Journal article
Kinetics of T-cell subset reconstitution following treatment with bendamustine and rituximab for low-grade lymphoproliferative disease: a population-based analysis.
- Martínez-Calle N Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Hartley S Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Ahearne M Haematology Department, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Kasenda B Department of Medical Oncology & Department of Haematology, University Hospital Basel, Basel, Switzerland.
- Beech A Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Knight H Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Balotis C Haematology Department, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Kennedy B Haematology Department, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Wagner S Haematology Department, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Dyer MJS Ernest and Helen Scott Haematological Research Institute, University of Leicester, Leicester, UK.
- Smith D Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- McMillan AK Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Miall F Haematology Department, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Bishton M Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Fox CP Department of Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- 2018-12-15
Published in:
- British journal of haematology. - 2019
CD4 lymphopenia
bendamustine
chronic lymphocytic leukaemia
non-Hodgkin lymphoma
Adult
Aged
Aged, 80 and over
Antineoplastic Agents, Alkylating
Bendamustine Hydrochloride
Female
Humans
Lymphoproliferative Disorders
Male
Middle Aged
Rituximab
T-Lymphocyte Subsets
English
Delayed lymphocyte and T-cell immune reconstitution following bendamustine-rituximab (BR) for indolent non-Hodgkin lymphoma (iNHL) has been described, but no information is available for chronic lymphocytic leukaemia (CLL). We present a population-based retrospective analysis of immune reconstitution and risk of infection following BR. Outcomes included timing/correlates of CD4+ recovery and risk of ≥grade 3 infections. Consecutively treated patients (1 April 2014 to 31 January 2017) were included (n = 295),with a median age of 65 years (range 33-92); 57% were 1st line treatments. Median cumulative bendamustine dose was 1080 mg/m2 (range 140-1440 mg/m2 ). CD4/CD8/CD19/NK subsets were available for 148 patients. Median follow-up was 24 months. Median times to lymphocyte count (ALC) recovery (≥1 × 109 /l) and CD4+ recovery (≥0·2 × 109 /l) were 26 and 24 months, respectively. Bendamustine total dose >1080 mg/m2 (hazard ratio [HR] 0·4; 95% confidence interval [CI]: 0·2-0·8), end-of-treatment ALC ≤0·4 × 109 /l (HR 0·53; 95% CI: 0·3-0·9) and CD4+ <0·1 × 109 /l 1-year post-BR (HR 0·03; 95% CI: 0·008-0·15) were covariables for delayed CD4+ recovery. ALC-recovery ≥1 × 109 /l was an unreliable predictor of CD4+ recovery (negative predictive vale 74%, positive predictive value 86%, likelihood ratio 3·3). CD4+ lymphopenia >3 years was a significant risk factor for ≥grade 3 infections (Odds ratio 3·4; 95% CI: 1·4-6·9). CD4+ recovery after BR is unexpectedly delayed and late recovery is associated with risk of serious infections. Monitoring CD4+ following BR could identify patients at high risk of delayed infections.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1111/bjh.15722
- PMID 30548597
- Persistent URL
- https://sonar.ch/global/documents/231767
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