Influence of R-CHOP Therapy on Immune System Restoration in Patients with B-Cell Lymphoma

Oncology. 2016;91(6):302-310. doi: 10.1159/000449251. Epub 2016 Sep 29.

Abstract

Objective: To assess the immunosuppressive effect of R-CHOP in patients with B-cell lymphoma at 2 years.

Methods: Parameters of humoral and cell-mediated immunity were assessed in 89 patients with diffuse large B-cell lymphoma or follicular lymphoma before and after 6-8 cycles of R-CHOP-14 or R-CHOP-21 regimen.

Results: Data on pre- and posttreatment serum IgG (sIgG) levels were available for all 89 patients, while the corresponding data on serum CD20+, CD3+, CD4+, and CD8+ lymphocyte counts were available in only 43. Median sIgG levels significantly decreased from 1,221 mg/dl (baseline) to 733 mg/dl (after chemotherapy) (p < 0.001). Although CD20+ and CD4+ cell counts decreased (p < 0.001), no significant effect of chemotherapy on CD3+ and CD8+ cell counts was observed. CD20+ cell counts were restored to baseline levels at the 12-month follow-up. sIgG levels and CD4+ cell counts were not completely restored at 24 months, indicating a sustained immunosuppressive effect of R-CHOP in these patients. The incidence of infections over the 2-year period was 16.3-23.6%.

Conclusion: The immunosuppressive effect of R-CHOP in newly diagnosed cases of B-cell lymphoma tends to persist for >2 years, although sIgG levels were restored more quickly than CD4+ cell counts.

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage
  • Antigens, CD20 / analysis
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / immunology*
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology*
  • CD3 Complex / analysis
  • CD4 Lymphocyte Count
  • CD8-Positive T-Lymphocytes / drug effects
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • Humans
  • Immunoglobulin G / blood
  • Immunoglobulin G / drug effects*
  • Immunosuppression Therapy / adverse effects
  • Infections / chemically induced
  • Lymphoma, B-Cell / drug therapy*
  • Male
  • Middle Aged
  • Prednisone / administration & dosage
  • Rituximab / administration & dosage
  • T-Lymphocytes / chemistry
  • T-Lymphocytes / drug effects*
  • Time Factors
  • Vincristine / administration & dosage

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antigens, CD20
  • CD3 Complex
  • Immunoglobulin G
  • R-CHOP protocol
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone