Primary brain tumors treated with steroids and radiotherapy: Low CD4 counts and risk of infection
Primary brain tumors treated with steroids and radiotherapy: Low CD4 counts and risk of infection
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DOI：
10.1016/j.ijrobp.2004.12.085
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发表时间：
2005-08-01
影响因子：
7
通讯作者：
Kleinberg, L
中科院分区：
文献类型：
--
作者：
Hughes, MA;Parisi, M;Kleinberg, L
目的：原发性脑肿瘤患者通常长时间使用高剂量皮质类固醇治疗，以减少颅内肿胀和缓解头痛等症状。这种治疗可能导致免疫抑制，使患者面临危及生命的机会性感染的风险，如卡氏肺孢子虫肺炎。预防性抗生素可以降低感染某些类型感染的风险。本研究的目的是确定低CD 4的发生率。计数和是否监测CD 4计数期间和放疗后（RT）是warranty.Methods和材料：CD 4计数进行了测量，在RT在70的76例新诊断的III级和IV级星形细胞瘤和间变性少突胶质细胞瘤皮质类固醇治疗，并看到在约翰霍普金斯医院。最近25例患者每周进行一次CD 4测量。预防性甲氧苄啶-磺胺甲恶唑（160 mg/800 mg p.o.每周一、周三和周五）或氨苯砜（100 mg p.o.每日），只有当患者出现低CD 4计数时，才开具磺胺过敏处方。23%的患者在手术时放置了卡莫司汀化疗片，各组之间均匀分布。结果：70例患者中有17例（24%）CD 4计数降至< 200/mm 3。对于25名每周进行一次CD 4计数的患者，RT前所有患者的CD 4计数均> 450/mm 3，但在RT期间，25名患者中有6名（24%）下降至< 200/mm 3。计数< 200/mm 3的患者更有可能住院治疗（41% vs. 9%，p < 0.01）和在RT期间因感染住院（23% vs. 4%，p < 0.05）。所有CD 4计数低的患者均接受预防性抗生素治疗，无患者发生卡氏肺孢子虫肺炎。没有患者对抗生素治疗产生严重不良反应。类固醇的平均剂量、平均最低白色血细胞计数和接受Gliadel华夫饼治疗的患者数量在组间没有显着差异。结论：本研究的结果证实了临床印象，即使用高剂量皮质类固醇和RT治疗原发性脑癌患者足以导致严重的免疫抑制，并使这些患者面临危及生命的机会性感染的风险。为有风险的人提供预防性抗生素的方案可能有助于防止治疗的潜在致命副作用。一项前瞻性研究正在进行中，以确定这一发现的频率，深度和预后意义。(c)2005年爱思唯尔公司
Purpose: Patients with primary brain tumors are often treated with high doses of corticosteroids for prolonged periods to reduce intracranial swelling and alleviate symptoms such as headaches. This treatment may lead to immunosuppression, placing the patient at risk of life-threatening opportunistic infections, such as Pneumocystis carinii pneumonia. The risk of contracting some types of infection may be reduced with prophylactic antibiotics. The purpose of this study was to determine the occurrence of low CD4. counts and whether monitoring CD4 counts during and after radiotherapy (RT) is warranted.Methods and Materials: CD4 counts were measured during RT in 70 of 76 consecutive patients with newly diagnosed Grade III and IV astrocytoma and anaplastic oligodendroglioma treated with corticosteroids and seen at the Johns Hopkins Hospital. Weekly CD4 measurements were taken in the most recent 25 patients. Prophylactic trimethoprim-sulfamethoxazole (160 mg/800 mg p.o. every Monday, Wednesday, and Friday) or dapsone (100 mg p.o. daily) in those with sulfa allergy was prescribed only if patients developed a low CD4 count. Carmustine chemotherapy wafers were placed at surgery in 23% of patients, evenly distributed between the groups. No patient received any other chemotherapy concurrent with RT.Results: CD4 counts decreased to < 200/mm(3) in 17 (24%) of 70 patients. For the 25 patients with weekly CD4 counts, all CD4 counts were > 450/mm(3) before RT, but 6 (24%) of 25 fell to < 200/mm(3) during RT. Patients with counts < 200/mm(3) were significantly more likely to be hospitalized (41% vs. 9%, p < 0.01) and be hospitalized for infection (23% vs. 4%, p < 0.05) during RT. Overall survival was not significantly different between the groups. All patients with low CD4 counts were treated with prophylactic antibiotics, and no patient developed Pneumocystis carinii pneumonia. No patients developed a serious adverse reaction to antibiotic therapy. The mean dose of steroids, mean minimal white blood cell count, and number of patients treated with Gliadel wafers were not significantly different between the groups.Conclusion: The results of this study have confirmed the clinical impression that the use of high-dose corticosteroids and RT in patients with primary brain cancer is sufficient to result in severe immunosuppression and place these patients at risk of life-threatening opportunistic infections. A protocol of prophylactic antibiotics for those at risk may help prevent a potentially fatal side effect of treatment. A prospective study is underway to determine the frequency, depth, and prognostic implications of this finding. (c) 2005 Elsevier Inc.