Predictive value of tumor necrosis factor (TNF)‎ alpha and its soluble receptors, among other factors for chemotherapy-induced neutropenia in non-Hodgkin’s lymphoma

Abstract EN

Objectives: Successive trials are going on to identify clinical and Laboratory parameters present at the time of first evaluation that could help to predict febrile neutropenia (FN) after the Is' course chemotherapy in non Hodgkin's Lymphoma (NHL).

This prospective study examined the value ofTNF-alpha and its soluble receptors P55 (RI) and P75 (RII).

patient age, performance status (PS), hemoglobin level (Hb) and platelet count (PC) in prediction of FN in NHL.

Patients: Twenty-six newly diagnosed patients (10m & 16f) with NHL with 10 healthy subjects as controls were studied Results: Before start of treatment, TNF alpha, RI and Rll levels were significantly higher in NHL patients compared to controls.

Patients with stages III and IV NHL (9 patients) had significantly higher TNF°c and RI and II compared to patients with stages 1 and II (17 patients).

Ten patients (38.5%) developed FN (Gla).

They hadpretreatment lower ages (P<0.001), lower performance status score (P<0.001), lower Hb level (P<0.001), lower PC (P<0.001), higher TNF alpha and RII (P= 0.007 & 0.02 respectively) compared to 16patients who did not develop FN (Gib).

Occurrence of FN showed positive correlation with TNF alpha level (r.

+0.63, P<0.001), RII level (+0.40, P<0.05) and showed negative correlations with PS score (r.-0.84, P<0.001), Hb level (r.-0.58, P<0.01), PC(r.-0.64, P<0.001) andpatient age (r.-0.72, P<0.001).

Conclusions: Elevated TNF alpha and RII levels, poor PS, decreased Hb level and decreased PC at the time of diagnosis of NHL predict the occurrence of FN after l" course of chemotherapy especially in young patients.

Future clinical trials for occurrence of FN in NHL should take into consideration all these variables.