Immunochemotherapeutic increase of peripheral absolute monocyte count predicts interstitial pneumonia in lymphoma patients
Immunochemotherapeutic increase of peripheral absolute monocyte count predicts interstitial pneumonia in lymphoma patients
复制标题
免疫化疗增加外周绝对单核细胞计数可预测淋巴瘤患者的间质性肺炎。
DOI：
10.1002/hon.2556
复制
发表时间：
2018-12-01
影响因子：
3.3
通讯作者：
Zhang, Huilai
中科院分区：
文献类型：
--
作者：
Lang, Mingxiao;Yu, Jingwei;Zhang, Huilai
间质性肺炎(IP)是接受免疫化疗的淋巴瘤患者的潜在致命性不良事件之一。然而，这种并发症的危险因素和预测标记物仍然不清楚。本研究旨在探讨免疫化疗过程中单核细胞绝对计数(AMC)的变化是否与IP的发生发展有关。2014-2016年间共500例接受免疫化疗的淋巴瘤患者纳入本次调查。间质性肺炎一般在CT上诊断为弥漫性肺间质浸润性病变，结合呼吸道症状或肺功能检查，也可作为本研究的诊断工具。在500例患者中，有40例被诊断为IP，占受试者总数的8%。免疫化疗前患者化疗周期的中位数为4个。本研究提示，免疫化疗2个周期后外周血巨噬细胞数增加到0.565×10(9)/L以上是发展为IP的巨大潜力。经多因素分析，免疫化疗2个周期后淋巴瘤肺部受累和AMC升高是IP的独立危险因素。大多数持续AMC升高的IP患者(>；0.575×10(9)/L发病时)伴有严重的肺部症状，而AMC回落的患者可能耐受随后的免疫化疗。因此，本研究得出结论，在淋巴瘤肺部受累的患者进行免疫化疗时，早期AMC的增加提示了发生IP的巨大潜力。AMC的动态变化可作为预测IP严重程度的指标，并指导肿瘤和肺损伤的治疗调整。
Interstitial pneumonia (IP) is one of the potentially fatal adverse events for lymphoma patients undergoing immunochemotherapy. However, the risk factors and predictive markers remain unclear for this complication. This retrospective study aims to explore whether the change of absolute monocyte count (AMC) during immunochemotherapy is correlated with IP occurrence and progression. A total of 500 lymphoma patients receiving immunochemotherapy from 2014 to 2016 were enrolled in this investigation. Interstitial pneumonia was generally diagnosed as diffused pulmonary interstitial infiltrates on computed tomography images in conjunction with respiratory symptoms or pulmonary function test, which is also adopted as a diagnosing tool of IP in this study. Among the total 500 participating patients, 40 patients were diagnosed as IP, which account for 8% of the total subjects. The median number of chemotherapy cycles for those patients prior to IP occurrence is 4. This research suggests that the increase of peripheral AMC over 0.565 x 10(9)/L after 2 cycles of immunochemotherapy is a great potential to develop IP. Using the method of multivariate analysis, lymphoma lung involvement and high AMC after 2 cycles of immunochemotherapy were identified as independent risk factors for IP. Most IP patients with sustained AMC elevation (>0.575 x 10(9)/L at IP onset) accompanied severe pulmonary symptoms, while those with AMC fall-back might tolerate subsequent immunochemotherapy. Thus, this study concludes that early increase of AMC during immunochemotherapy in lymphoma patients with lung involvement suggested a great potential to develop IP. Dynamic changes in AMC may serve as a predictive marker for IP severity and a guide for treatment adjustment for both tumor and pulmonary injuries.