Kinetics of T‐cell subset reconstitution following treatment with bendamustine and rituximab for low‐grade lymphoproliferative disease: a population‐based analysis

Medientyp: E-Artikel
Titel: Kinetics of T‐cell subset reconstitution following treatment with bendamustine and rituximab for low‐grade lymphoproliferative disease: a population‐based analysis
Beteiligte: Martínez‐Calle, Nicolás; Hartley, Sarah; Ahearne, Matthew; Kasenda, Benjamin; Beech, Amy; Knight, Helen; Balotis, Constantine; Kennedy, Ben; Wagner, Simon; Dyer, Martin J. S.; Smith, Dean; McMillan, Andrew K.; Miall, Fiona; Bishton, Mark; Fox, Christopher P.
Erschienen: Wiley, 2019
Erschienen in: British Journal of Haematology
Sprache: Englisch
DOI: 10.1111/bjh.15722
ISSN: 0007-1048; 1365-2141
Schlagwörter: Hematology
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Beschreibung: <jats:title>Summary</jats:title><jats:p>Delayed lymphocyte and T‐cell immune reconstitution following bendamustine‐rituximab (<jats:styled-content style="fixed-case">BR</jats:styled-content>) for indolent non‐Hodgkin lymphoma (<jats:styled-content style="fixed-case">iNHL</jats:styled-content>) has been described, but no information is available for chronic lymphocytic leukaemia (<jats:styled-content style="fixed-case">CLL</jats:styled-content>). We present a population‐based retrospective analysis of immune reconstitution and risk of infection following <jats:styled-content style="fixed-case">BR</jats:styled-content>. Outcomes included timing/correlates of <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ recovery and risk of ≥grade 3 infections. Consecutively treated patients (1 April 2014 to 31 January 2017) were included (<jats:italic>n</jats:italic> = 295),with a median age of 65 years (range 33–92); 57% were 1st line treatments. Median cumulative bendamustine dose was 1080 mg/m<jats:sup>2</jats:sup> (range 140–1440 mg/m<jats:sup>2</jats:sup>). <jats:styled-content style="fixed-case">CD</jats:styled-content>4/<jats:styled-content style="fixed-case">CD</jats:styled-content>8/<jats:styled-content style="fixed-case">CD</jats:styled-content>19/<jats:styled-content style="fixed-case">NK</jats:styled-content> subsets were available for 148 patients. Median follow‐up was 24 months. Median times to lymphocyte count (<jats:styled-content style="fixed-case">ALC</jats:styled-content>) recovery (≥1 × 10<jats:sup>9</jats:sup>/l) and <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ recovery (≥0·2 × 10<jats:sup>9</jats:sup>/l) were 26 and 24 months, respectively. Bendamustine total dose >1080 mg/m<jats:sup>2</jats:sup> (hazard ratio [<jats:styled-content style="fixed-case">HR</jats:styled-content>] 0·4; 95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>]: 0·2–0·8), end‐of‐treatment <jats:styled-content style="fixed-case">ALC</jats:styled-content> ≤0·4 × 10<jats:sup>9</jats:sup>/l (<jats:styled-content style="fixed-case">HR</jats:styled-content> 0·53; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 0·3–0·9) and <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ <0·1 × 10<jats:sup>9</jats:sup>/l 1‐year post‐<jats:styled-content style="fixed-case">BR</jats:styled-content> (<jats:styled-content style="fixed-case">HR</jats:styled-content> 0·03; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 0·008–0·15) were covariables for delayed <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ recovery. <jats:styled-content style="fixed-case">ALC</jats:styled-content>‐recovery ≥1 × 10<jats:sup>9</jats:sup>/l was an unreliable predictor of <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ recovery (negative predictive vale 74%, positive predictive value 86%, likelihood ratio 3·3). <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ lymphopenia >3 years was a significant risk factor for ≥grade 3 infections (Odds ratio 3·4; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 1·4–6·9). <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ recovery after <jats:styled-content style="fixed-case">BR</jats:styled-content> is unexpectedly delayed and late recovery is associated with risk of serious infections. Monitoring <jats:styled-content style="fixed-case">CD</jats:styled-content>4+ following <jats:styled-content style="fixed-case">BR</jats:styled-content> could identify patients at high risk of delayed infections.</jats:p>

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