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Lymphocyte depletion during treatment with intensive chemotherapy for
cancer
CL Mackall, TA Fleisher, MR Brown, IT Magrath, AT Shad, ME Horowitz, LH Wexler, MA Adde, LL McClure and RE Gress
Experimental Immunology Branch, National Cancer Institute, National
Institutes of Health, Bethesda, MD 20892.
Recently we have observed an increased incidence of opportunistic
infections in patients treated with intensive chemotherapy for cancer.
Because T-cell depletion is associated with similar clinical events in
human immunodeficiency virus infection and after bone marrow
transplantation, we have analyzed peripheral blood lymphocyte populations
in a series of patients during treatment with intensive chemotherapy for
cancer. Although neutrophil, monocyte, and platelet numbers consistently
recovered to greater than 50% of pretreatment values after each sequential
cycle of therapy, lymphocyte numbers did not recover within the same time
period. B cells decreased rapidly from a mean value of 149 +/- 46/mm3
before chemotherapy to 4 +/- 1/mm3 during chemotherapy (P = .01). CD4+ T
cells decreased from a mean of 588 +/- 76/mm3 before chemotherapy to 105
+/- 28/mm3 during chemotherapy (P = .0002) and CD8+ T cells decreased from
a mean of 382 +/- 41/mm3 before chemotherapy to 150 +/- 46/mm3 during
chemotherapy (P = .0009). Natural killer cell numbers did not show
significant declines (171 +/- 30/mm3 before, 114 +/- 24/mm3 during, P =
.19). Based on the history of opportunistic complications in patients with
other disorders who display similar degrees of CD4+ T-cell lymphopenia and
preliminary observations in this population, immune incompetence could
surface as a dose-limiting toxicity for highly dose-intensive chemotherapy
regimens.
Volume 84,
Issue 7,
pp. 2221-2228,
10/01/1994
Copyright © 1994 by The American Society of Hematology
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