8. [PMID: 27766708 DOI: 10.1111/dote.12486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aims to evaluate the effect of neoadjuvant chemoradiotherapy (NCRT) on perioperative immune function during surgery to treat resectable locally advanced esophageal cancer. Records were retrospectively analyzed for 220 patients with locally advanced esophageal cancer, of whom 112 received surgery alone and 98 received neoadjuvant NCRT plus surgery. The two groups were compared in terms of proportions of CD3+, CD4+, CD8+, and natural kill (NK) cells, as well as the ratio of CD4+ to CD8+ cells. These measurements were made using flow cytometry on preoperative day 1 and on postoperative days 1 and 7. Subgroup analysis were performed in terms of degrees of pathological response of NCRT. When the entire NCRT and no-NCRT (surgery alone) cohorts were compared, no significant differences in propocrtions of CD3+, CD4+, CD8+, or NK cells or in the CD4+/CD8+ ratio occurred at any of the three time points. Similar results were obtained using the subgroup of NCRT patients who were NCRT-sensitive, but the subgroup of NCRT-insensitive patients showed significantly lower CD4+ and NK proportions and lower CD4+/CD8+ ratio than the no-NCRT group. Our findings suggest that NCRT does not affect perioperative immune function in patients who are NCRT-sensitive, but it does significantly reduce such function in patients who are NCRT-insensitive.
Collapse
Affiliation(s)
- Jun-Tao Tan
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Yang Yang
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Nai-Qun Mao
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - De-Sen Liu
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Ding-Ming Huang
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Hong Pan
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Tong Xie
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Qi Pan
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Li Yang
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Jian-Hong Zhong
- Department of Surgical Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Chuan-Tian Zuo
- Department of Thoracic Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
12
|
Phakathi BP, Basson G, Karusseit VOL, Olorunju SAS, Mokoena T. The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study. Int J Surg 2016; 34:109-115. [PMID: 27573692 DOI: 10.1016/j.ijsu.2016.08.520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 08/16/2016] [Accepted: 08/24/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Breast cancer is the most common cancer of women in the world. Twenty-five percent of people living with the human immunodeficiency virus (HIV) reside in South Africa. The coincidence of breast cancer and HIV infection is therefore common in South Africa. There is a perception that systemic and local surgical complications are more common in HIV-infected patients, and that these patients tolerate chemo- and radiotherapy poorly. AIM The aim of the study was to determine the effect of HIV infection on the management of breast cancer by comparing HIV-infected to -noninfected patients. The outcomes of surgery and adjuvant/neoadjuvant therapy were examined in these groups. METHOD The study was performed at the Steve Biko Academic Hospital, Pretoria, South Africa, during 2009-2014. Patients scheduled for surgery for breast cancer were recruited prospectively and their HIV status was determined. All patients were managed according to standard guidelines for breast cancer. Patients were followed up for 30 days and local and systemic surgical complications documented. Completion or non-completion of courses of chemo- and radiotherapy, and reasons for non-completion were documented. HIV-infected and -noninfected patients respectively were grouped, and compared statistically. RESULTS One hundred and sixty patients (31 HIV-infected) were included. The frequency of surgical complications did not differ significantly between HIV-noninfected and infected patients (p = 0.08), more occurring in the HIV-noninfected patients. The risk ratio of HIV infection for surgical complications was 0.20 and the odds ratio 0.23. The completion of courses of chemo- and radiotherapy did not differ between the HIV-infected and -noninfected patients. Twenty-five of 27 HIV-infected patients (93%) and 100 of 113 HIV-noninfected patients (94%) completed their courses of chemotherapy (p = 0.68). Twelve of 14 HIV-infected patients (86%) and 40 of 41 HIV-noninfected patients (98%) completed their courses of radiotherapy (p = 0.16). CONCLUSION These results suggest that HIV-infected patients with breast cancer do not experience more treatment-related complications and can be treated according to standard guidelines.
Collapse
Affiliation(s)
- Boitumelo P Phakathi
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Gerhard Basson
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Victor O L Karusseit
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
| | - Steve A S Olorunju
- Biostatistics Unit, South African Medical Research Council, South Africa
| | - Taole Mokoena
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| |
Collapse
|
13
|
Grossman SA, Ellsworth S, Campian J, Wild AT, Herman JM, Laheru D, Brock M, Balmanoukian A, Ye X. Survival in Patients With Severe Lymphopenia Following Treatment With Radiation and Chemotherapy for Newly Diagnosed Solid Tumors. J Natl Compr Canc Netw 2016; 13:1225-31. [PMID: 26483062 DOI: 10.6004/jnccn.2015.0151] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The immune system plays an important role in cancer surveillance and therapy. Chemoradiation can cause severe treatment-related lymphopenia (TRL) (<500 cells/mm3) that is associated with reduced survival. MATERIALS AND METHODS Data from 4 independent solid tumor studies on serial lymphocyte counts, prognostic factors, treatment, and survival were collected and analyzed. The data set included 297 patients with newly diagnosed malignant glioma (N=96), resected pancreatic cancer (N=53), unresectable pancreatic cancer (N=101), and non-small cell lung cancer (N=47). RESULTS Pretreatment lymphocyte counts were normal in 83% of the patient population, and no patient had severe baseline lymphopenia. Two months after initiating chemoradiation, 43% developed severe and persistent lymphopenia (P=.001). An increased risk for death was attributable to TRL in each cancer cohort (gliomas: hazard rate [HR], 1.8; 95% CI, 1.13-2.87; resected pancreas: HR, 2.2; 95% CI, 1.17-4.12; unresected pancreas: HR, 2.9; 95% CI, 1.53-5.42; and lung: HR, 1.7; 95% CI, 0.8-3.61) and in the entire study population regardless of pathologic findings (HR, 2.1; 95% CI, 1.54-2.78; P<.0001). Severe TRL was observed in more than 40% of patients 2 months after initiating chemoradiation, regardless of histology or chemotherapy regimen, and was independently associated with shorter survival from tumor progression. CONCLUSIONS Increased attention and research should be focused on the cause, prevention, and reversal of this unintended consequence of cancer treatment that seems to be related to survival in patients with solid tumors.
Collapse
Affiliation(s)
- Stuart A Grossman
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Susannah Ellsworth
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Jian Campian
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Aaron T Wild
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Joseph M Herman
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Dan Laheru
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Malcolm Brock
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Ani Balmanoukian
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| | - Xiaobu Ye
- From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California
| |
Collapse
|
14
|
Chen WY, Kuo SH, Shen CW, Huang BS, Lan KH, Liang HK, Wang CW. Good tolerance and long-term complete remission after definitive intensity-modulated radiotherapy for locally advanced head and neck cancer in a patient with human immunodeficiency virus infection: A case report and literature review. Head Neck 2015; 37:E186-90. [PMID: 25821193 DOI: 10.1002/hed.24058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/15/2015] [Accepted: 03/22/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The main concerns with radiation therapy for head and neck cancer in human immunodeficiency virus (HIV)-infected patients include limited tumor response and profound mucosal or skin toxicities under severe immunocompromised status. METHODS In this study, we describe the clinicopathological features, chronological changes in HIV viral loads and CD4 counts, and treatment outcomes of definitive radiotherapy for locally advanced head and neck cancer in an HIV-infected patient. RESULTS Despite low CD4 counts (80 cells/µL), a combination of highly active antiretroviral therapy (HAART) and definitive concurrent chemoradiotherapy (70 Gy of simultaneously integrated boost intensity-modulated radiotherapy (IMRT), fluorouracil, and leucovorin) was well-tolerated. Grade 3 mucositis and dermatitis were resolved 2 weeks after treatment completion. The patient was alive and remained disease-free 31 months after treatment. CONCLUSION For patients with HIV diagnosed with locally advanced head and neck cancer, good tolerance and outcome can be achieved with definitive radiotherapy while on HAART.
Collapse
Affiliation(s)
- Wan-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Hsin Kuo
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Wei Shen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Keng-Hsueh Lan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiang-Kuang Liang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Wei Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
15
|
Long-term effects of chemoradiotherapy for anal cancer in patients with HIV infection: oncological outcomes, immunological status, and the clinical course of the HIV disease. Dis Colon Rectum 2014; 57:423-31. [PMID: 24608297 DOI: 10.1097/dcr.0000000000000057] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the increasing evidence for chemoradiotherapy as standard treatment for anal cancer in patients with HIV infection, there is still some uncertainty regarding increased toxicity and adverse effects on the immune status. OBJECTIVE We report the clinical outcome of 5-fluorouracil/mitomycin C-based concurrent chemoradiotherapy for anal carcinoma in patients with HIV infection with an emphasis on the long-term course of CD4 counts and the HIV-related morbidity during follow-up. DESIGN AND SETTINGS A retrospective single-institution chart review was performed. PATIENTS Between 1997 and 2012, 36 HIV-positive patients were treated with standard chemoradiotherapy (median tumor dose, 54 (range, 50.4-60.4) Gy at 1.8 Gy/fraction; 5-fluorouracil, 800-1000 mg/m(2), days 1-4 or 1-5; mitomycin C, 10 mg/m(2), day 1, in the first and fifth week). MAIN OUTCOME MEASURES A retrospective analysis was performed with respect to tumor response, local control, cancer and overall survival, and toxicity. Immunological parameters, including pre- and posttreatment CD4 counts, viral load, and HIV-specific morbidity were recorded during follow-up. RESULTS Chemoradiotherapy could be completed in all patients. Acute grade 3 toxicities occurred in 17/36 patients (47%). Complete response was achieved in 31 patients (86%). Five-year local control, colostomy-free, cancer-specific, and overall survival were 72%, 87%, 77%, and 74%. The median pretreatment CD4 count significantly decreased from 367 cells/μL to 139 cells/μL, 3 to 7 weeks after completion of chemoradiotherapy (p < 0.001). Four patients (11%) experienced opportunistic illnesses during the follow-up (median, 66; range, 10-164 months). LIMITATIONS This study is limited by its retrospective design and its small sample size. CONCLUSIONS Our data confirm again that, in the highly active antiretroviral therapy era, anal cancer can be treated in HIV-positive patients with standard chemoradiotherapy, with a clinical outcome similar to their HIV-negative counterparts. The chemoradiotherapy-related decline of the CD4 counts, which remain decreased up to 6 years after chemoradiotherapy, was not associated with increased HIV-related clinical morbidity.
Collapse
|
16
|
Changes of peripheral blood lymphocyte subtypes in patients with end stage cancer administered localized radiotherapy and bojungikki-tang. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:207613. [PMID: 24696700 PMCID: PMC3950642 DOI: 10.1155/2014/207613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/06/2014] [Accepted: 01/11/2014] [Indexed: 11/17/2022]
Abstract
Localized radiotherapy (RT) can cause immune dysfunction. Bojungikki-tang is known to restore immune function. We investigated the absolute counts and percentages of peripheral blood (PB) lymphocyte subtypes in end stage cancer patients before and after RT and after oral administration of Bojungikki-tang water extract (BJITE) and to evaluate the changes mediated by RT and BJITE. Absolute counts and percentages of lymphocyte and lymphocyte subsets were determined in whole blood using the TetraONE System (Beckman Coulter, USA). Flow cytometry results were compared before and after RT and after administration of BJITE. Absolute numbers of CD3+, CD4+, and CD8+ T cells and CD19+ B cells decreased significantly after RT (P < 0.05). Absolute numbers of CD3-CD56+ cells did not change in both groups. No significant differences were observed in the absolute counts of lymphocyte subtypes before and after administration of BJITE or vitamin group. When BJITE group was compared with vitamin group, absolute numbers of CD19+ B cells increased. RT-induced decrease in T cells and B cells in PB suggests that immune deterioration occurs after RT. Administration of BJITE might be effective in the restoration of number of B cells.
Collapse
|
17
|
Ellsworth S, Balmanoukian A, Kos F, Nirschl CJ, Nirschl TR, Grossman SA, Luznik L, Drake CG. Sustained CD4 + T cell-driven lymphopenia without a compensatory IL-7/IL-15 response among high-grade glioma patients treated with radiation and temozolomide. Oncoimmunology 2014; 3:e27357. [PMID: 24790790 PMCID: PMC4004618 DOI: 10.4161/onci.27357] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022] Open
Abstract
Prolonged lymphopenia correlating with decreased survival commonly occurs among glioma patients undergoing radiation therapy (RT) and temozolomide (TMZ) treatment. To better understand the pathophysiology of this phenomenon, we prospectively monitored serum cytokine levels and lymphocyte subsets in 15 high-grade glioma patients undergoing combined radiation and TMZ (referred to as RT/TMZ) treatment. Sufficient data for analysis were acquired from 11 of the patients initially enrolled. Lymphocyte phenotyping data were obtained using cytofluorometric analysis and serum cytokine levels were measured using the a multiplex bead-based assays. Total lymphocyte counts (TLCs) were > 1000 cells per μL peripheral blood in 10/11 patients at baseline, but dropped significantly after treatment. Specifically, after RT/TMZ therapy, the TLCs were found to be < 500 cells/μL in 2/11 patients, 500-1000 cells/μL in 7/11 patients, and > 1000 cells/μL in the remaining 2 patients. Among residual mononuclear blood cells, we observed a proportional drop in B and CD4+ T cells but not in CD8+ T lymphocytes. Natural killer cells remained to near-to-baseline levels and there was a transient and slight (insignificant) increase in regulatory T cells (Tregs). The circulating levels of IL-7 and IL-15 remained low despite marked drops in both the total and CD4+ T lymphocyte counts. Thus, patients with malignant glioma undergoing RT/TMZ treatment exhibit a marked decline in TLCs, affecting both CD4+ T cells and B lymphocytes, in the absence of a compensatory increase in interleukin-7 levels. The failure to mount an appropriate homeostatic cytokine response may be responsible for the prolonged lymphopenia frequently observed in these patients.
Collapse
Affiliation(s)
- Susannah Ellsworth
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | - Ani Balmanoukian
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | | | - Christopher J Nirschl
- Department of Medical Oncology; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | - Thomas R Nirschl
- Department of Medical Oncology; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | - Stuart A Grossman
- Department of Medical Oncology; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | - Leo Luznik
- Department of Medical Oncology; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| | - Charles G Drake
- Department of Medical Oncology; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
- James Buchanan Brady Urological Institute; Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center; Baltimore, MD USA
| |
Collapse
|
18
|
Prolonged decrease of CD4+ T lymphocytes in HIV-1-infected patients after radiotherapy for a solid tumor. J Acquir Immune Defic Syndr 2013; 62:546-9. [PMID: 23314415 DOI: 10.1097/qai.0b013e318285d934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In HIV-negative patients, radiotherapy (RT) decreases CD4 T-cell counts. We studied the effects of RT in HIV-1 positive patients. METHODS HIV-1 positive patients with a subsequent diagnosis of a solid tumor were selected from the Dutch national observational HIV cohort, Aids Therapy Evaluation in the Netherlands (ATHENA). The patients were grouped according to whether they had received RT or not. Primary endpoint of the study was the time from baseline to reaching CD4 cell counts higher than those at baseline. Kaplan-Meier estimates of the percentage of patients reaching the endpoint were calculated. RESULTS Ninety patients were included of whom 36 received RT and 54 did not. Median duration of RT was 46 [interquartile range (IQR) 30-63] days. Median first CD4 cell count after stopping RT was 150 (IQR 30-270) × 10/L lower compared with baseline. In 13 of the 36 patients receiving RT, CD4 cell counts recovered to baseline, after a median of 469 (IQR 345-595) days. In 35 of the 54 patients without RT, the CD4 cell count recovered to baseline or higher, after a median of 112 (IQR 42-182) days. After 3 years, in 39% of patients who had RT compared with 71% of patients without RT, CD4 cell counts recovered to baseline or higher (P < 0.0001). In a Cox regression adjusted for potential confounders, RT was associated with a longer (hazard ratio 0.29; 95% confidence interval 0.13 to 0.63) and combination antiretroviral therapy use with a shorter time to return to baseline [hazard ratio 2.46 (95% confidence interval 1.11 to 5.48)]. CONCLUSIONS RT resulted in a significant and prolonged decrease in CD4 cell counts.
Collapse
|
19
|
Tanigawa T, Araki S, Nakata A, Araki T, Sakurai S. Decreases in Subpopulations of T Lymphocytes and Natural Killer Cells in the Blood of Retired Chromate Workers. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2013. [DOI: 10.1179/oeh.1996.2.3.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
20
|
Comparison of partial splenic embolization versus splenic irradiation as a treatment of hypersplenism in advanced cirrhosis. EGYPTIAN LIVER JOURNAL 2012. [DOI: 10.1097/01.elx.0000415482.05652.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
21
|
Kmieciak M, Basu D, Payne KK, Toor A, Yacoub A, Wang XY, Smith L, Bear HD, Manjili MH. Activated NKT cells and NK cells render T cells resistant to myeloid-derived suppressor cells and result in an effective adoptive cellular therapy against breast cancer in the FVBN202 transgenic mouse. THE JOURNAL OF IMMUNOLOGY 2011; 187:708-17. [PMID: 21670315 DOI: 10.4049/jimmunol.1100502] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Attempts to cure breast cancer by adoptive cellular therapy (ACT) have not been successful. This is primarily due to the presence of tumor-induced immune-suppressive mechanisms as well as the failure of tumor-reactive T cells to provide long-term memory responses in vivo. To address these clinically important challenges, we developed an ex vivo protocol for the expansion of tumor-reactive immune cells obtained from tumor-bearing animals prior to or after local radiation therapy. We used an Ag-free protocol that included bryostatin 1/ionomycin and sequential common γ-chain cytokines (IL-7/IL-15 + IL-2). The proposed protocol expanded tumor-reactive T cells as well as activated non-T cells, including NKT cells, NK cells, and IFN-γ-producing killer dendritic cells. Antitumor efficacy of T cells depended on the presence of non-T cells. The effector non-T cells also rendered T cells resistant to myeloid-derived suppressor cells. Radiation therapy altered phenotypic distribution and differentiation of T cells as well as their ability to generate central memory T cells. ACT by means of the expanded cells protected animals from tumor challenge and generated long-term memory responses against the tumor, provided that leukocytes were derived from tumor-bearing animals prior to radiation therapy. The ex vivo protocol was also able to expand HER-2/neu-specific T cells derived from the PBMC of a single patient with breast carcinoma. These data suggest that the proposed ACT protocol should be studied further in breast cancer patients.
Collapse
Affiliation(s)
- Maciej Kmieciak
- Department of Microbiology and Immunology, Virginia Commonwealth University, Massey Cancer Center, Richmond, VA 23298, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Housri N, Yarchoan R, Kaushal A. Radiotherapy for patients with the human immunodeficiency virus: are special precautions necessary? Cancer 2010; 116:273-83. [PMID: 20014399 PMCID: PMC3409663 DOI: 10.1002/cncr.24878] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Shortly after the onset of the acquired immunodeficiency syndrome (AIDS) epidemic in the 1980s, reports of radiation-associated toxicity in patients with the human immunodeficiency virus (HIV) and AIDS began to appear in the medical literature. Although the majority of reports have focused on AIDS-defining malignancies such as Kaposi sarcoma, greater-than-expected toxicity after a course of radiotherapy or chemoradiotherapy has also been documented in cancers not generally classified as being related to HIV. With improved antiretroviral therapies, HIV patients are living longer and have the potential to develop a variety of HIV-associated and nonassociated malignancies that require treatment, including radiotherapy. This review reports the published data regarding the interactions of HIV, AIDS, and antiretroviral therapy with radiotherapy and implications for the management of malignancies in patients with HIV.
Collapse
Affiliation(s)
- Nadine Housri
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Aradhana Kaushal
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
23
|
Koukourakis GV, Zabatis H, Zacharias GA, Koukourakis MJ. Post-surgical irradiation causes cellular immune suppression in patients with breast cancer. Eur J Cancer Care (Engl) 2010; 18:306-12. [PMID: 19445021 DOI: 10.1111/j.1365-2354.2008.00995.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
According to several studies, even the locoregional irradiation of patients with carcinoma can cause a severe and rather alarming cellular immune defect. We thus designed a prospective research in order to study the effect of post-operative irradiation on cellular immunity in patients suffering from breast cancer. In 35 patients with breast cancer who required post-operative irradiation, four blood samples were taken at indicated point times. Nineteen out of 35 patients received post-surgical chemotherapy before irradiation. The total lymphocytes as well as CD4 and CD8 subpopulations were measured by using flow cytometry analysis. The mean T-lymphocyte (Tol) count dropped from 1487.77 to 1227.91 (P = 0.0013) and the CD4+ count from 674.17 to 580.91 (P = 0.0189). The mean value of CD8+ dropped from 421.31 to 314.00 (P = 0.0003). Moreover, a statistically significant difference regarding the pattern of temporal change was observed between a group of patients that received irradiation only and a group that received radiation therapy (RT) with chemotherapy (P-values 0.0015, 0.01 and 0.092 for Tol, CD4+ and CD8+ respectively). The group of patients that received RT only presented a more rapid decrease of Tol concerning the decrease observed in the group that underwent chemotherapy and RT.
Collapse
Affiliation(s)
- G V Koukourakis
- Section of Radiation Therapy in University Hospital of Athens ATTIKON, Haidari, Athens.
| | | | | | | |
Collapse
|
24
|
Differential responses to mutagens among human lymphocyte subpopulations. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2009; 672:1-9. [DOI: 10.1016/j.mrgentox.2008.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 09/24/2008] [Accepted: 10/26/2008] [Indexed: 11/13/2022]
|
25
|
Tanigawa T, Takehashi H, Nakata A. Naïve (CD4+CD45RA+) T cell subpopulation is susceptible to various types of hazardous substances in the workplace. Int J Immunopathol Pharmacol 2006; 17:109-14. [PMID: 15345201 DOI: 10.1177/03946320040170s218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To find the most susceptible lymphocyte subpopulation with exposure to various occupational hazardous substances, we reanalyzed our previous data. We measured T, B and natural killer NK cell subpopulations by means of flowcytometry among workers who were exposed to aromatic amines, chromate, mercury lead and organic-solvents. The exposed/non-exposed ratio was defined as the mean value of the absolute number of lymphocyte subpopulations in the exposed workers divided by the corresponding value of the non-exposed control group in 5 studies reported previously by us. The ratio of CD4+CD45RA+ T cells in all the exposed groups examined in this study was less than 1.0, and the mean of these ratio was 0.77, which was the lowest among lymphocyte subpopulations examined. The mean ratio was 1.06 for CD4+CD29+ T cells, 0.91 for CD4+ T cells, 0.99 for CD8+ T cells, 0.93 for CD3+ T cells, 0.99 for CD19+B cells, 0.96 for CD57-CD16+ NK cells, 0.82 for CD57+CD16+ NK cells, 1.25 for CD57+CD16- NK cells and 0.89 for total lymphocytes. With regard to the difference between exposed and non-exposed workers the estimated overall difference in the mean absolute number of CD4+CD45RA+ T cell subpopulation between exposed and non-exposed workers among five studies was -135 ((% confidence interval, CI: (-194,-75)) cells/mm3 (p<0.01). In conclusion, naïve (CD4+CD45RA+) T cell subpopulation was the most susceptible to the effects of various toxic substances as compared with other lymphocyte subpopulations. This lympohocyte subpopulation may be useful for monitoring immune system of workers exposed to various types of substances in the workplace.
Collapse
Affiliation(s)
- T Tanigawa
- Department of Public Health Medicine, Institute of Community Medicine, University of Tsukuba 1-1-1, Tsukuba-shi, Ibaraki-ken, Japan.
| | | | | |
Collapse
|
26
|
Filippi AR, Franco P, Galliano M, Ricardi U. Peripheral blood complete remission after splenic irradiation in mantle-cell lymphoma with 11q22-23 deletion and ATM inactivation. Radiat Oncol 2006; 1:35. [PMID: 16956411 PMCID: PMC1569379 DOI: 10.1186/1748-717x-1-35] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 09/06/2006] [Indexed: 11/10/2022] Open
Abstract
Mantle Cell Lymphoma (MCL) is a well-known histological and clinical subtype of B-cell non-Hodgkin's Lymphomas. It is usually characterized by an aggressive disease course, presenting with advanced stage disease at diagnosis and with low response rates to therapy. However few cases of indolent course MCL have been described. We herein report a case of MCL with splenomegaly and peripheral blood involvement as main clinical features. The patient underwent moderate dose splenic radiation therapy and achieved spleen downsizing and peripheral blood complete remission. Splenic irradiation has been extensively used in the past as palliative treatment in several lymphoproliferative disorders and a systemic effect and sometimes peripheral blood complete remissions have been observed. Mainly advocated mechanisms responsible for this phenomenon are considered direct radiation-induced apoptotic cell death, immune modulation via proportional changes of lymphocyte subsets due to known differences in intrinsic radiosensitivity and a radiation-induced cytokine release. The peculiar intrinsic radiosensitivity pattern of lymphoid cells could probably be explained by well-defined individual genetic and molecular features. In this context, among NHLs, MCL subtype has the highest rate of ATM (Ataxia Teleangiectasia Mutated) inactivation. While the ATM gene is thought to play a key-role in detecting radiation-induced DNA damage (expecially Double Strand Breaks), recent in vitro data support the hypothesis that ATM loss may actually contribute to the radiosensitivity of MCL cells. ATM status was retrospectively investigated in our patient, with the tool of Fluorescence In Situ Hybridization, showing a complete inactivation of a single ATM allele secondary to the deletion of chromosomal region 11q22-23. The presence of this kind of cytogenetic aberration may be regarded in the future as a potential predictive marker of radiation response.
Collapse
Affiliation(s)
| | - Pierfrancesco Franco
- Radiation Oncology, University of Torino, Ospedale S. Giovanni Battista, Torino, Italy
| | - Marco Galliano
- Medical Oncology, Ospedale Alba-Bra-ASL 18, Alba-Bra, Italy
| | - Umberto Ricardi
- Radiation Oncology, University of Torino, Ospedale S. Giovanni Battista, Torino, Italy
| |
Collapse
|
27
|
Collado-Hidalgo A, Bower JE, Ganz PA, Cole SW, Irwin MR. Inflammatory biomarkers for persistent fatigue in breast cancer survivors. Clin Cancer Res 2006; 12:2759-66. [PMID: 16675568 DOI: 10.1158/1078-0432.ccr-05-2398] [Citation(s) in RCA: 292] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study seeks to define immunologic and inflammatory variables associated with persistent post-treatment fatigue in breast cancer survivors. EXPERIMENTAL DESIGN Leukocyte subsets, plasma inflammatory markers, and ex vivo proinflammatory cytokine production were assessed in 50 fatigued and nonfatigued breast cancer survivors recruited > or = 2 years after successful primary therapy. Multivariate statistical analyses were used to define a composite immunologic biomarker of fatigue risk. RESULTS Fatigued breast cancer survivors were distinguished from nonfatigued survivors by increased ex vivo monocyte production of interleukin (IL)-6 and tumor necrosis factor-alpha following lipopolysaccharide stimulation, elevated plasma IL-1ra and soluble IL-6 receptor (sIL-6R/CD126), decreased monocyte cell-surface IL-6R, and decreased frequencies of activated T lymphocytes and myeloid dendritic cells in peripheral blood (all P < 0.05). An inverse correlation between sIL-6R and cell-surface IL-6R was consistent with inflammation-mediated shedding of IL-6R, and in vitro studies confirmed that proinflammatory cytokines induced such shedding. Multivariate linear discriminant function analysis identified two immunologic markers, the ratio of sIL-6R to monocyte-associated IL-6R and decreased circulating CD69+ T lymphocytes, as highly diagnostic of fatigue (P = 0.0005), with cross-validation estimates indicating 87% classification accuracy (sensitivity = 0.83; specificity = 0.83). CONCLUSION These results extend links between fatigue and inflammatory markers to show a functional alteration in proinflammatory cytokine response to lipopolysaccharide and define a prognostic biomarker of behavioral fatigue.
Collapse
Affiliation(s)
- Alicia Collado-Hidalgo
- Cousins Center for Psychoneuroimmunology, University of California at Los Angeles Semel Institute for Neuroscience and Human Behavior, Los Angeles, California 90095-7076, USA
| | | | | | | | | |
Collapse
|
28
|
Fujita T, Teh BS, Timme TL, Mai WY, Satoh T, Kusaka N, Naruishi K, Fattah EA, Aguilar-Cordova E, Butler EB, Thompson TC. Sustained long-term immune responses after in situ gene therapy combined with radiotherapy and hormonal therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 2006; 65:84-90. [PMID: 16472937 DOI: 10.1016/j.ijrobp.2005.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 10/12/2005] [Accepted: 11/07/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore long-term immune responses after combined radio-gene-hormonal therapy. METHODS AND MATERIALS Thirty-three patients with prostate specific antigen 10 or higher or Gleason score of 7 or higher or clinical stage T2b to T3 were treated with gene therapy that consisted of 3 separate intraprostatic injections of AdHSV-tk on Days 0, 56, and 70. Each injection was followed by 2 weeks of valacyclovir. Intensity-modulated radiation therapy was delivered 2 days after the second AdHSV-tk injection for 7 weeks. Hormonal therapy was initiated on Day 0 and continued for 4 months or 2.3 years. Blood samples were taken before, during, and after treatment. Lymphocytes were analyzed by fluorescent antibody cell sorting (FACS). RESULTS Median follow-up was 26 months (range, 4-48 months). The mean percentages of DR+CD8+ T cells were increased at all timepoints up to 8 months. The mean percentages of DR+CD4+ T cells were increased later and sustained longer until 12 months. Long-term (2.3 years) use of hormonal therapy did not affect the percentage of any lymphocyte population. CONCLUSIONS Sustained long-term (up to 8 to 12 months) systemic T-cell responses were noted after combined radio-gene-hormonal therapy for prostate cancer. Prolonged use of hormonal therapy does not suppress this response. These results suggest the potential for sustained activation of cell-mediated immune responses against cancer.
Collapse
Affiliation(s)
- Tetsuo Fujita
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Gulley JL, Arlen PM, Bastian A, Morin S, Marte J, Beetham P, Tsang KY, Yokokawa J, Hodge JW, Ménard C, Camphausen K, Coleman CN, Sullivan F, Steinberg SM, Schlom J, Dahut W. Combining a recombinant cancer vaccine with standard definitive radiotherapy in patients with localized prostate cancer. Clin Cancer Res 2005; 11:3353-62. [PMID: 15867235 DOI: 10.1158/1078-0432.ccr-04-2062] [Citation(s) in RCA: 264] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Many patients with clinically localized prostate cancer develop biochemical failure despite excellent local therapy perhaps due to occult metastatic disease. One potential solution is the utilization of a well-tolerated systemic therapy (e.g., vaccine) in concert with local therapy. EXPERIMENTAL DESIGN We present a randomized phase II clinical trial designed to determine if a poxviral vaccine encoding prostate-specific antigen (PSA) can induce a PSA-specific T-cell response when combined with radiotherapy in patients with clinically localized prostate cancer. Thirty patients were randomized in a 2:1 ratio into vaccine plus radiotherapy or radiotherapy-only arms. Those patients in the combination arm received a "priming" vaccine with recombinant vaccinia (rV) PSA plus r V containing the T-cell costimulatory molecule B7.1 (rV-B7.1) followed by monthly booster vaccines with recombinant fowlpox PSA. The vaccines were given with local granulocyte-macrophage colony-stimulating factor and low-dose systemic interleukin-2. Standard external beam radiation therapy was given between the fourth and the sixth vaccinations. RESULTS Seventeen of 19 patients in the combination arm completed all eight vaccinations and 13 of these 17 patients had increases in PSA-specific T cells of at least 3-fold versus no detectable increases in the radiotherapy-only arm (P < 0.0005). There was also evidence of de novo generation of T cells to well-described prostate-associated antigens not found in the vaccine, providing indirect evidence of immune-mediated tumor killing. The vaccine was well tolerated. CONCLUSION This vaccine regimen can be safely given in patients undergoing radiation therapy for localized prostate cancer, with the majority of patients generating a PSA-specific cellular immune response to vaccine.
Collapse
Affiliation(s)
- James L Gulley
- Laboratory of Tumor Immunology and Biology, Medical Oncology Clinical Research Unit, Radiation Oncology Branch, and Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Satoh T, Teh BS, Timme TL, Mai WY, Gdor Y, Kusaka N, Fujita T, Pramudji CK, Vlachaki MT, Ayala G, Wheeler T, Amato R, Miles BJ, Kadmon D, Butler EB, Thompson TC. Enhanced systemic T-cell activation after in situ gene therapy with radiotherapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 2004; 59:562-71. [PMID: 15145177 DOI: 10.1016/j.ijrobp.2004.01.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Revised: 01/14/2004] [Accepted: 01/16/2004] [Indexed: 01/02/2023]
Abstract
PURPOSE In situ cytotoxic gene therapy can potentially trigger a systemic immune response, which could impact occult metastatic disease. We are currently conducting three clinical trials using in situ adenoviral vector mediated herpes simplex virus-thymidine kinase (HSV-tk) gene delivery followed by the HSV-tk prodrug ganciclovir (GCV) or valacyclovir (VCV). This study evaluates the systemic T-cell response after gene therapy in each trial. METHODS AND MATERIALS The study protocol included three separate clinical trials in the Baylor Prostate Cancer SPORE Program: Trial A gene therapy in prostate cancer patients failing radiotherapy (36 patients), Trial B neoadjuvant gene therapy in pre-radical prostatectomy patients (22 patients), and Trial C gene therapy in combination with radiotherapy for prostate cancer (27 patients). Heparinized blood was collected at the time of vector injection and at selected intervals afterward. A complete blood count was performed, and peripheral blood lymphocytes were analyzed by fluorescent antibody cell sorting after labeling with dual color-labeled antibody pairs. RESULTS The pretreatment mean percentage of activated CD8+ T cells (DR+CD8+ T cells) was 12.23%, 16.72%, and 14.09% (Trials A, B, and C, respectively). Two weeks posttreatment, this increased to 22.87%, 26.15%, and 39.04% (Trials A, B, and C, respectively), and these increases were statistically significant (p = 0.0188, p = 0.0010, p < 0.0001, respectively). The increase of DR+CD8+ T cells was significantly larger in Trial C than in Trial A (p = 0.0044) or Trial B (p = 0.0288). Total CD8+ T cells significantly increased at 2 weeks posttreatment in Trial B and C (p = 0.0013, p = 0.0004, respectively). Interestingly, only in Trial C were significant increases in activated CD4+ T cells seen at 2 weeks (p = 0.0035). CONCLUSIONS This is the first report of systemic T-cell responses after HSV-tk+GCV/VCV gene therapy under three clinical trial conditions. There was an increase in activated CD8+ T cells in the peripheral blood after vector injection, suggesting the potential for activation of components of cell-mediated immune response in all trial conditions. The addition of radiotherapy to in situ gene therapy seems to further increase the total CD8+ T cells and activated CD4+ T cells.
Collapse
Affiliation(s)
- Takefumi Satoh
- Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Shabtai M, Waltzer WC, Ayalon A, Shabtai EL, Malinowski K. Down regulation of CD45 expression on CD4 T cells during acute renal allograft rejection: evidence of a decline in T suppressor/inducer activity. Int Urol Nephrol 2003; 34:555-8. [PMID: 14577504 DOI: 10.1023/a:1025641404743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Acute rejection is associated with the activation of helper and cytotoxic cells. A shifting balance between the suppressor/inducer CD45+ CD4+ and T helper/inducer (CD4+CD45-) cells may be responsible for the transition from quiescence to overt rejection. We examined the kinetics of CD45 expression on CD4+ T cells in renal allograft recipients from pretransplant values to acute rejection and after reversal of rejection, searching for a shift in balance between helper/inducer and suppressor/inducer cell subsets. Using two color flow cytometry, the peripheral blood levels of CD4+, CD4+CD45- [T helper/inducer (Thi)], CD4+CD45+ [T suppressor/inducer (Tsi)], CD3+, and CD8+ T cells subsets and their interrelationships, were determined in 49 patients prior to transplantation, and in 10 of them, during acute rejection and after its reversal. Results were analyzed and compared to data obtained from 10 healthy blood donors. Acute rejection was associated with a significant decline in CD45+ CD4+ expression compared to quiescent phase (22% +/- 3.7% vs. 26.5% +/- 3.2%, p = 0.05) and controls (29.5% +/- 6.2%, p = 0.01). No difference was observed compared to pretransplant levels (19.9% +/- 3.2%, p = ns). CD45-/CD45+ (Thi/Tsi) ratio was lowest during quiescence (0.75) compared to rejection (0.97, p = 0.05), in controls (0.98, p = 0.05) and pretransplant values (1.4, p = 0.01). Acute rejection was characterized by higher Thi/CD8+ and lower Tsi/CD8+ ratio (103 and 88 respectively, p = 0.045), compared to clinical quiescence (104 and 116 respectively, p = 0.039). These data suggest that acute rejection is associated with down regulation of CD4+CD45+ suppressor/inducer subset. This shift may account for the transition from quiescence to overt rejection, concurring with reports on CD4+CD45 regulatory function.
Collapse
Affiliation(s)
- M Shabtai
- Department of Surgery and Transplantation, Sheba Medical Center, Tel Aviv University School of Medicine, Tel Hashomer, 52621, Israel.
| | | | | | | | | |
Collapse
|
32
|
Aquino VM, Douek DC, Berryman B, Johnson M, Jain VK, Collins RH. Evaluation of thymic output by measurement of T-cell-receptor gene rearrangement excisional circles (TREC) in patients who have received fludarabine. Leuk Lymphoma 2003; 44:343-8. [PMID: 12688355 DOI: 10.1080/1042819021000029696] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The role of the thymus in immune reconstitution in adults receiving chemotherapy is controversial. Detection of T-cell-receptor gene rearrangement excisional circles (TREC) in peripheral blood T cells has been shown to estimate thymic output. Therefore, we measured TREC levels to assess the contribution of the thymus to immune recovery following treatment with fludarabine. Patients who had received fludarabine alone or a fludarabine containing regimen were identified. Cryopreserved peripheral-blood mononuclear cells were obtained and analyzed by four-color flow cytometry utilizing fluorochrome-conjugated antibodies against CD4, CD8, CD45RO and CD27. Proportions of naïve T cells in each CD4+ and CD8+ subset were measured by gating on CD45RO-negative, CD27+ cells. Quantification of TREC in sorted naïve CD4+ and CD8+ T cells was performed by real-time PCR. Thirteen patients received a mean of 3.8 +/- 0.4 courses of fludarabine and samples were obtained at a average of 18.8 (range 3.6-40.3) months after completing chemotherapy. Ten (77%) had detectable TREC levels. There was a positive correlation (Spearman's rank correlation) between the degree of TREC expression and the percentage of naïve T cells (r = 0.6, p = 0.03), naïve CD4+ (r = 0.6, p = 0.03) and naïve CD8+ (r = 0.66, p = 0.01) cells. We conclude that increased thymic output as demonstrated by an increase in TREC levels correlated with, and was predictive ofincreased numbers of naive T cell following fludarabine administration. The thymus appears to play a role in immune recovery in adults after receiving chemotherapy.
Collapse
Affiliation(s)
- Victor M Aquino
- Department of Pediatrics, the University of Texas Southwestern Medical Center of Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Winnicka A, Jagielski D, Hoffmann-Jagielska M, Lechowski R. Cytometric evaluation of peripheral blood lymphocytes in dogs with lymphoma during chemotherapy. JOURNAL OF VETERINARY MEDICINE. A, PHYSIOLOGY, PATHOLOGY, CLINICAL MEDICINE 2002; 49:303-6. [PMID: 12227473 DOI: 10.1046/j.1439-0442.2002.00455.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Twenty dogs with clinically diagnosed multicentric lymphoma were evaluated for percentages of peripheral blood lymphocyte subpopulations. Cytometric analysis was performed before and during chemotherapy. The results were compared to those obtained from a control group of healthy dogs. The percentages of CD5+, CD4+ and CD8+ cells were markedly decreased and CD21-like+ cells markedly increased in dogs with lymphoma in comparison with the control group. During the course of chemotherapy these values returned to ranges observed in healthy animals.
Collapse
Affiliation(s)
- A Winnicka
- Department of Internal Diseases, Faculty of Veterinary Medicine, Warsaw, Poland.
| | | | | | | |
Collapse
|
34
|
Abstract
OBJECTIVE Fatigue is a common problem among cancer patients and survivors, yet the mechanisms underlying the occurrence and persistence of this symptom are not known. Activation of the immune system may evoke feelings of fatigue, which are mediated by proinflammatory cytokines. We examined whether fatigued breast cancer survivors would show elevations in proinflammatory cytokines and markers of cytokine activity compared with nonfatigued survivors. Differences in lymphocyte subsets, cortisol, and behavioral symptoms associated with proinflammatory cytokines were also assessed. METHODS Forty breast cancer survivors (20 fatigued, 20 nonfatigued) provided blood samples at visits scheduled to control for diurnal variability. Cytokines, soluble markers of cytokine activity, and cortisol were measured by immunoassay and lymphocyte subsets by flow cytometry. Participants also completed questionnaires measuring demographic, medical, and behavioral variables. RESULTS Fatigued breast cancer survivors had significantly higher serum levels of several markers associated with proinflammatory cytokine activity than nonfatigued survivors, including interleukin-1 receptor antagonist (IL-1ra), soluble tumor necrosis factor receptor type II (sTNF-RII), and neopterin. They were also more likely to report behavioral problems that co-occur with fatigue in the context of immune activation. Fatigued survivors had significantly lower serum levels of cortisol than the nonfatigued group as well as differences in two lymphocyte populations. CONCLUSIONS Fatigued breast cancer survivors showed elevations in serum markers associated with proinflammatory cytokine activity an average of 5 years after diagnosis. Results suggest mechanisms through which enduring immune activation may occur, including alterations in cortisol and in lymphocyte subsets.
Collapse
Affiliation(s)
- Julienne E Bower
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles 90095-6900, USA.
| | | | | | | |
Collapse
|
35
|
Bargellini A, Rovesti S, Barbieri A, Vivoli R, Roncaglia R, Righi E, Borella P. Effects of chronic exposure to anaesthetic gases on some immune parameters. THE SCIENCE OF THE TOTAL ENVIRONMENT 2001; 270:149-156. [PMID: 11327388 DOI: 10.1016/s0048-9697(00)00778-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A cross-sectional survey was carried out to evaluate the relation between occupational exposure to low levels of anaesthetic gases (nitrous oxide and isoflurane) and immune parameters. Fifty-one anaesthetists were recruited among different Services of Anaesthesiology and Reanimation. The control group consisted of non-exposed physicians, similar for gender, age, and job grade. Total number of lymphocytes, lymphocyte subpopulations and the natural killer (NK) cytotoxic activity were measured. Information on personal and professional characteristics and on short- and long-term exposure was collected. Percentages of T cells (CD3) decreased significantly in anaesthetists compared to controls, whereas numbers of NK cells (CD16+ CD3-) increased. After correction for confounders, short-term (last 2 weeks) exposure was associated with a decrease in percentages of total T and T helper (CD4) cells. Furthermore, T helper percentages were significantly reduced with increasing individual exposure score evaluated on the basis of working days and levels of anaesthetic gases in operating rooms. A significant X-ray-associated increase of numbers and percentages of NK cells was lastly observed. Despite limited present exposure to anaesthetic gases, a specific derangement in lymphocyte subpopulations, with T lymphocytes more affected than B, has been observed.
Collapse
Affiliation(s)
- A Bargellini
- Department of Hygiene, Microbiology, and Biostatistics, University of Modena and Reggio Emilia, Italy
| | | | | | | | | | | | | |
Collapse
|
36
|
Belka C, Ottinger H, Kreuzfelder E, Weinmann M, Lindemann M, Lepple-Wienhues A, Budach W, Grosse-Wilde H, Bamberg M. Impact of localized radiotherapy on blood immune cells counts and function in humans. Radiother Oncol 1999; 50:199-204. [PMID: 10368044 DOI: 10.1016/s0167-8140(98)00130-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Immune cells subsets were prospectively analyzed after localized radiotherapy (LRT). LRT reduced the levels of all lymphocyte subsets, with B-cells and naive T-cells being most sensitive. Lymphocyte function was suppressed, but still within the normal range. Rapid recovery of cytotoxic T-cells/natural killer cells after LRT and the functional suppression within normal levels explains the low incidence of infections after LRT.
Collapse
Affiliation(s)
- C Belka
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Tisch M, Heimlich F, Daniel V, Opelz G, Maier H. Cellular immune defect caused by postsurgical radiation therapy in patients with head and neck cancer. Otolaryngol Head Neck Surg 1998; 119:412-7. [PMID: 9782004 DOI: 10.1016/s0194-5998(98)70092-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effects of locoregional postoperative radiation therapy (60 Gy on average) on cellular immunity were investigated in 11 patients with squamocellular carcinomas of the oral cavity, pharynx, or larynx. During radiation treatment, the total lymphocyte counts, CD8+ T-lymphocyte count, and especially CD4+ T-lymphocyte count decreased significantly. The mean CD4+ T-lymphocyte counts dropped from an average of 739/microl to 183/microl (p <0.001), and the CD4+/CD8+ quotient also decreased significantly. Not only the lymphocyte counts but also the in vitro lymphocyte stimulation responses to several mitogens decreased, with reductions averaging 10% to 50% of normal responses by the end of radiation therapy. Within 3 to 4 weeks after radiation therapy, the CD4+ T-lymphocyte counts and the in vitro lymphocyte stimulation responses showed a tendency toward normalization. This study shows that postoperative locoregional radiation therapy in patients with head and neck cancer induces a severe generalized impairment of cellular immunity.
Collapse
Affiliation(s)
- M Tisch
- Department of Otorhinolaryngology-Head and Neck Surgery, Armed Forces Hospital, Ulm, Germany
| | | | | | | | | |
Collapse
|
38
|
Oliver RT, Tobias J, Gallagher C. Prebiopsy neo-adjuvant endocrine therapy for breast cancer to prevent post-surgery trauma-induced growth factor and immune-suppression mediated tumour progression. Eur J Cancer 1996; 32A:396-7. [PMID: 8814680 DOI: 10.1016/0959-8049(95)00589-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- R T Oliver
- Department of Medical Oncology, London Hospital Medical College, UK
| | | | | |
Collapse
|
39
|
Igietseme JU, Smith K, Simmons A, Rayford PL. Effect of gamma-irradiation on the effector function of T lymphocytes in microbial control. Int J Radiat Biol 1995; 67:557-64. [PMID: 7775831 DOI: 10.1080/09553009514550671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A chlamydial-specific T cell clone, capable of inhibiting the growth of infectious Chlamydia in vivo and in vitro, was employed to investigate the effect of gamma-irradiation on the ability of effector T cells to control infections. Clone 2.14-0 (CD4+), specific for the Chlamydia trachomatis biovar agent of mouse pneumonitis (MoPn), was irradiated with varying doses (0, 2.5, 5.0, 10.0, 20.0 and 40.0 Gy) and its biological functions and ability to inhibit the intraepithelial growth of MoPn were assessed. The results revealed that although gamma-irradiation drastically reduced the proliferative response of the clone to antigen, it did not affect the phenotype and the effector function of inhibiting chlamydial growth. The preservation of anti-chlamydial function after gamma-irradiation correlated with the retention of IFN-gamma and TNF-alpha secretion in response to antigenic stimulation. We conclude that the biologic functions of T cells requiring proliferation and differentiation are more likely to be adversely affected by gamma-irradiation on the short-term, but the effector functions, possibly associated with cytokines and cytolysis, may be preserved among persisting effector T cells in an irradiated individual.
Collapse
Affiliation(s)
- J U Igietseme
- Department of Microbiology, University of Arkansas for Medical Sciences, Little Rock 72205, USA
| | | | | | | |
Collapse
|