Severe cytopenia during adjuvant chemotherapy for early breast cancer in a patient with idiopathic CD4+ lymphocytopenia

Mimura,Kaito; Shimomura,Akihiko; Watanabe,Koji; Koda,Hanako; Nakayama,Kanako; Kitagawa,Dai; Shimizu,Chikako

doi:10.3892/ol.2023.13943

August-2023 Volume 26 Issue 2

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

August-2023 Volume 26 Issue 2

Full Size Image

Case Report Open Access

Severe cytopenia during adjuvant chemotherapy for early breast cancer in a patient with idiopathic CD4+ lymphocytopenia

Authors:
- Kaito Mimura
- Akihiko Shimomura
- Koji Watanabe
- Hanako Koda
- Kanako Nakayama
- Dai Kitagawa
- Chikako Shimizu
View Affiliations / Copyright

Affiliations: Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo 162‑8655, Japan, AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo 162‑8655, Japan, Department of Surgery, National Center for Global Health and Medicine, Tokyo 162‑8655, Japan, Department of Breast Surgical Oncology, National Center for Global Health and Medicine, Tokyo 162‑8655, Japan

Copyright: © Mimura et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 357
|
Published online on: July 4, 2023

https://doi.org/10.3892/ol.2023.13943
Expand metrics +

Abstract

Idiopathic CD4+ lymphocytopenia (ICL) is a rare immunodeficiency disorder characterized by decreased CD4+ T‑cell counts in the absence of human immunodeficiency virus (HIV) infection. Similar to HIV infection, ICL is commonly associated with acquired immunodeficiency syndrome‑defining cancers, such as Kaposi sarcoma, non‑Hodgkin lymphoma and cervical cancer; however, the presentation of breast cancer in a patient with ICL is rare. The current study presented the clinical course of a patient with early breast cancer and ICL. Following surgery, the patient underwent adjuvant chemotherapy comprising doxorubicin plus cyclophosphamide, followed by paclitaxel. The patient's immunodeficiency status required the prophylactic administration of clarithromycin, trimethoprim‑sulfamethoxazole and valganciclovir. Throughout the course of chemotherapy, the patient experienced severe complications of febrile neutropenia, anemia, neutropenia and thrombocytopenia, and was eventually forced to discontinue anticancer chemotherapy, as the relative dose intensity (RDI) could not be maintained. Similar hematological complications and reduced RDI, leading to worse outcomes, are also common in patients with HIV infection receiving chemotherapy, suggesting that CD4+ T cell‑deficient patients are prone to developing cytopenia during chemotherapy. The present study demonstrates the importance of further data accumulation in patients with ICL with cancer and the development of a methodology for maintaining the RDI.

View Figures

View References

1	Walker UA and Warnatz K: Idiopathic CD4 lymphocytopenia. Curr Opin Rheumatol. 18:389–395. 2006. View Article : Google Scholar : PubMed/NCBI
2	Ahmad DS, Esmadi M and Steinmann WC: Idiopathic CD4 lymphocytopenia: Spectrum of opportunistic infections, malignancies, and autoimmune diseases. Avicenna J Med. 3:37–47. 2013. View Article : Google Scholar : PubMed/NCBI
3	Régent A, Autran B, Carcelain G, Cheynier R, Terrier B, Muylder BCD, Krivitzky A, Oksenhendler E, Costedoat-Chalumeau N, Hubert P, et al: Idiopathic CD4 lymphocytopenia: Clinical and immunologic characteristics and follow-up of 40 patients. Medicine (Baltimore). 93:61–72. 2014. View Article : Google Scholar : PubMed/NCBI
4	Yarmohammadi H and Cunningham-Rundles C: Idiopathic CD4 lymphocytopenia: Pathogenesis, etiologies, clinical presentations and treatment strategies. Ann Allergy Asthma Immunol. 119:374–378. 2017. View Article : Google Scholar : PubMed/NCBI
5	Shiels MS, Cole SR, Kirk GD and Poole C: A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 52:611–622. 2009. View Article : Google Scholar : PubMed/NCBI
6	Chu VH, Curry JL, Elghetany MT and Curry CV: MonoMAC versus idiopathic CD4+ lymphocytopenia. Comment to Haematologica. 2011.96((8)): 1221–5. Haematologica. 97:e9–e11. 2012.PubMed/NCBI
7	Hengge UR, Esser S, Rudel HP and Goos M: Long-term chemotherapy of HIV-associated Kaposi's sarcoma with liposomal doxorubicin. Eur J Cancer. 37:878–883. 2001. View Article : Google Scholar : PubMed/NCBI
8	Saville MW, Lietzau J, Pluda JM, Feuerstein I, Odom J, Wilson WH, Humphrey R, Feigel E, Steinberg S and Broder S: Treatment of HIV-associated Kaposi's sarcoma with paclitaxel. Lancet. 346:26–28. 1995. View Article : Google Scholar : PubMed/NCBI
9	Sparano JA, Hu X, Wiernik PH, Sarta C, Reddy DM, Hanau L and Henry DH: Opportunistic Infection and immunologic function in patients with human immunodeficiency virus-associated Non-Hodgkin's lymphoma treated with chemotherapy. J Natl Cancer Inst. 89:301–307. 1997. View Article : Google Scholar : PubMed/NCBI
10	Torres HA and Mulanovich V: Management of HIV infection in patients with cancer receiving chemotherapy. Clin Infect Dis. 59:106–114. 2014. View Article : Google Scholar : PubMed/NCBI
11	Khalil MAM, Khalil MAU, Khan TFT and Tan J: Drug-induced hematological cytopenia in kidney transplantation and the challenges it poses for kidney transplant physicians. J Transplant. 2018:94292652018.PubMed/NCBI
12	Brum S, Nolasco F, Sousa J, Ferreira A, Possante M, Pinto J, Barroso E and Santos J: Leukopenia in kidney transplant patients with the association of valganciclovir and mycophenolate mofetil. Transplant Proc. 40:752–754. 2008. View Article : Google Scholar : PubMed/NCBI
13	Kalil AC, Mindru C and Florescu DF: Effectiveness of valganciclovir 900 mg versus 450 mg for cytomegalovirus prophylaxis in transplantation: Direct and indirect treatment comparison meta-analysis. Clin Infect Dis. 52:313–321. 2011. View Article : Google Scholar : PubMed/NCBI
14	Singh SN, Zhu Y, Chumsri S, Kesmodel S, Gilliam BL and Riedel DJ: Outcomes and chemotherapy-related toxicity in HIV-infected patients with breast cancer. Clin Breast Cancer. 14:e53–e59. 2014. View Article : Google Scholar : PubMed/NCBI
15	Martei YM, Narasimhamurthy M, Setlhako DI, Ayane G, Ralefala T, Chiyapo S, Gross R, Shulman LN, Grover S and DeMichele A: Relative dose intensity and pathologic response rates in patients with breast cancer and with and without HIV who received neoadjuvant chemotherapy. JCO Glob Oncol. 8:e22000162022. View Article : Google Scholar : PubMed/NCBI
16	Ngidi S, Magula N, Sartorius B, Govender P and Madiba TE: Incidence of chemotherapy-induced neutropenia in HIV-infected and uninfected patients with breast cancer receiving neoadjuvant chemotherapy. S Afr Med J. 107:595–601. 2017. View Article : Google Scholar : PubMed/NCBI
17	Bundow D and Aboulafia DM: Potential drug interaction with paclitaxel and highly active antiretroviral therapy in two patients with AIDS-associated kaposi sarcoma. Am J Clin Oncol. 27:81–84. 2004. View Article : Google Scholar : PubMed/NCBI
18	El-Rayes BF, Berenji K, Schuman P and Philip PA: Breast cancer in women with human immunodeficiency virus infection: Implications for diagnosis and therapy. Breast Cancer Res Treat. 76:111–116. 2002. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Severe cytopenia during adjuvant chemotherapy for early breast cancer in a patient with idiopathic CD4+ lymphocytopenia

This article is mentioned in:

Abstract

Figure 1

Figure 2

Figure 3

Related Articles