RESUMO
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.
Assuntos
Doença Enxerto-Hospedeiro/diagnóstico por imagem , Artéria Hepática/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Transplante de Células-Tronco/efeitos adversos , Ultrassonografia Doppler , Resistência Vascular , Adolescente , Adulto , Feminino , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/mortalidade , Doença Enxerto-Hospedeiro/fisiopatologia , Artéria Hepática/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Coreia (Geográfico) , Hepatopatias/etiologia , Hepatopatias/mortalidade , Hepatopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco , Transplante de Células-Tronco/mortalidade , Fatores de Tempo , Transplante Homólogo , Resultado do Tratamento , Adulto JovemAssuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Baço/patologia , Biomarcadores Tumorais/análise , Progressão da Doença , Seguimentos , Humanos , Leucemia Linfocítica Crônica de Células B/mortalidade , Leucemia Linfocítica Crônica de Células B/patologia , Tamanho do Órgão , Prognóstico , Baço/diagnóstico por imagem , Análise de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
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.
