Nakayama Hirokazu, Iizuka Hiromitsu, Kato Toshiaki, Usuki Kensuke
Department of Pharmacy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan.
Department of Hematology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan.
J Pharm Health Care Sci. 2023 Jan 23;9(1):4. doi: 10.1186/s40780-022-00270-x.
Dasatinib, which is used to treat treating chronic myeloid leukemia, induces increases in blood lymphocytes during the treatment. In addition, neutrophil-lymphocyte count ratio (NLR) is associated with the related to development of chronic kidney disease (CKD). However, it has not been reported whether development of CKD during long-term dasatinib treatment is related to lymphocyte count or NLR. This study aimed to reveal the relationship between CKD and lymphocyte count or NLR during long-term dasatinib treatment.
A retrospective study was conducted in patients treated with dasatinib for 6 months or longer. Risk factors for CKD development were explored using multivariate analysis. Changes in maximal lymphocyte count and NLR over time were examined separately.
A total of 33 patients in CKD group (n = 8) and No CKD group (n = 25) who received dasatinib were enrolled. In univariate analysis, significant differences between the groups were observed in maximal lymphocyte count, lymphocytosis, age, and estimated glomerular filtration rate at baseline. As the factor independently associated with the development of CKD, maximal lymphocyte count (odds ratio 0.999, 95% confidence interval: 0.999-1.000, p = 0.033) was identified. In this analysis, age had borderline significance (odds ratio 1.073, 95% CI: 0.999-1.153, p = 0.054)]. After 6 months of dasatinib therapy, lymphocyte count was significantly lower in CKD group [median (range), 2184 (878‒3444)/μL] than in the No CKD group [3501 (966‒7888)/μL] (p = 0.020). However, no significant difference in lymphocyte count was observed between the groups at the last follow-up. During the study period, the median NLR in the No CKD group fluctuated between 1.11 and 1.42, and median NLR in CKD group was increased from 1.13 to 2.24 between after 6 months of dasatinib therapy and the last follow-up.
The development of CKD during dasatinib therapy was associated with lower maximal lymphocyte counts. In contrast, the higher levels of lymphocytes induced during dasatinib treatment may prevent CKD progression.
用于治疗慢性髓性白血病的达沙替尼在治疗期间会导致血液淋巴细胞增多。此外，中性粒细胞与淋巴细胞计数比值（NLR）与慢性肾脏病（CKD）的发生有关。然而，长期使用达沙替尼治疗期间CKD的发生是否与淋巴细胞计数或NLR相关尚未见报道。本研究旨在揭示长期使用达沙替尼治疗期间CKD与淋巴细胞计数或NLR之间的关系。
对接受达沙替尼治疗6个月或更长时间的患者进行回顾性研究。采用多因素分析探讨CKD发生的危险因素。分别检查最大淋巴细胞计数和NLR随时间的变化。
共纳入33例接受达沙替尼治疗的患者，分为CKD组（n = 8）和非CKD组（n = 25）。单因素分析显示，两组在最大淋巴细胞计数、淋巴细胞增多、年龄和基线估计肾小球滤过率方面存在显著差异。确定最大淋巴细胞计数（比值比0.999，95%置信区间：0.999 - 1.000，p = 0.033）是与CKD发生独立相关的因素。在此分析中，年龄具有临界显著性（比值比1.073，95%CI：0.999 - 1.153，p = 0.054）。达沙替尼治疗6个月后，CKD组的淋巴细胞计数[中位数（范围），2184（878 - 3444）/μL]显著低于非CKD组[3501（966 - 7888）/μL]（p = 0.020）。然而，在最后一次随访时，两组之间的淋巴细胞计数无显著差异。在研究期间，非CKD组的NLR中位数在1.11至1.42之间波动，CKD组的NLR中位数在达沙替尼治疗6个月后至最后一次随访期间从1.13增加至2.24。
达沙替尼治疗期间CKD的发生与较低的最大淋巴细胞计数有关。相反，达沙替尼治疗期间诱导的较高淋巴细胞水平可能会阻止CKD进展。
