Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma.
OBJECTIVE
The D-index and the L-index, calculated as the area over the neutrophil and lymphocyte curves, respectively, reflect both the intensity and duration of cytopenia. We, retrospectively, investigated the impact of these indexes on pulmonary infection (PI) in induction chemotherapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL).


METHODS
We included 92 patients (ALL 83, LBL 9) from two institutions. We calculated the D-index and cumulative D-index until the development of PI (c-D-index), which enables real-time risk assessment for infection. We also calculated the L-index (35), defined as the area over the lymphocyte curve during lymphopenia (<700/µl) until day 35 and the cumulative-L-index until the development of PI (c-L-index).


RESULTS
Eight patients developed PI on day 20 (median). Two patients were strongly suspected to have bacterial pneumonia, and the others were suspected to have pulmonary fungal infection. The D-index and the L-index (35) in patients with PI were higher than those in patients without PI (7230 ± 4734 vs. 4519 ± 3416, P = 0.041 and 15 458 ± 5243 vs. 8920 ± 5901, P = 0.018), while the c-D-index and the c-L-index were not significantly different. Although the c-L-index did not have predictive value for PI, c-D-index, when treated as a dichotomous variable with a cutoff value of 5589 as determined by a receiver operating characteristic curve analysis, showed a significant difference between two groups (P = 0.045). This association became clearer when we focused on suspected pulmonary fungal infection.


CONCLUSIONS
In induction chemotherapy for ALL/LBL, c-D-index with a cutoff value of 5589 might have predictive value for the development of PI.
Yuko
Y
Ishihara
Shun-ichi
S
Kimura
Yu
Y
Akahoshi
Naonori
N
Harada
Hirofumi
H
Nakano
Kazuaki
K
Kameda
Tomotaka
T
Ugai
Hidenori
H
Wada
Ryoko
R
Yamasaki
Koji
K
Kawamura
Kana
K
Sakamoto
Masahiro
M
Ashizawa
Miki
M
Sato
Kiriko
K
Terasako-Saito
Misato
M
Kikuchi
Hideki
H
Nakasone
Rie
R
Yamazaki
Junya
J
Kanda
Shinichi
S
Kako
Aki
A
Tanihara
Junji
J
Nishida
Kensuke
K
Usuki
Yoshinobu
Y
Kanda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects* / Q000379:methods; D007958:Leukocyte Count; D008168:Lung / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D008214:Lymphocytes / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies
Acute lymphoblastic leukemia; D-index; L-index; Lymphoblastic lymphoma; Pulmonary infection