Nicolás Martínez-Calle
Kinetics of T-cell subset reconstitution following treatment with bendamustine and rituximab for low-grade lymphoproliferative disease: a population-based analysis
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.
Authors
Sarah Hartley
Matthew Ahearne
Benjamin Kasenda
Amy Beech
Helen Knight
Constantine Balotis
Ben Kennedy
Simon Wagner
Martin J. S. Dyer
DEAN SMITH Dean.Smith@nottingham.ac.uk
Clinical Associate Professor in Haematology
Andrew K. McMillan
Fiona Miall
Mark Bishton
Christopher P. Fox
Abstract
Delayed lymphocyte and T-cell immune reconstitution following bendamustine-rituximab (BR) for indolent non-Hodgkin lymphoma (iNHL) has been described, but no information is available for chronic lymphocytic leukaemia (CLL). We present a population-based retrospective analysis of immune reconstitution and risk of infection following BR. Outcomes included timing/correlates of CD4+ recovery and risk of ≥grade 3 infections. Consecutively treated patients (1 April 2014 to 31 January 2017) were included (n=295),with a median age of 65years (range 33–92); 57% were 1st line treatments. Median cumulative bendamustine dose was 1080mg/m 2 (range 140–1440mg/m 2 ). CD4/CD8/CD19/NK subsets were available for 148 patients. Median follow-up was 24months. Median times to lymphocyte count (ALC) recovery (≥1×10 9 /l) and CD4+ recovery (≥0·2×10 9 /l) were 26 and 24months, respectively. Bendamustine total dose >1080mg/m 2 (hazard ratio [HR] 0·4; 95% confidence interval [CI]: 0·2–0·8), end-of-treatment ALC ≤0·4×10 9 /l (HR 0·53; 95% CI: 0·3–0·9) and CD4+ <0·1×10 9 /l 1-year post-BR (HR 0·03; 95% CI: 0·008–0·15) were covariables for delayed CD4+ recovery. ALC-recovery ≥1×10 9 /l was an unreliable predictor of CD4+ recovery (negative predictive vale 74%, positive predictive value 86%, likelihood ratio 3·3). CD4+ lymphopenia >3years was a significant risk factor for ≥grade 3 infections (Odds ratio 3·4; 95% CI: 1·4–6·9). CD4+ recovery after BR is unexpectedly delayed and late recovery is associated with risk of serious infections. Monitoring CD4+ following BR could identify patients at high risk of delayed infections.
Citation
Martínez-Calle, N., Hartley, S., Ahearne, M., Kasenda, B., Beech, A., Knight, H., …Fox, C. P. (2019). Kinetics of T-cell subset reconstitution following treatment with bendamustine and rituximab for low-grade lymphoproliferative disease: a population-based analysis. British Journal of Haematology, 184(6), 957-968. https://doi.org/10.1111/bjh.15722
Journal Article Type | Article |
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Acceptance Date | Nov 5, 2018 |
Online Publication Date | Dec 13, 2018 |
Publication Date | Mar 1, 2019 |
Deposit Date | Dec 15, 2022 |
Journal | British Journal of Haematology |
Print ISSN | 0007-1048 |
Electronic ISSN | 1365-2141 |
Publisher | Wiley |
Peer Reviewed | Peer Reviewed |
Volume | 184 |
Issue | 6 |
Pages | 957-968 |
DOI | https://doi.org/10.1111/bjh.15722 |
Keywords | Hematology |
Public URL | https://nottingham-repository.worktribe.com/output/14322705 |
Publisher URL | https://onlinelibrary.wiley.com/doi/10.1111/bjh.15722 |