Influence of R-CHOP Therapy on Immune System Restoration in Patients with B-Cell Lymphoma

Abstract

Objective: To assess the immunosuppressive effect of R-CHOP in patients with B-cell lymphoma at 2 years. Methods: Parameters of humoral and cell-mediated immunity were assessed in 89 patients with diffuse large B-cell lymphoma or follicular lymphoma before and after 6-8 cycles of R-CHOP-14 or R-CHOP-21 regimen. Results: Data on pre- and posttreatment serum IgG (sIgG) levels were available for all 89 patients, while the corresponding data on serum CD20+, CD3+, CD4+, and CD8+ lymphocyte counts were available in only 43. Median sIgG levels significantly decreased from 1,221 mg/dl (baseline) to 733 mg/dl (after chemotherapy) (p < 0.001). Although CD20+ and CD4+ cell counts decreased (p < 0.001), no significant effect of chemotherapy on CD3+ and CD8+ cell counts was observed. CD20+ cell counts were restored to baseline levels at the 12-month follow-up. sIgG levels and CD4+ cell counts were not completely restored at 24 months, indicating a sustained immunosuppressive effect of R-CHOP in these patients. The incidence of infections over the 2-year period was 16.3-23.6%. Conclusion: The immunosuppressive effect of R-CHOP in newly diagnosed cases of B-cell lymphoma tends to persist for >2 years, although sIgG levels were restored more quickly than CD4+ cell counts.

Trial watch: Immunogenic cell death induction by anticancer chemotherapeutics

“…244 Brown and collaborators (from University of Oxford, John Radcliffe Hospital, Oxford, UK) reported that patients with DLBCL receiving R-CHOP exhibited decreased levels of major histocompatibility complex, class II, DR alpha (HLA-DRA) on DLBCL cells, correlating with inferior overall survival. 245 On a relatively conciliatory note though, Wu and co-authors (from The Second Hospital of Lanzhou University, Lanzhou, China) found that the low circulating levels of monocytes and monocytic myeloid-derived suppressor cells (MDSCs) have profound positive prognostic impact on the overall survival of DLBCL patients treated with R-CHOP.…”

Autoimmune Cytopenias Occurring after Treatment with Chemoimmunotherapy for Non-Hodgkin Lymphomas

“…Imbalances in helper and suppressor T-cell populations have been reported after R-CHOP chemotherapy, and the recovery of serum IgG and CD4+ counts required more than 2 years following R-CHOP therapy in patients with B-cell lymphoma [12]. Our two elderly patients (case 2 and 10) showed evidence of a T-cell imbalance more than 4 years after R-CHOP chemotherapy.…”

Relationship between Autoimmune Diseases and Imbalances in Helper/Suppressor T-cell Populations after Rituximab-containing Chemotherapyfor Non-Hodgkin Lymphoma

“…In this case, infection may be one of the triggers for immune dysregulation. Imbalances in helper and suppressor T-cell populations have been reported after R-CHOP chemotherapy [11,12]. The effects of rituximab alone on the restoration of immunity after treatments remain unknown.…”

“…However, the effects of rituximab in R-CHOP therapy on immune function have not yet been elucidated. Ito et al [11] reported the recovery of serum IgG and CD4+ counts more than 2 years after R-CHOP therapy in patients with B-cell lymphoma. Our patient, who had anti-red cell or platelet antibodies, showed evidence of a T-cell imbalance more than 5 years after R-CHOP chemotherapy.…”

“…This autoimmune phenomenon may be related to imbalances in helper/suppressor T-cell populations [10]. Imbalances in helper and suppressor T-cell populations have been reported after R-CHOP chemotherapy, and the recovery of serum IgG and CD4+ counts was observed more than 2 years after R-CHOP therapy in patients with B-cell lymphoma [11,12]. Our patient, who had anti-red cell or platelet antibodies, showed evidence of a T-cell imbalance more than 5 years after R-CHOP chemotherapy.…”