RESUMEN
The hepatic artery resistance index (HARI) reflects portal venous blood pressure and resistance in several diseases of the liver. This study investigated whether preconditioning HARI values would predict hepatic complications such as hepatic graft-vs-host disease (GvHD), veno-occlusive disease, and drug- and sepsis-related hepatotoxicity after allogeneic stem cell transplantation (SCT). Fifty-nine patients who underwent allogeneic SCT were studied to determine whether pre-SCT HARI would predict post-SCT hepatic complications. Twenty-six patients (44.1%) had high HARI values (≥0.74) before allogeneic SCT. At univariate analysis, a high HARI value correlated with incidence of hepatic GvHD. Multivariate analysis revealed that a nonmyeloablative regimen (P = .009; hazard ratio [HR], 4.05), infused CD34-positive cell dosage (P = .01; HR, 3.32), and high HARI (P = .02; HR, 2.82) were independent predictors. However, a high HARI did not correlate with nonrelapsed mortality and overall survival. In conclusion, it seems that a high HARI before SCT might be an important predictor of significant hepatic GvHD in patients after allogeneic SCT.
Asunto(s)
Enfermedad Injerto contra Huésped/diagnóstico por imagen , Arteria Hepática/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Trasplante de Células Madre/efectos adversos , Ultrasonografía Doppler , Resistencia Vascular , Adolescente , Adulto , Femenino , Enfermedad Injerto contra Huésped/etiología , Enfermedad Injerto contra Huésped/mortalidad , Enfermedad Injerto contra Huésped/fisiopatología , Arteria Hepática/fisiopatología , Humanos , Estimación de Kaplan-Meier , Corea (Geográfico) , Hepatopatías/etiología , Hepatopatías/mortalidad , Hepatopatías/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Trasplante de Células Madre/mortalidad , Factores de Tiempo , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Leucemia Linfocítica Crónica de Células B/diagnóstico , Bazo/patología , Biomarcadores de Tumor/análisis , Progresión de la Enfermedad , Estudios de Seguimiento , Humanos , Leucemia Linfocítica Crónica de Células B/mortalidad , Leucemia Linfocítica Crónica de Células B/patología , Tamaño de los Órganos , Pronóstico , Bazo/diagnóstico por imagen , Análisis de Supervivencia , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Rituximab has dramatic impact on outcome of patients with diffuse large B-cell lymphoma (DLBCL), especially nongerminal center (non-GC) type. A low absolute lymphocyte count (ALC) before rituximab, cyclophosphamide, vincristine, adriamycin, and prednisone (R-CHOP) therapy as a surrogate marker of immune status is associated with poor clinical outcome in DLBCL. Therefore, we hypothesized that low ALC before R-CHOP would have effect on the survival in non-GC type. PATIENTS AND METHODS: One hundred and thirty-six DLBCL patients who were treated with R-CHOP from 2003 to 2007 were analyzed in the present study. RESULTS: ALC > or = 1.0 x 10(9)/l predicted a longer 3-year progression-free survival (PFS) and 3-year overall survival (OS) versus ALC <1.0 x 10(9)/l (82.6% versus 60.0%, P = 0.005 and 87.2% versus 62.0%, P < 0.001, respectively). Non-GC type had similar PFS and OS to germinal center type (68.2% versus 80.0%, P = 0.074 and 72.7% versus 82.9%, P = 0.111, respectively). However, considering clinical influence of the ALC according to immunophenotype, low ALC in non-GC type DLBCL was associated with lower PFS and OS compared with others (PFS, P = 0.002; OS, P < 0.001). Multivariate analysis revealed that low ALC in non-GC type had lower PFS [hazard ratio (HR) = 3.324, P = 0.001] and OS (HR = 4.318, P < 0.001), independent of international prognostic index. CONCLUSION: A low ALC in non-GC type DLBCL counteracted the beneficial effect of rituximab on survival.