TCD4pos lymphocytosis in rheumatoid and psoriatic arthritis patients following TNFα blocking agents

Abstract

BackgroundLymphocyte expansion and true lymphocytosis are commonly observed in the everyday clinical practice. The meaning of such phenomenon is often poorly understood so that discrimination between benign and malignant lymphocytosis remains difficult to establish. This is mainly true when lymphocytosis rises in patients affected by immune-mediated chronic inflammatory diseases under immunosuppressive treatment, conditions potentially associated with lymphomagenesis. In this brief report the development of mild T CD4pos lymphocytosis in a group of patients with chronic arthritis under anti-TNF-α treatment is described.MethodsTwo hundred eight rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients have been evaluated longitudinally for at least 1-year before and 2-years after anti-TNF-α therapy introduction for the possible appearance of a lymphocyte expansion. In patients who developed lymphocyte expansion, T, B and NK cells were analysed.ResultsTwenty-five out of 208 (12%) subjects developed a mild T CD4pos lymphocytosis, during anti-TNF-α therapy, which reverted after its interruption. Higher lymphocyte count, more frequent use of steroids and shorter disease duration, before biological therapy start, have emerged as risk factors for lymphocytosis development.ConclusionsThis is the first longitudinal cohort study evaluating the onset of lymphocytosis in RA and PsA patients under anti-TNF-α treatment and its possible clinical relevance. A mild T CD4pos lymphocytosis has been observed in 12% of RA and PsA patients probably related to anti-TNF-α treatment as previously reported by anecdotal cases. Patients with higher baseline lymphocyte count, use of steroids and shorter disease duration before the introduction of biologic therapy, seem to be prone to develop this laboratory reversible abnormality.

Analysis of Gut Microbiota in Rheumatoid Arthritis Patients: Disease-Related Dysbiosis and Modifications Induced by Etanercept

“…It was recently demonstrated that different environmental factors are involved in the development of both intestinal/oral dysbiosis and arthritis onset and outcome, among which the most relevant are diet, smoking, infections, and drugs [ 9 , 10 , 11 , 12 ].…”

Analysis of hematological parameters in rheumatoid arthritis patients receiving biological therapy: contribution to prevention of avoidable hematological complications

“…In addition, we detected a higher level of the total lymphocyte counts in GOL and ADA groups. This might be related to the fact that TNFα has a bi-functional role in the growth of hematopoietic stem and progenitor cells and its inhibition is associated with the onset of lymphoproliferative disorders and pathological abnormalities (Autrel-Moignet and Lamy, 2014[ 2 ]; Bessissow et al, 2012[ 6 ]; Picchianti Diamanti et al, 201[ 30 ]; Tian et al, 2014[ 42 ]). Interestingly, while the therapeutically mediated decrease of the lymphocyte counts is generally correlated to RA activity, ADA and GOL treatments improved the DAS28 score even in presence of higher lymphocyte levels.…”

One-Step Microfluidic Purification of White Blood Cells from Whole Blood for Immunophenotyping

“…White blood cell (WBC) abnormalities (i.e., deviation from normal cell counts and phenotypes) are important indicators of a range of clinical conditions such as some cancers, , autoimmune diseases, , and infectious diseases. , Hematology analyzers provide automated differential cell counts including the five main WBC subsets (i.e., lymphocytes, neutrophils, monocytes, eosinophils, and basophils) as well as immature or atypical cells. , However, due to the limited capability of hematology analyzers for phenotype analysis, abnormal cell flags are often followed by manual blood film reviews, which require high technical competence and considerable time to make an analytical level of blood smear and minimize errors inherent to subjective interpretation. Alternatively, WBC differential by flow cytometry can provide accurate, detailed, automated differential information concerning lymphocytes subsets, and blast subsets, which are not reported with hematology analyzers or manual smear examination. , This flow cytometric approach provides a complementary method to detect WBC abnormalities, but its workflow still relies on manual sample preparation including red blood cell (RBC) lysis or density-gradient centrifugation by experienced technicians.…”

“…W hite blood cell (WBC) abnormalities (i.e., deviation from normal cell counts and phenotypes) are important indicators of a range of clinical conditions such as some cancers, 1,2 autoimmune diseases, 3,4 and infectious diseases. 5,6 Hematology analyzers provide automated differential cell counts including the five main WBC subsets (i.e., lymphocytes, neutrophils, monocytes, eosinophils, and basophils) as well as immature or atypical cells.…”