Multiple blood parameters may serve as a warning to immunochemotherapy-related interstitial lung disease in b-cell lymphoma

Abstract

Background: The main aim of this study was to determine some simple but meaningful parameters that indicate immunochemotherapy-related interstitial lung disease (ILD) early in B-cell lymphoma and provide direction to hematologists. Methods: The clinical and laboratory characteristics, the treatments and outcomes of 21 B-cell lymphoma patients with ILD who underwent rituximab (RTX)-based immunochemotherapy were collected and retrospectively analyzed. Results: More cycles of immunochemotherapy and higher cumulative doses of RTX and doxorubicin hydrochloride liposome conferred a high risk of ILD. Compared to the baseline, patients had a significantly lower white blood cell count (WBC), absolute lymphocyte count (ALC), and albumin level (4.95×109 vs. 6.32×109, 0.71×109 vs. 1.61×109, 34.1 vs. 40.4 g/L; P<0.05), and higher C-reactive protein (CRP), alpha-hydroxybutyrate dehydrogenase (α-HBDH), and lactate dehydrogenase (LDH) (15.36 vs. 7.00 mg/L, 293.0 vs. 163.1 U/L, 361.8 vs. 231.1 U/L; P<0.05) levels at ILD onset. Further, a positive correlation was found between early glucocorticosteroid intervention and the good prognostication of ILD. In addition, an analysis of the prognoses of 2 cases of patients with pneumocystis pneumonia (PCP) infection indicated that after 3 cycles of treatment, patients, especially unfit patients or those who have received ILD glucocorticoid treatment, may need to receive trimethoprim/sulfamethoxazole (TMP/SMX) to prevent PCP. Conclusions: There was a relationship between variations of blood parameters and the occurrence of ILD which might serve as a warning for B-cell lymphoma patients with immunochemotherapy-related ILD.