title: Low absolute lymphocyte count and addition of rituximab confer high risk for interstitial pneumonia in patients with diffuse large B-cell lymphoma.
abstract: Several small-scale studies have reported pulmonary toxicity among patients with diffuse large B-cell lymphoma (DLBCL) receiving rituximab-containing chemotherapy, though whether the use of rituximab predisposes to interstitial pneumonia (IP) remains unclear. This retrospective study was intended to identify the characteristics and risk factors of IP in patients with DLBCL. Between 2000 and 2009, 529 consecutive patients with DLBCL receiving first-line tri-weekly COP- or CHOP-based chemotherapy with or without rituximab were enrolled as subjects. IP was defined as diffuse pulmonary interstitial infiltrates found on computed tomography scans in conjunction with respiratory symptoms. IP was observed in 26 patients (4.9%), six of whom were confirmed with Pneumocystis jirovecii pneumonia. The median number of chemotherapy courses before IP was four cycles. Using multivariate analysis, absolute lymphocyte count less than 1×10(9)/l at diagnosis [odds ratio (OR) 2.75, p=0.014] and the addition of rituximab to chemotherapy (OR 4.56, p=0.003) were identified as independent risk factors for IP. In conclusion, the incidence of IP is increased in patients with DLBCL receiving rituximab-containing chemotherapy. Specific subgroups with lymphopenia at diagnosis may justify close scrutiny to detect pulmonary complications.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, No. 201 Sec. 2 Shipai Road, Taipei, Taiwan, Republic of China.
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Huang
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Jih-Tung
authors.initials: JT
authors.lastname: Pai
authors.forename: Ying-Chung
authors.initials: YC
authors.lastname: Hong
authors.forename: Hao-Wei
authors.initials: HW
authors.lastname: Teng
authors.forename: Liang-Tsai
authors.initials: LT
authors.lastname: Hsiao
authors.forename: Ta-Chung
authors.initials: TC
authors.lastname: Chao
authors.forename: Jyh-Pyng
authors.initials: JP
authors.lastname: Gau
authors.forename: Jin-Hwang
authors.initials: JH
authors.lastname: Liu
authors.forename: Hui-Chi
authors.initials: HC
authors.lastname: Hsu
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chen
authors.forename: Yuan-Bin
authors.initials: YB
authors.lastname: Yu
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D004198:Disease Susceptibility / Q000139:chemically induced; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D018655:Lymphocyte Count; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008231:Lymphopenia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016019:Survival Analysis
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab