Low absolute lymphocyte count and addition of rituximab confer high risk for interstitial pneumonia in patients with diffuse large B-cell lymphoma

Abstract

Several small-scale studies have reported pulmonary toxicity among patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab-containing chemotherapy, though whether the use of rituximab predisposes to interstitial pneumonia (IP) remains unclear. This retrospective study was intended to identify the characteristics and risk factors of IP in patients with DLBCL. Between 2000 and 2009, 529 consecutive patients with DLBCL receiving first-line tri-weekly COP- or CHOP-based chemotherapy with or without rituximab were enrolled as subjects. IP was defined as diffuse pulmonary interstitial infiltrates found on computed tomography scans in conjunction with respiratory symptoms. IP was observed in 26 patients (4.9%), six of whom were confirmed with Pneumocystis jirovecii pneumonia. The median number of chemotherapy courses before IP was four cycles. Using multivariate analysis, absolute lymphocyte count less than 1×10(9)/l at diagnosis [odds ratio (OR) 2.75, p=0.014] and the addition of rituximab to chemotherapy (OR 4.56, p=0.003) were identified as independent risk factors for IP. In conclusion, the incidence of IP is increased in patients with DLBCL receiving rituximab-containing chemotherapy. Specific subgroups with lymphopenia at diagnosis may justify close scrutiny to detect pulmonary complications.

Point prevalence of Pneumocystis pneumonia in patients with non-Hodgkin lymphoma according to the number of cycles of R-CHOP chemotherapy

“…Repeated R-CHOP has been shown to change the host immune status by depleting lymphocytes [10,15], and a trial based on this finding showed that low ALC was associated with PCP development in patients with NHL [15]. However, this previous study only included cross-sectional comparison of ALC values at the time of NHL diagnosis between patients with and without PCP [15]. This was not sufficient to confirm the validity of ALC for prediction of PCP because the impact of R-CHOP on the value of ALC was not reflected in the analysis.…”

“…The development of PCP has not been notable in previous studies addressing the efficacy of R-CHOP in NHL [8,11,12]. A few case series of PCP in patients with NHL were reported and some studies have considered the issue of PCP development in patients receiving R-CHOP for NHL [9,[13][14][15][16][17][18]. However, these studies included only a few patients with PCP confirmed by biopsy or direct immunofluoresecence assay.…”

“…All patients with either definite or probable PCP received trimethoprim/sulfamethoxazole (TMP/SMX) for first-line therapy. The median treatment duration was 13 days (IQR,[8][9][10][11][12][13][14][15][16]. 87.5 % (28/32) patients received adjunctive corticosteroid.…”

Epidemiology and risk factors associated with Pneumocystis jirovecii pneumonia in kidney transplant recipients after 6‐month trimethoprim‐sulfamethoxazole prophylaxis: A case‐control study

“…Therefore, a routine TMP-SMX prophylaxis for 12 months may be warranted especially in the setting of CMV preemptive monitoring, although the current guidelines 4 did not give the preference Previous studies showed that a low lymphocyte count was associated with PCP development. 15,18,20 However, these studies provide cross-sectional comparisons of lymphocyte counts within one month before PCP 15 or at the end of PCP prophylaxis. 18 One case-control study provided total lymphocyte and CD4 counts during follow-up after transplantation.…”

Absolute lymphocyte count predicts response to rituximab-containing salvage treatment for relapsed/refractory B-cell non-Hodgkin's lymphoma with prior rituximab exposure

“…The demographic data and clinical characteristics of the study population were obtained from clinical chart review, lymphoma registry information, and physician records, as previously described. 15 The Institutional Review Board of Taipei Veterans General Hospital approved this retrospective study.…”