Kemoterapi Alan Lenfopenik Malign Hastalarda Herpes Viridea ve Parvovirus B19 Sıklıklarının Araştırılması

Yıl 2024, Cilt: 17 Sayı: 3, 159 - 165, 30.12.2024

Adil Furkan Kılıç , Salim Başol Tekin

https://doi.org/10.52976/vansaglik.1547450

Öz

Giriş/Amaç: Bu çalışmada kliniğimizde kemoterapi alan kanser tanısı almış hastalarda Epstein-Barr virüsü (EBV), Herpes simpleks virüsü (HSV), Sitomegalovirüs (CMV) ve Parvovirüs B19 viral enfeksiyonlarının sıklığını araştırmayı amaçladık. Yöntemler: Bu çalışmada Nisan 2018 - Temmuz 2018 tarihleri ​​arasında Tıbbi Onkoloji Kliniği'nde yatarak kemoterapi alan 138 lenfopenik hasta prospektif olarak değerlendirildi. Çalışmaya dahil edilen hastaların kanser tanıları akciğer, özofagus, prostat, meme, pankreas, kolorektal, mide, beyin ve sinir sistemi, over ve diğerleri (Ewing sarkomu, hepatoselüler karsinom, larinks karsinomu, mesane karsinomu, malign mezenkimal tümör, multipl miyelom, primeri bilinmeyen lenfoma, primeri bilinmeyen metastatik karsinom, renal hücreli karsinom, servikal karsinom, testis karsinomu) kanserleriydi. Hastalar çeşitli kanser evrelerindeydi, çeşitli histolojik alt tiplere sahipti ve çeşitli kemoterapiler almaktaydı. Serum örneklerinde EBV, HSV, CMV ve Parvovirus B19'un % sıklığı belirlendi. Bulgular: Hastaların ortalama yaşı 58,93 ± 13,28 yıl, ortalama tanı süresi 2,0 ± 2,2 yıldı. EBV PCR pozitifliği 9 hastada (%6,5), CMV PCR pozitifliği 12 hastada (%8,7) ve EBV ve CMV (birlikte) PCR pozitifliği 1 hastada (%0,7) saptandı. Hiçbir hastada HSV ve parvovirus B19 PCR pozitifliği saptanmadı. Sağkalım analizi sonuçlarına göre tüm lenfopenik hastalarda ortalama sağkalım süresi 3,71 ay olarak bulundu. Tüm lenfopenik hastaların %65,21'inin lenfopeni tanısı konulduktan sonraki 12 ay içinde öldüğü görüldü.
Sonuçlar: Çalışmamızın sonucunda kemoterapi alan tüm lenfopenik hastalarda EBV ve CMV PCR pozitifliği oranları belirlendi (%6,5 ve %8,7). HSV ve parvovirüs B19 insidansını belirlemek için daha kapsamlı çalışmalara ihtiyaç vardır. Ayrıca kemoterapi alan lenfopenik hastalar viral enfeksiyonlar açısından hekimler tarafından takip edilmeli ve enfeksiyonun erken evrelerinde antiviral tedavi uygulanmalıdır.

Anahtar Kelimeler

CMV, EBV, HSV, Lymphopenia, Parvovirus B19

Etik Beyan

Ethics committee approval was obtained from the local ethics committee with the decision dated 15.02.2018, reference number 02-51.

Investigation of Herpes Viridea and Parvovirus B19 Frequencies in Lymphopenic Malignant Patients Receiving Chemotherapy

Öz

Background/Aims: In this study, we aimed to investigate the incidence of Epstein-Barr virus (EBV), Herpes simplex virus (HSV), Cytomegalovirus (CMV) and Parvovirus B19 viral infections in patients diagnosed with cancer receiving chemotherapy in our clinic.
Methods: In this study, 138 lymphopenic patients who were hospitalized and received chemotherapy at Medical Oncology Clinic between April 2018 and July 2018 were evaluated prospectively. Cancer diagnoses of the patients included in the study were lung, esophagus, prostate, breast, pancreatic, colorectal, stomach, brain and nervous system, ovarian and others (ewing sarcoma, hepatocellular carcinoma, larynx carcinoma, bladder carcinoma, malignant mesenchymal tumor, multiple myeloma, primary unknown lymphoma, metastatic carcinoma of unknown primary, renal cell carcinoma, cervical carcinoma, testicular carcinoma) cancers. The patients were at various stages of cancer, had various histological subtypes, and were receiving various chemotherapies. The % frequency of EBV, HSV, CMV and Parvovirus B19 in serum samples were determined.
Results: The mean age of the patients was 58.93 ± 13.28 years, and the mean duration of diagnosis was 2,0 ± 2,2 years. EBV PCR positivity was detected in 9 patients (6.5%), CMV PCR positivity in 12 patients (8.7%), and EBV and CMV (together) PCR positivity in 1 (0,7%) patient. HSV and parvovirus B19 PCR positivitys were not determined in any patients. According to the results of the survival analysis, the average survival time in all lymphopenic patients was 3.71 months. It was observed that 65.21% of all lymphopenic patients die within 12 months following lymphopenia diagnosis.
Conclusions: As a result of our study, EBV and CMV PCR positivity rates were determined in all lymphopenic patients receiving chemotherapy (6.5% and 8.7%, respectively). More comprehensive studies are needed to determine the incidence of HSV and parvovirus B19. In addition, lymphopenic patients receiving chemotherapy should be followed up by physicians for viral infections and treated with antiviral therapy in the early stages of infection.

Anahtar Kelimeler

CMV, EBV, HSV, Lymphopenia, Parvovirus B19

Kaynakça

• Abou Dagher G, El Khuri C, Chehadeh AA, Chami A, Bachir R, Zebian D, et al. (2017). Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon. BMJ Open, 7, e013502.
• Anitei MG, Zeitoun G, Mlecnik B, Marliot F, Haicheur N, Todosi AM, et al. (2014). Prognostic and predictive values of the immunoscore in patients with rectal cancer. Clinical Cancer Research, 20(7), 1891–1899.
• Boeckh M, Leisenring W, Riddell SR, Bowden RA, Huang ML, Myerson D, et al. (2003). Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: Importance of viral load and T-cell immunity. Blood, 101(2), 407–414.
• Campian JL, Ye X, Brock M, Grossman SA. (2013). Treatment-related lymphopenia in patients with stage III non-small-cell lung cancer. Cancer Investigation, 31(3), 183–188.
• Colugnati FA, Staras SA, Dollard SC, Cannon MJ. (2007). Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infectious Diseases, 7, 71.
• Dahlin AM, Henriksson ML, Van Guelpen B, Stenling R, Oberg A, Rutegård J, et al. (2011). Colorectal cancer prognosis depends on T-cell infiltration and molecular characteristics of the tumor. Modern Pathology, 24(5), 671–682.
• de Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, et al. (2012). Global burden of cancers attributable to infections in 2008: A review and synthetic analysis. Lancet Oncology, 13(6), 607–615.
• Fleisher TA, Oliveira JB. (2004). Functional and molecular evaluation of lymphocytes. Journal of Allergy and Clinical Immunology, 114(1), 227–234; quiz 235.
• Galon J, Angell HK, Bedognetti D, Marincola FM. (2013). The continuum of cancer immunosurveillance: Prognostic, predictive, and mechanistic signatures. Immunity, 39(1), 11–26.
• Jehn U. (1988). Managing fungal and viral infection in the immunocompromised host. Recent Results in Cancer Research, 108, 61–70.
• Johnson RA, Roodman GD. (1989). Hematologic manifestations of malignancy. Disease-a-Month, 35(11), 721–768.
• Kitayama J, Yasuda K, Kawai K, Sunami E, Nagawa H. (2010). Circulating lymphocyte number has a positive association with tumor response in neoadjuvant chemoradiotherapy for advanced rectal cancer. Radiation Oncology, 5, 47.
• Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheidt D, Hentrich M, et al. (2019). Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Annals of Hematology, 98(5), 1051–1069.
• Kroese TE, Jairam J, Ruurda JP, Lin SH, Mohan R, Mook S, et al. (2021). Severe lymphopenia acquired during chemoradiotherapy for esophageal cancer: Incidence and external validation of a prediction model. Radiotherapy and Oncology, 163, 192–198.
• Lissoni P, Brivio F, Fumagalli L, Messina G, Ghezzi V, Frontini L, et al. (2004). Efficacy of cancer chemotherapy in relation to the pretreatment number of lymphocytes in patients with metastatic solid tumors. International Journal of Biological Markers, 19(2), 135–140.
• Miyoshi Y, Yoshimura Y, Saito K, Muramoto K, Sugawara M, Alexis K, et al. (2020). High absolute lymphocyte counts are associated with longer overall survival in patients with metastatic breast cancer treated with eribulin-but not with treatment of physician's choice-in the EMBRACE study. Breast Cancer, 27(4), 706–715.
• Oliveira JB, Fleisher TA. (2010). Laboratory evaluation of primary immunodeficiencies. Journal of Allergy and Clinical Immunology, 125(2), S297–305.
• Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. (2016). Global burden of cancers attributable to infections in 2012: A synthetic analysis. Lancet Global Health, 4(9), e609–616. Stowell JD, Forlin-Passoni D, Din E, Radford K, Brown D, White A, et al. (2012). Cytomegalovirus survival on common environmental surfaces: Opportunities for viral transmission. Journal of Infectious Diseases, 205(2), 211–214.
• Sylwester AW, Mitchell BL, Edgar JB, Taormina C, Pelte C, Ruchti F, et al. (2005). Broadly targeted human cytomegalovirus-specific CD4+ and CD8+ T cells dominate the memory compartments of exposed subjects. Journal of Experimental Medicine, 202(5), 673–685.
• Yahav D, Gafter-Gvili A, Muchtar E, Skalsky K, Kariv G, Yeshurun M, et al. (2009). Antiviral prophylaxis in haematological patients: Systematic review and meta-analysis. European Journal of Cancer, 45(18), 3131–3148.
• Zaorsky NG, Churilla TM, Egleston BL, Fisher SG, Ridge JA, Horwitz EM, et al. (2017). Causes of death among cancer patients. Annals of Oncology, 28(2), 400–407.