WBC COUNT AS A PROGNOSTIC INDICATOR IN THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS

Abstract

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a progressive form of interstitial lung disease resulting in varying degrees of scarring that is further exacerbated by acute inflammatory processes. White blood cell (WBC) count has been established as an inflammatory marker and is a known prognostic indicator in several cardiopulmonary processes. For IPF patients on disease-modifying therapy such as nintedanib or pirfenidone, the correlation between WBC and disease-related events has not been well studied. METHODS: Patient demographics, complete blood cell (CBC) counts, and pulmonary function tests from patients with IPF evaluated at Inova Fairfax Hospital between October 2014 and January 2019 were collected. CBCs were compared before and after initiation of anti-fibrotic therapy. Outcome events collated were respiratory hospitalizations, lung transplant, or death following the initiation of anti-fibrotic therapy. Event-free survival was calculated and compared between patients on nintedanib versus pirfenidone. RESULTS: Sixty-one patients with IPF had CBCs available prior to initiation of anti-fibrotic therapy. WBC range was 3.5 to 16.0 (median 8.0). Subsequently, 28 patients had been started on pirfenidone and 33 patients had been prescribed nintedanib. Of the 61 patients, those with baseline WBC count less than 8 (N=32) had a median event-free survival of 710 days (P=NS) compared with 703 days (P=NS) for those with baseline WBC count greater than 8 (N=29). The median change in WBC count amongst the 61 patients was -0.3. Median event-free survival for those with an increase in WBC count (N=23) after initiating anti-fibrotic therapy was 683 days (P=NS) compared with 761 days (P=NS) for those with no change or a decrease in WBC count (N=38). CONCLUSIONS: Trending the change in WBC count in patients with IPF on anti-fibrotic therapy did not serve as a prognostic indicator with statistical significance. This result may have been influenced by the small sample size of the study. Additionally, although WBC count has been suggested as a biomarker of prognosis in IPF, the mechanism of action of anti-fibrotic therapy may be independent of factors that influence the WBC count. CLINICAL IMPLICATIONS: Based on the findings of this study, further research is indicated to investigate the potential significance of WBC count and its role in inflammation in the evolution of IPF and its management. DISCLOSURES: No relevant relationships by Scott Barnett, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Anne Brown, source=Web Response, value=Consulting fee No relevant relationships by Talha Demirci, source=Web Response Speaker/Speaker's Bureau relationship with Genentech Please note: $1001 - $5000 Added 03/08/2019 by Christopher King, source=Web Response, value=Honoraria Consultant relationship with Roche-Genentech Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with Promedior Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee Advisory Committee Member relationship with United Therapeutics Please note: $1001 - $5000 Added 03/15/2019 by Steven Nathan, source=Web Response, value=Consulting fee