Diurnal Variability in Neutrophil Counts in Clozapine Treatment

Hathaway, David B; Frankenburg, Frances R.

doi:10.1097/jcp.0000000000001096

Cited by 2 publications

(2 citation statements)

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“…In addition, NLR could be monitored over the therapeutic periods as an auxiliary index for the progress and outcome of HCC after treatment. However, since the lymphocyte and neutrophil counts are affected by many factors, especially infections [46,47] and drugs [48], and in a recent study, COVID-19 infection was also found to result in severe lymphopenia [49], therefore, cautions should be taken to interpret the changes of NLR in HCC patients, and additional data, particularly inflammation-related data, are needed to trace the therapeutic outcomes and to rule out other factors and diseases that may affect changes. For example, the pathogenesis of several diseases such cardiovascular diseases [50], retinal artery occlusion [51], and spinal epidural abscess [52] have been found to result in high NLR, while treatment with 25-hydroxyvitamin D 3 and smoking cessation are associated with a reduced blood NLR [53,54], suggesting when NLR is used for individual patients, it should be evaluated along with other pathological conditions to obtain more reliable prediction.…”

Section: Discussionmentioning

confidence: 99%

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts Poor Prognosis in Patients with Liver Cancer after Interventional Treatments

Zhang

2022

BioMed Research International

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This study is aimed at examining the prognostic value of blood neutrophil-to-lymphocyte ratio (NLR) in patients with hepatocellular carcinoma (HCC). Demographic and clinical data of 543 HCC patients treated with interventional therapies were retrospectively analyzed. Preoperative NLRs were determined and receiver operating characteristic (ROC) curves were plotted for survival time in patients with high (NLR ≥3.8) and low (NLR<3.8) NLR. The median overall survival (OS) was 1241 days after interventional therapies and was significantly reduced in the high NLR group when compared to the low NLR group. The median progression-free survival time (PFST) of patients was also significantly shorter in the high NLR group than in the low NLR group. Univariate analysis revealed that tumor type, therapy method, maximum tumor size (>3 mm), and NLR (>3.8) were risk factors for OST and PFST ( P < 0.05 ). Multivariate analysis indicated that tumor type, maximum tumor diameter, therapy method, and NLR (>3.8) were independent risk factors for PFST ( P < 0.05 ). Our results demonstrate that preoperative NLR has prognostic value for patients with HCC undergoing interventional therapies, and high NLR is an indication of poor prognosis.

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Section: Discussionmentioning

confidence: 99%

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts Poor Prognosis in Patients with Liver Cancer after Interventional Treatments

Zhang

2022

BioMed Research International

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“…Even if the ANC shows slightly below 1500 cells/mm 3 , clozapine treatment must be discontinued in Japan based on the ANC cutoff level of <1500 cells/mm 3 , but the ANC may often recover quickly to an acceptable value. This may be because an ANC of around 1500 cells/mm 3 can fluctuate; for example, it may show diurnal variation (Hathaway and Frankenburg, 2019), decrease with viral infection (Dunk et al, 2006), or increase with exercise (Phillips et al, 2000). Therefore, we assume that a subset of patients with CIG may not involve adaptive immune reactions and may not be continuous with CIA.…”

Section: Introductionmentioning

confidence: 99%

Clozapine-specific proliferative response of peripheral blood-derived mononuclear cells in Japanese patients with clozapine-induced agranulocytosis

et al. 2022

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Background: Although clozapine-induced granulocytopenia (CIG) is less severe than clozapine-induced agranulocytosis (CIA), and some patients with CIG may not go on to develop serious complications, clozapine is discontinued in cases of both CIA and CIG. Understanding the pathogenic mechanisms of CIA/CIG could provide better management of clozapine therapy. Recently, as a mechanistic insight into adaptive immune systems, European groups reported clozapine-specific proliferative responses and clozapine-specific T cells using blood taken from patients with CIA and/or CIG. Aims: The aims of our study are to support this mechanistic evidence and to investigate the difference in the lymphocyte response to clozapine between patients with CIG and those with CIA. Methods: Lymphocyte stimulation tests (LSTs) were conducted using CD25-positive cell-depleted peripheral blood-derived mononuclear cells (PBMCs) isolated from blood of four Japanese patients with CIA, four patients with CIG, and nine clozapine-tolerant subjects. Results: Three of four patients with CIA and one of four patients with CIG showed proliferative responses to clozapine with a stimulation index of greater than 2. In contrast, none of the nine clozapine-tolerant subjects showed any response to clozapine. Olanzapine did not stimulate PBMCs of patients with CIA, patients with CIG, or clozapine-tolerant subjects. Conclusions: Clozapine- and CIA-specific lymphocyte reactions in a Japanese population provided supportive evidence that the pathogenesis of CIA is based on adaptive immune reactions. In addition, patients with CIG who show a positive response to an LST may at the very least not be chosen for clozapine-rechallenge and further prospective studies are desirable to verify this hypothesis.

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Diurnal Variability in Neutrophil Counts in Clozapine Treatment

Cited by 2 publications

References 12 publications

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts Poor Prognosis in Patients with Liver Cancer after Interventional Treatments

An Elevated Neutrophil-to-Lymphocyte Ratio Predicts Poor Prognosis in Patients with Liver Cancer after Interventional Treatments

Clozapine-specific proliferative response of peripheral blood-derived mononuclear cells in Japanese patients with clozapine-induced agranulocytosis

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