Fischer Cheryl, Petriccione Mary, Vitolano Stephanie, Guarini Edith, Davis Mary Elizabeth, Dunkel Ira J
Departments of *Pediatrics †Nursing, Memorial Sloan Kettering Cancer Center ‡Department of Pediatrics, Weill Cornell Medical College, New York, NY.
J Pediatr Hematol Oncol. 2017 Oct;39(7):555-559. doi: 10.1097/MPH.0000000000000968.
Ophthalmic artery chemosurgery (OAC) is associated with grade 3 and 4 neutropenia, however the effect on T-cell number and function is unknown. The purpose of this retrospective review was to confirm that patients treated with OAC do not develop immunosuppression warranting Pneumocystis pneumonia prophylaxis.
IRB approval was obtained for a single center retrospective review of immune function tests in retinoblastoma patients who received OAC.
Twenty-three patients received ≥3 cycles of OAC and had immune function testing (absolute CD4 count) performed at a median of 34 days postcompletion of therapy (range, 15 to 63 d). Only 1 patient had a low absolute CD4 count of 189 cells/μL (normal, 359 to 1570 cells/μL) 2 and a half months after IV carboplatin and 28 days after their third dose of OAC. This patient was found to have coexisting hypogammaglobulinemia. Repeat immune function testing normalized through continued OAC treatment.
Clinically significant immune suppression appears rare following OAC alone, but patients previously treated with IV chemotherapy may be immunosuppressed and may benefit from pneumocystis pneumonia prophylaxis until the CD4 count recovers.
眼动脉化学手术（OAC）与3级和4级中性粒细胞减少有关，但其对T细胞数量和功能的影响尚不清楚。本回顾性研究的目的是确认接受OAC治疗的患者不会出现需要预防性使用肺孢子菌肺炎药物的免疫抑制情况。
获得机构审查委员会（IRB）批准，对接受OAC治疗的视网膜母细胞瘤患者的免疫功能测试进行单中心回顾性研究。
23例患者接受了≥3个周期的OAC治疗，并在治疗完成后中位34天（范围15至63天）进行了免疫功能测试（绝对CD4计数）。只有1例患者在静脉注射卡铂后2个半月以及第三次OAC给药后28天，绝对CD4计数低至189个细胞/μL（正常范围为359至1570个细胞/μL）。该患者同时存在低丙种球蛋白血症。通过持续的OAC治疗，重复免疫功能测试结果恢复正常。
单独使用OAC后出现具有临床意义的免疫抑制似乎很少见，但先前接受过静脉化疗的患者可能会出现免疫抑制，在CD4计数恢复之前，可能会从预防性使用肺孢子菌肺炎药物中获益。
