Hemostatic abnormalities and leukocyte activation caused by infection in patients with malignant lymphoma during chemotherapy.
Hemostatic parameters were examined before and during 102 courses of chemotherapy in 42 patients with malignant lymphoma with high risk for infection. The white blood cell count was significantly reduced in all patients at days 1 and 3, but significantly increased at days 7 and 9, compared to before chemotherapy. At day 7 of chemotherapy, tissue factor (TF) mRNA levels in leukocytes were significantly increased in all patients, especially those with infection. Plasma concentrations of granulocyte elastase derived-XDP (GE-XDP) levels correlated with D-dimer levels during chemotherapy in patients with malignant lymphoma, suggesting that the elevated D-dimer is fibrin products degraded by granulocyte elastase. GE-XDP, C-reactive protein (CRP), GE-XDP and D-dimer were significantly higher in patients with infection, disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS) than those without. In patients with DIC or ARDS, TF mRNA correlated with D-dimer, and GE-XDP correlated with leukocyte count, CRP and D-dimer, suggesting that inflammatory changes due to thrombosis may cause the activation of leukocytes in patients with malignant lymphoma during chemotherapy. Activated leukocytes and granulocyte elastase may elicit a hypercoagulable state and ARDS in patients with malignant lymphoma during chemotherapy.
Kamikura
Yuko
Y
Second Department of Internal Medicine, Mie University Hospital, Tsu, Japan.
Wada
Hideo
H
Sase
Tomohiro
T
Yamaguchi
Motoko
M
Kaneko
Toshihiro
T
Sakaguchi
Akane
A
Abe
Yasunori
Y
Nishioka
Junji
J
Nobori
Tsutomu
T
Shiku
Hiroshi
H
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D005260:Female; D005337:Fibrin / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D007239:Infections; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000097:blood; D007962:Leukocytes / Q000502:physiology*; D008223:Lymphoma / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012333:RNA, Messenger / Q000032:analysis; D012128:Respiratory Distress Syndrome / Q000150:complications; D013925:Thromboplastin / Q000032:analysis; D013997:Time Factors
D000970:Antineoplastic Agents; D005338:Fibrin Fibrinogen Degradation Products; D012333:RNA, Messenger; C036309:fibrin fragment D; D005337:Fibrin; D005340:Fibrinogen; D002097:C-Reactive Protein; D013925:Thromboplastin; D019272:Leukocyte Elastase