Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma

Yuko Ishihara, Shun Ichi Kimura, Yu Akahoshi, Naonori Harada, Hirofumi Nakano, Kazuaki Kameda, Tomotaka Ugai, Hidenori Wada, Ryoko Yamasaki, Koji Kawamura, Kana Sakamoto, Masahiro Ashizawa, Miki Sato, Kiriko Terasako-Saito, Misato Kikuchi, Hideki Nakasone, Rie Yamazaki, Junya Kanda, Shinichi Kako, Aki TaniharaJunji Nishida, Kensuke Usuki, Yoshinobu Kanda

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: The D-index and the L-index, calculated as the area over the neutrophil and lymphocyte curves, respectively, reflect both the intensity and duration of cytopenia. We, retrospectively, investigated the impact of these indexes on pulmonary infection (PI) in induction chemotherapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). Methods: We included 92 patients (ALL 83, LBL 9) from two institutions. We calculated the D-index and cumulative D-index until the development of PI (c-D-index), which enables real-time risk assessment for infection. We also calculated the L-index (35), defined as the area over the lymphocyte curve during lymphopenia (<700/μl) until day 35 and the cumulative-L-index until the development of PI (c-L-index). Results: Eight patients developed PI on day 20 (median). Two patients were strongly suspected to have bacterial pneumonia, and the others were suspected to have pulmonary fungal infection. The D-index and the L-index (35) in patients with PI were higher than those in patients without PI (7230 ± 4734 vs. 4519 ± 3416, P = 0.041 and 15 458 ± 5243 vs. 8920 ± 5901, P = 0.018), while the c-D-index and the c-L-index were not significantly different. Although the c-L-index did not have predictive value for PI, c-D-index, when treated as a dichotomous variable with a cutoff value of 5589 as determined by a receiver operating characteristic curve analysis, showed a significant difference between two groups (P = 0.045). This association became clearer when we focused on suspected pulmonary fungal infection. Discussion and conclusion: In induction chemotherapy for ALL/LBL, c-D-index with a cutoff value of 5589 might have predictive value for the development of PI.

Original languageEnglish
Pages (from-to)19-25
Number of pages7
JournalHematology
Volume21
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1
Externally publishedYes

Fingerprint

Induction Chemotherapy
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Lung
Infection
Fungal Lung Diseases
Lymphocytes
Bacterial Pneumonia
Lymphopenia
ROC Curve
Neutrophils

Keywords

  • Acute lymphoblastic leukemia
  • D-index
  • L-index
  • Lymphoblastic lymphoma
  • Pulmonary infection

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma. / Ishihara, Yuko; Kimura, Shun Ichi; Akahoshi, Yu; Harada, Naonori; Nakano, Hirofumi; Kameda, Kazuaki; Ugai, Tomotaka; Wada, Hidenori; Yamasaki, Ryoko; Kawamura, Koji; Sakamoto, Kana; Ashizawa, Masahiro; Sato, Miki; Terasako-Saito, Kiriko; Kikuchi, Misato; Nakasone, Hideki; Yamazaki, Rie; Kanda, Junya; Kako, Shinichi; Tanihara, Aki; Nishida, Junji; Usuki, Kensuke; Kanda, Yoshinobu.

In: Hematology, Vol. 21, No. 1, 01.01.2016, p. 19-25.

Research output: Contribution to journalArticle

Ishihara, Y, Kimura, SI, Akahoshi, Y, Harada, N, Nakano, H, Kameda, K, Ugai, T, Wada, H, Yamasaki, R, Kawamura, K, Sakamoto, K, Ashizawa, M, Sato, M, Terasako-Saito, K, Kikuchi, M, Nakasone, H, Yamazaki, R, Kanda, J, Kako, S, Tanihara, A, Nishida, J, Usuki, K & Kanda, Y 2016, 'Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma', Hematology, vol. 21, no. 1, pp. 19-25. https://doi.org/10.1179/1607845415Y.0000000051
Ishihara, Yuko ; Kimura, Shun Ichi ; Akahoshi, Yu ; Harada, Naonori ; Nakano, Hirofumi ; Kameda, Kazuaki ; Ugai, Tomotaka ; Wada, Hidenori ; Yamasaki, Ryoko ; Kawamura, Koji ; Sakamoto, Kana ; Ashizawa, Masahiro ; Sato, Miki ; Terasako-Saito, Kiriko ; Kikuchi, Misato ; Nakasone, Hideki ; Yamazaki, Rie ; Kanda, Junya ; Kako, Shinichi ; Tanihara, Aki ; Nishida, Junji ; Usuki, Kensuke ; Kanda, Yoshinobu. / Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma. In: Hematology. 2016 ; Vol. 21, No. 1. pp. 19-25.
@article{97e5a9270e8045519cebb46f4febee91,
title = "Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma",
abstract = "Objectives: The D-index and the L-index, calculated as the area over the neutrophil and lymphocyte curves, respectively, reflect both the intensity and duration of cytopenia. We, retrospectively, investigated the impact of these indexes on pulmonary infection (PI) in induction chemotherapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). Methods: We included 92 patients (ALL 83, LBL 9) from two institutions. We calculated the D-index and cumulative D-index until the development of PI (c-D-index), which enables real-time risk assessment for infection. We also calculated the L-index (35), defined as the area over the lymphocyte curve during lymphopenia (<700/μl) until day 35 and the cumulative-L-index until the development of PI (c-L-index). Results: Eight patients developed PI on day 20 (median). Two patients were strongly suspected to have bacterial pneumonia, and the others were suspected to have pulmonary fungal infection. The D-index and the L-index (35) in patients with PI were higher than those in patients without PI (7230 ± 4734 vs. 4519 ± 3416, P = 0.041 and 15 458 ± 5243 vs. 8920 ± 5901, P = 0.018), while the c-D-index and the c-L-index were not significantly different. Although the c-L-index did not have predictive value for PI, c-D-index, when treated as a dichotomous variable with a cutoff value of 5589 as determined by a receiver operating characteristic curve analysis, showed a significant difference between two groups (P = 0.045). This association became clearer when we focused on suspected pulmonary fungal infection. Discussion and conclusion: In induction chemotherapy for ALL/LBL, c-D-index with a cutoff value of 5589 might have predictive value for the development of PI.",
keywords = "Acute lymphoblastic leukemia, D-index, L-index, Lymphoblastic lymphoma, Pulmonary infection",
author = "Yuko Ishihara and Kimura, {Shun Ichi} and Yu Akahoshi and Naonori Harada and Hirofumi Nakano and Kazuaki Kameda and Tomotaka Ugai and Hidenori Wada and Ryoko Yamasaki and Koji Kawamura and Kana Sakamoto and Masahiro Ashizawa and Miki Sato and Kiriko Terasako-Saito and Misato Kikuchi and Hideki Nakasone and Rie Yamazaki and Junya Kanda and Shinichi Kako and Aki Tanihara and Junji Nishida and Kensuke Usuki and Yoshinobu Kanda",
year = "2016",
month = "1",
day = "1",
doi = "10.1179/1607845415Y.0000000051",
language = "English",
volume = "21",
pages = "19--25",
journal = "Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program",
issn = "1520-4391",
publisher = "American Society of Hematology",
number = "1",

}

TY - JOUR

T1 - Impact of D-index and L-index on pulmonary infection in induction chemotherapy for acute lymphoblastic leukemia and lymphoblastic lymphoma

AU - Ishihara, Yuko

AU - Kimura, Shun Ichi

AU - Akahoshi, Yu

AU - Harada, Naonori

AU - Nakano, Hirofumi

AU - Kameda, Kazuaki

AU - Ugai, Tomotaka

AU - Wada, Hidenori

AU - Yamasaki, Ryoko

AU - Kawamura, Koji

AU - Sakamoto, Kana

AU - Ashizawa, Masahiro

AU - Sato, Miki

AU - Terasako-Saito, Kiriko

AU - Kikuchi, Misato

AU - Nakasone, Hideki

AU - Yamazaki, Rie

AU - Kanda, Junya

AU - Kako, Shinichi

AU - Tanihara, Aki

AU - Nishida, Junji

AU - Usuki, Kensuke

AU - Kanda, Yoshinobu

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objectives: The D-index and the L-index, calculated as the area over the neutrophil and lymphocyte curves, respectively, reflect both the intensity and duration of cytopenia. We, retrospectively, investigated the impact of these indexes on pulmonary infection (PI) in induction chemotherapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). Methods: We included 92 patients (ALL 83, LBL 9) from two institutions. We calculated the D-index and cumulative D-index until the development of PI (c-D-index), which enables real-time risk assessment for infection. We also calculated the L-index (35), defined as the area over the lymphocyte curve during lymphopenia (<700/μl) until day 35 and the cumulative-L-index until the development of PI (c-L-index). Results: Eight patients developed PI on day 20 (median). Two patients were strongly suspected to have bacterial pneumonia, and the others were suspected to have pulmonary fungal infection. The D-index and the L-index (35) in patients with PI were higher than those in patients without PI (7230 ± 4734 vs. 4519 ± 3416, P = 0.041 and 15 458 ± 5243 vs. 8920 ± 5901, P = 0.018), while the c-D-index and the c-L-index were not significantly different. Although the c-L-index did not have predictive value for PI, c-D-index, when treated as a dichotomous variable with a cutoff value of 5589 as determined by a receiver operating characteristic curve analysis, showed a significant difference between two groups (P = 0.045). This association became clearer when we focused on suspected pulmonary fungal infection. Discussion and conclusion: In induction chemotherapy for ALL/LBL, c-D-index with a cutoff value of 5589 might have predictive value for the development of PI.

AB - Objectives: The D-index and the L-index, calculated as the area over the neutrophil and lymphocyte curves, respectively, reflect both the intensity and duration of cytopenia. We, retrospectively, investigated the impact of these indexes on pulmonary infection (PI) in induction chemotherapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). Methods: We included 92 patients (ALL 83, LBL 9) from two institutions. We calculated the D-index and cumulative D-index until the development of PI (c-D-index), which enables real-time risk assessment for infection. We also calculated the L-index (35), defined as the area over the lymphocyte curve during lymphopenia (<700/μl) until day 35 and the cumulative-L-index until the development of PI (c-L-index). Results: Eight patients developed PI on day 20 (median). Two patients were strongly suspected to have bacterial pneumonia, and the others were suspected to have pulmonary fungal infection. The D-index and the L-index (35) in patients with PI were higher than those in patients without PI (7230 ± 4734 vs. 4519 ± 3416, P = 0.041 and 15 458 ± 5243 vs. 8920 ± 5901, P = 0.018), while the c-D-index and the c-L-index were not significantly different. Although the c-L-index did not have predictive value for PI, c-D-index, when treated as a dichotomous variable with a cutoff value of 5589 as determined by a receiver operating characteristic curve analysis, showed a significant difference between two groups (P = 0.045). This association became clearer when we focused on suspected pulmonary fungal infection. Discussion and conclusion: In induction chemotherapy for ALL/LBL, c-D-index with a cutoff value of 5589 might have predictive value for the development of PI.

KW - Acute lymphoblastic leukemia

KW - D-index

KW - L-index

KW - Lymphoblastic lymphoma

KW - Pulmonary infection

UR - http://www.scopus.com/inward/record.url?scp=85012039851&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012039851&partnerID=8YFLogxK

U2 - 10.1179/1607845415Y.0000000051

DO - 10.1179/1607845415Y.0000000051

M3 - Article

C2 - 26352559

AN - SCOPUS:85012039851

VL - 21

SP - 19

EP - 25

JO - Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program

JF - Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program

SN - 1520-4391

IS - 1

ER -