Lymphopenia Research Articles

Increasing Immune Dysfunction is Associated with Increasing Matrix-Metalloproteinase-2 Expression and Predicts Biochemical Failure in Men with Bone Marrow Micro-Metastasis Positive Localized Prostate Cancer.

To determine if there was an association of the ALC (absolute lymphocyte count) and LCP (lymphocytopenia) with the expression of MMP-2 in bone marrow micro-metastasis, the changes occurring during follow-up and association with biochemical failure. One month after surgery blood and bone marrow samples were taken to determine the presence of micro-metastasis, the presence of circulating prostate cells (CPCs) and ALC. CPCs and micro-metastasis were detected using immunocytochemistry and MMP-2 expression determined in micro-metastasis. Only men positive for micro-metastasis participated in the study. At end follow blood was taken for serum PSA, ALC and CPCs, if the ALC decreased by more than 10% bone marrow sampling was repeated and MMP-2 expression determined, similarly for men with BF. Men who had stable ALCs had an end of study evaluation of the bone marrow. 402 men underwent radical prostatectomy, one month post surgery 79 men were positive for only bone marrow micro-metastasis and formed the study group; of whom 36/79 (45%) underwent BF. Clinical pathological findings were not significantly different between men with or without BF. In men with BF the ALC was significantly lower one-month post surgery. The 5 and 10 year Kaplan-Meier survival was 100% at 5-years and 65% at 10-years for the whole cohort. Men without BF had stable ALCs. A decrease of >10% in the ALC was associated with increasing MMP-2 expression in the micro-metastasis and surrounding stromal tissue, the appearance of CPCs 6-12 months later and BF. the immune host-tumour cell interaction in the microenvironment is dynamic and changes with time. A decreasing ALC may be a valuable marker in identifying men with high risk of BF and changes in immune mediated dormancy before the PSA rises.

The CAPRA-S Score and Immune Dysfunction as a Guide to Outcome in Men Treated with Prostatectomy Radical as Mono-Therapy for Prostate Cancer.

Incorporate the immune function as determined by the absolute lymphocyte count (ALC) into the CAPRA-S risk stratification score to determine if predictive values could be improved. The clinical pathological findings in the surgical specimen and total PSA were used to define the three CAPRA-S risk groups. One month after surgery and at each follow up total PSA and the ALC were determined, until biochemical failure (BF) or the end of the study period. A cut off value of <1,000 lymphocytes/mm3 was used to define lymphocytopenia (LCP). Each CAPRA-S group was sub-divided based on the presence or absence of LCP. Kaplan-Meier biochemical failure free survival (BFFS) curves and restricted mean biochemical failure free survival times were calculated for each group. 404 patients participated of whom 103 (25.5%) underwent BF. 270 men were CAPRA-S low risk (LR), 89 intermediate risk (IR) and 45 high risk (HR), of whom LCP was found in 22 (8%) of low risk, 24 (27%) of intermediate risk and 17 (38%) of high risk men. LCP was significantly associated with a higher PSA, higher Gleason and CAPRA-S scores and BF. HRs were 1.76 for IR, 2.49 for HR and 1.29 for LCP. Five-year BFFS for men without LCP, LR 93.5%, IR 61% and HR 36%, for those with LCP, LR 55%, IR 25% and HR 6%. All patients with LCP and IR or HR scores relapsed within 6 years. 10 year BFFS for men without LCP were 71% LR, 43% IR and 23% HR, LR with LCP 16%. Men with BF had increasing LCP approximately 18 months before BF. The incorporation of the ALC taken one month after surgery with the CAPRA-S improves risk stratification; decreases in the ALC suggest that BF is occuring. These results need to be confirmed with larger studies.

Hematological parameters and globulin profile of Bothrops asper and Crotalus simus snakes (Serpentes: Viperidae), after the main venom gland removal

Snakebite accidents are a neglected tropical disease worldwide recognized, and in Costa Rica the snakes Bothrops asper and Crotalus simus causes more than the 60% of the snakebite accidents reported. To fight this neglected disease, institutions need to establish and keep a venomous snake collection in order to extract the venom and produce the antivenom. The welfare of the snakes in captivity must be guaranteed, specially to old animals with defective venom production, which is the case of the Clodomiro Picado Institute. A surgical removal of the main venom gland was performed in five animals of B . asper and C . simus with none or low venom production, and the hematological parameters and plasma proteins were analyzed pre-surgery and for 90 days post-surgery. As result of the surgical procedure, the animals did not show anemia post-surgery, a heterophilia was found in respond to the invasive method, a relative monocytosis and lymphopenia at day one to three was also found, meaning that the surgical removal of the main venom gland is a safe procedure and did not affect the snake’s health. Additionally, the electrophoretic determination of the albumin:globulin ratio, is a good test to assess the body health condition in the snakes studied. Finally, the relative monocytosis and lymphopenia seems to be directly linked to a continuously handling of the snakes during consecutive days. with monocytes playing a key role in a stress respond, therefore, these relative monocytosis and lymphopenia values should be considered in the interpretation of stress leukogram reports.

Predictors of Intensive Care Unit Admission among Hospitalized COVID-19 Patients in a Large University Hospital in Tehran, Iran.

Background: The rapid increase in the spread of COVID-19 and the numbers of infected patients worldwide has highlighted the need for intensive care unit (ICU) beds and more advanced therapy. This need is more urgent in resource-constrained settings. The present study aimed to identify the predictors of ICU admission among hospitalized COVID-19 patients. Study design: The current study was conducted based on a retrospective cohort design. Methods: The participants included 665 definite cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospitalized in Imam Hossein Hospital from February 20 to May 14, 2020. The baseline characteristics of patients were assessed, and multivariate logistic regression analysis was utilized to determine the significant odds ratio (OR) for ICU admission. Results: Participants were aged 59.52±16.72 years, and the majority (55.6%) of them were male. Compared to non-ICU patients (n=547), the ICU patients (n=118) were older, had more baseline comorbidities, and presented more often with dyspnea, convulsion, loss of consciousness, tachycardia, tachypnea, and hypoxia, and less often with myalgia. Significant OR (95% CI) of ICU admission was observed for the 60-80 age group (2.42, 95%CI: 1.01; 5.79), ≥80 age group (3.73, 95%CI: 1.44; 9.42), ≥3 comorbidities (2.07, 95%CI: 1.31; 3.80), loss of consciousness (6.70, 95%CI: 2.94, 15.24), tachypnea (1.79, 95%CI: 1.03, 3.11), and SpO2<90 (5.83, 95%CI: 2.74; 12.4). Abnormal laboratory results were more common among ICU-admitted patients; in this regard, leukocytosis (4.45, 95%CI: 1.49, 13.31), lymphopenia (2.39, 95%CI: 1.30; 4.39), elevated creatine phosphokinase (CPK) (1.99, 95%CI: 1.04; 3.83), and increased aspartate aminotransferase (AST) (2.25, 95%CI: 1.18-4.30) had a significant OR of ICU admission. Chest computer tomography (CT) revealed that consolidation (1.82, 95%CI: 1.02, 3.24), pleural effusion (3.19, 95%CI: 1.71, 5.95), and crazy paving pattern (8.36, 95%CI: 1.92, 36.48) had a significant OR of ICU admission. Conclusion: As evidenced by the obtained results, the predictors of ICU admission were identified among epidemiological characteristics, presenting symptoms and signs, laboratory tests, and chest CT findings.

Paraoxonase activity assessment as a potential biomarker of parvovirus infection in dogs

Parvovirus enteritis is one of the most common causes of acute diarrhea and death in dogs younger than 6 months of age. Paraoxonase/arylesterase 1 acts as an antioxidant enzyme and acute phase protein in dogs. The aim of the present study was to evaluate any changes in paraoxonase activity in dogs suffering from parvovirus infection compared with normal dogs. For this purpose, blood samples were taken from 27 infected dogs (test group) and 9 normal dogs (control group) that were presented to the Hospital of Veterinary School of Shahid Bahonar University of Kerman, Iran. Samples were sent to the laboratory for complete cell blood count and also biochemical factors assessment (paraoxonase/arylesterase 1 activity, liver, kidney and metabolic profiles). Infected dogs significantly showed an increase number of segmented and band neutrophils and lymphopenia compared with normal dogs. Moreover, albumin, total protein level and paraoxonase/arylesterase 1 enzyme activity were lower in infected dogs rather than healthy ones; however, alanine aminotransferase enzyme was higher. Significant decrease in paraoxonase/arylesterase 1 enzyme activity was also seen in dogs with neutropenia or leukocytosis when compared to control group. It seems that paraoxonase/arylesterase 1 enzyme activity could have been used as a diagnostic biomarker beside the cell blood count in parvovirus infected dogs.

Clinical Features and Prognostic Risk Factors of COVID-19 in Adults: a Retrospective Analysis of 93 Cases

Background: Since April 2020, the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients Objective: To investigate the clinical features and prognostic risk factors of adult patients with COVID-19, offering a reference for clinical diagnosis and treatment of this disease Methods: A retrospective design was used Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020 They were categorized into common, severe and critical types by the most serious conditions during hospitalization, in accordance with the Diagnosis and Treatment Protocol for COVID-19(Trial Version 7)issued by the National Health Commission of the People's Republic of China Indications such as general information, major clinical manifestations, baseline laboratory parameters, APACHE II and SOFA scores within 24 hours of admission, imaging findings, comorbidities and complications, treatments and outcomes were collected Results: There were 57 cases of common type(61 3%), 22 of severe type(23 7%)and 14 of critical type(15 0%) The male ratio was slighter higher in critical group, and female ratio was slighter higher in other groups, but sex composition showed no significant differences across the groups(P>0 05) The median age for common, severe and critical groups was 45 0, 62 0 and 81 0 years, respectively, showing significant differences(P0 05) Dyspnea occurred in all severe or critical cases, showing a higher incidence than common cases(100 0% vs 31 6%)(P<0 05) The incidence of lymphocytopenia in critical group was 100%, which was significantly higher than that in common group(49 1%)or severe group(59 1%)(P<0 05) Acute liver injury was the most common complication(58 1%)in all cases, but its incidence was obviously increased in severe group (77 3%) or critical group(92 9%), than that of common group(42 1%)(P<0 05) Chinese medicine therapy was used in 75 3% of all cases, but the severe cases had a higher rate of treating with Chinese medicine than critical cases(90 9% vs 50 0%, P<0 05) The rate of corticosteroid use in severe cases(63 6%)or critical cases(64 3%)was significantly increased than that of common cases(5 3%)(P<0 05) Six patients(6 5%)were treated with invasive ventilation, but only 1 of them(16 7%)was successfully extubated ultimately Nine patients(9 7%)died in hospital due to all causes Logistic regression analysis revealed that age ≥74 years〔OR(95%CI)=33 714(3 021, 376 211), P=0 004〕and baseline SOFA≥2 5〔OR(95%CI)=15 447(1 331, 179 260), P=0 029〕were independent risk factors for in-hospital death Conclusion: COVID-19 mainly manifests as respiratory infections Severe patients are apt to appear tissue injury and dysfunction of organs like liver, kidney and heart, etc The majority of patients have a favorable outcome Age and baseline SOFA score would help to label the prognosis of patients at an early stage Copyright © 2021 by the Chinese General Practice

Clinical features of children with Mycoplasma pneumoniae pneumonia and peripheral lymphocytopenia

OBJECTIVE To study the clinical features of children with Mycoplasma pneumoniae pneumonia (MPP) and peripheral lymphocytopenia. METHODS A total of 310 MPP children who were hospitalized and underwent bronchoalveolar lavage from June 2018 to June 2019 were enrolled and divided into two groups: simple MPP group with 241 children (without peripheral lymphocytopenia) and MPP + peripheral lymphocytopenia group with 69 children. The two groups were compared in terms of clinical data and treatment outcome. RESULTS Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly longer duration of fever and length of hospital stay and significant increases in C-reactive protein, lactate dehydrogenase, and Mycoplasma pneumoniae DNA copies in bronchoalveolar lavage fluid (P < 0.05). Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly higher incidence rates of intrapulmonary consolidation, extrapulmonary complications, and serious lesions under bronchoscopy (erosion or sputum bolt) and a significantly higher proportion of patients with severe MPP (P < 0.05). CONCLUSIONS Children with MPP and peripheral lymphocytopenia tend to have more severe immunologic injury. Peripheral blood lymphocyte count may be used to evaluate the severity of MPP.

COVID-19 Infection in Children and Young Adults with Chronic Kidney Disease: A Single Center Experience

Background: Coronavirus has affected millions of people worldwide and its severity is more pronounced in those with comorbidities; there is paucity of literature on its presentation and course in children and young adults suffering from chronic kidney disease (CKD). Aims: The aim of the study was to describe the clinico-epidemiological, biochemical, and radiological profile of children and young adults (up to 25 years of age) having CKD with coronavirus disease 2019 (COVID-19). Methods: This retrospective study was done at a tertiary care “dedicated COVID” hospital between May 1, 2020 and August 30, 2020. Ten children and young adults (up to 25 years of age) with underlying CKD who tested positive by reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 infection and were hospitalized during this period were included; their clinical presentation, outcomes, biochemical, and hematological parameters were recorded and analyzed. Results: All 10 patients (seven males and three females) were in stage 5 of CKD and were undergoing maintenance hemodialysis at admission. Fever and cough were the most common presenting symptoms of COVID-19, while anemia (100%), leukopenia (50%), lymphopenia (30%), and thrombocytopenia (30%) were the hematological findings. Radiological abnormalities on chest radiography were seen in 50% patients with a majority having bilateral lesions. The median (range) duration of hospital stay was 21.5 (10–46) days; five (50%) patients needed intensive care support and one patient required mechanical ventilation who eventually expired. Conclusion: The presenting features of COVID-19 were similar in children and young adults with underlying CKD compared to their healthy counterparts; however, the mortality rate and intensive care requirement were higher and duration of hospital stay too was longer.

Subpoblaciones linfocitarias de pacientes venezolanos infectados con SARS-CoV-2

La infección por SARS-CoV-2 ha infectado a más de 50 millones de personas con un rango de letalidad de 3 %-10 % de los casos. En Venezuela, cerca de 95 mil casos se han reportado con una letalidad del 1 %. El objetivo de este estudio es evaluar las diferentes poblaciones linfocitarias, analizar los posibles marcadores pronósticos y compararlos con la literatura. Un total de 18 pacientes positivos, por la prueba de transcriptasa reversa más reacción de la cadena de polimerasa (RT-PCR), fueron analizados 12 (5 masculinos) moderados, rango de edad 15-71 años, 6 (4 masculinos) severos (rango de edad 29-50 años) y 100 controles de la misma edad y sexo. Se encontró linfopenia en ambos grupos de pacientes con disminución significativa de linfocitos T. La población de células de memoria al igual que las células CD25 disminuye en la infección viral. Sin embargo, en los pacientes jóvenes del grupo moderado, se observaron los valores más altos de linfocitos T y valores normales de memoria sugiriendo la pronta resolución del proceso infeccioso. En conclusión, los disminución de linfocitos T y células CD25 está relacionada con la infección viral y CD45RO es un marcador de severidad en la población adulta.

Differential Diagnosis in the Age of COVID-19 and the Need to Maintain a Broad Differential

During the coronavirus pandemic, patients admitted to emergency departments (ED) with constitutional symptoms, respiratory complaints, and/or history of sick contacts have high clinical suspicion for COVID-19 regardless of whether initial screening tests are negative. Although communities seek daily coronavirus infection rates of less than one percent, physicians can be highly focused on narrow differentials despite adequate history and physical exams. This case report focuses on an elderly patient with a past medical history of hypertension, chronic kidney disease (CKD), and gout who presented with three days of fevers, chills, body aches, and shortness of breath and reported a home oxygen saturation of 89%. The patient was a health care worker with high risk of contracting COVID-19, and on admission was febrile and found to have lymphopenia. Nevertheless, COVID-19 Polymerase Chain Reaction (PCR) testing returned negative on two separate occasions prompting the team to broaden their differential. Leukopenia, thrombocytopenia and mildly elevated transaminases can all be due to COVID-19, but should also lead medical teams to include tick-borne illnesses as a potential etiology. Parasite serology returned positive for Babesia microti via IgG antibodies (1:512) and Anaplasma phagocytophilum via PCR and the patient was discharged on appropriate antimicrobial therapy. It is important for providers to understand and recognize the following: 1) overlapping symptoms of tick-borne disease and COVID-19, 2) proper diagnosis and management of babesiosis and anaplasmosis, and 3) benefits of broad differentials for patient care during the COVID-19 pandemic.

M411 ACTIVE TUBERCULOSIS (TB) MASQUERADING AS AN ASTHMA EXACERBATION DURING A SARS-COV-2 (COVID 19) PANDEMIC

Introduction: TB rarely presents as asthma Clinical symptoms of COVID-19 and asthma can mask a diagnosis of TB Case Description: A sixty-year old male presented to the allergy clinic in the spring of 2019 complaining of nasal congestion and cough associated with shortness of breath Skin prick testing confirmed tree pollen allergy The patient was treated for seasonal asthma and allergic rhinitis with nasal fluticasone spray, montelukast and inhaled albuterol His symptoms improved, and he did well until this spring, when he contacted us with similar complaints without fever Patient was evaluated at a televisit, medications were renewed and he was referred for COVID 19 testing which was negative Since cough and shortness of breath persisted he was prescribed prednisone for a possible asthma exacerbation and amoxicillin for sinusitis The patient did not improve and was seen in person He was diaphoretic but not febrile or hypoxic Twenty pounds of unintentional weight loss was recorded, the rest of exam was not contributory Chest X-ray revealed bilateral pneumonia in upper lung lobes and laboratory data was significant for leukocytosis with lymphopenia, increased inflammatory markers and positive quantiferon Repeated COVID-19 test was negative Sputum revealed Mycobacterium Tuberculosis Patient was treated for TB and improved Conclusion: Physicians must be mindful of the rare possibility of TB in patients who present as COVID-19 associated respiratory symptoms or asthma exacerbation Prompt diagnosis and treatment of TB is crucial for the affected individual and community

Impact of Lymphopenia on Survival for Elderly Patients with Glioblastoma: A Secondary Analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) Randomized Clinical Trial

Lymphopenia (LMP) may lead to worse outcomes for patients with glioblastoma (GBM). This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on LMP, as well as the association of LMP with overall survival. CCTG clinical trial CE.6 randomized elderly GBM patients (≥ 65 yrs) to short course radiation alone (RT) or short course radiation with temozolomide (RT + TMZ). In this study LMP (mild-mod: grade 1-2; severe: grade 3-4) was defined per CTCAE v3.0 criteria, and measured at baseline, 1 wk and 4 wks post-RT. Pre-selected key factors for the analysis included age, sex, ECOG, extent of resection, MGMT methylation, MMSE, and steroid use. Multinomial logistic regression models were used to identify factors associated with LMP and multivariable Cox regression models were used to study effect of LMP on survival. A total of 562 patients were included for analysis (281 RT vs 281 RT+TMZ). At baseline, both arms (RT vs RT+TMZ) had similar rates of mild-mod (21.4% vs 21.4%) and severe (3.2% vs 2.9%) LMP. The 1 wk post-RT LMP rates were also similar (p = 0.25). However, RT+TMZ pts were more likely to develop both mild-mod LMP (18.2% vs 27.9%) and severe LMP (1.8% vs 9.3%) [p < 0.001] at 4 wks post-RT. Developing mild-mod and severe LMP post-RT were both associated with baseline LMP (p < 0.001) and RT+TMZ (p < 0.001). Severe LMP at 4 wks post-RT was also associated with biopsy only (p < 0.02). After adjusting for confounding factors, 4 wks post-RT LMP was not significantly associated with PFS or OS regardless of severity. However, baseline LMP (HR 1.3) was significantly associated with worse OS (HR: 1.30, 95% C.I.: 1.05-1.62, p = 0.02), regardless of MGMT status. Other factors significantly associated with worse outcome included: males (HR 1.41), biopsy only (HR 1.59), and lower MMSE (HR 1.03). Short course RT alone does not lead to LMP after treatment. Development of LMP post-RT is associated with addition of TMZ and baseline LMP. However, only baseline LMP is associated with worse OS regardless of MGMT status. This may be considered as a prognostic biomarker for elderly GBM patients and warrants further validation.

Thrombocytopenia and Lymphocytopenia

Thrombocytopenia and Lymphocytopenia

Italian SARS-CoV-2 patients in intensive care: towards an identikit for subjects at risk?

To investigate patient characteristics and factors that increase the risk of being admitted to intensive care and that influence survival in cases of SARS-CoV-2 pneumonia. One-hundred and ninety-one SARS-CoV-2 patients were admitted to the "Fondazione Poliambulanza di Brescia" Hospital (Brescia, Lombardy, Italy) in the period 1st March 2020 to 11th April 2020. Data on demographics, clinical presentation at admission, co-morbidities, pharmacological treatment, admission to intensive care and death was recorded. Logistic regression and survival analysis were carried out to investigate the risk of being admitted to intensive care and the risk of death. The mean age of the study cohort was 64.6±9.9 years (range 20-88). Median BMI was 28.5±5 kg/m2. Fever (81%) and dyspnea (65%) were the most common symptoms on admission. Most of patients (63%) had at least one co-existing disease. The 157 (82%) patients admitted to intensive care were more likely to be of intermediate age (60-69 years; OR 3.23, 95% CI 1.32-8.38), overweight (OR 2.66, 95% CI 1.02-7.07) or obese (OR 5.63, 95% CI 1.73-21.09) and with lymphocytopenia (OR 2.75, 95% CI 1.17-6.89) than the 34 patients admitted to the ordinary ward. During intensive care, 50% of patients died and their death was associated with older age (HR 2.06, 95% CI 1.07-3.97), obesity (HR 2.23, 95% CI 1.15-4.35) and male gender (HR 1.9, 95% CI 1.02-3.57). We found that admission to intensive care and poor survival were associated with advanced age and higher body mass index, albeit with differences in statistical significance. Pre-existing diseases and symptoms on admission were not associated with different clinical outcomes. Interestingly, male gender was more prevalent among SARS-CoV-2 patients and was related negatively to survival, but it was not associated with more frequent admission to intensive care.

Hemophagocytic Lymphohistiocytosis in a Patient With Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection

Hemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening entity resulting from the dysregulated activation of T-lymphocytes. Secondary HLH (sHLH) complicates various medical conditions. Similar to 2009 H1N1 influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears to trigger a cytokine storm in a subset of individuals. The patient of 64 years old presented himself in the emergency department with cough and fever, and was subjected to the nasopharyngeal swab and tested positive for SARS-CoV-2, as expected from epidemiological data. Hospitalized in cohort isolation, he initially presented a multi-organ impairment and specifically a worsening of his renal function, initial coagulopathy, lymphopenia modest thrombocytopenia and systemic inflammatory commitment. During the course of the 6th day, a picture of a probable cytokine storm and clear multiple organ failure (MOF) was evident. Therefore a clinical diagnosis was made according to HScore criteria of secondary hemophagocytic lymphohistiocytosis. We started high-dose steroid therapy (dexamethasone 8 mg bid). And after 36 h, the patient was significantly improved: alert, oriented, weaned from non-invasive ventilation (NIV) and stable blood chemistry. In conclusion, in coronavirus disease 2019 (COVID-19) positive patients with evidence of cytokine storm and acute respiratory distress syndrome (ARDS), the levels of blood triglycerides and ferritin are useful and often decisive to comfort the diagnosis of sHLH if cytopenia of one or more lines is revealed. J Med Cases. 2020;11(10):327-329 doi: https://doi.org/10.14740/jmc3515

Impact of lymphopenia on survival for elderly patients with glioblastoma: A secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial.

2547 Background: Lymphopenia (LMP) may lead to worse outcomes for patients with glioblastoma (GBM). This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on LMP, as well as the association of LMP with overall survival. Methods: CCTG clinical trial CE.6 randomized elderly GBM patients (≥ 65 yrs) to short course radiation alone (RT) or short course radiation with temozolomide (RT + TMZ). In this study LMP (mild-mod: grade 1-2; severe: grade 3-4) was defined per CTCAE v3.0 criteria, and measured at baseline, 1 wk and 4 wks post-RT. Pre-selected key factors for the analysis included age, sex, ECOG, extent of resection, MGMT methylation, MMSE, and steroid use. Multinomial logistic regression models were used to identify factors associated with LMP and multivariable Cox regression models were used to study effect of LMP on survival. Results: A total of 562 patients were included for analysis (281 RT vs 281 RT+TMZ). At baseline, both arms (RT vs RT+TMZ) had similar rates of mild-mod (21.4% vs 21.4%) and severe (3.2% vs 2.9%) LMP. The 1 wk post-RT LMP rates were also similar (p = 0.25). However, RT+TMZ pts were more likely to develop both mild-mod LMP (18.2% vs 27.9%) and severe LMP (1.8% vs 9.3%) [p &lt; 0.001] at 4 wks post-RT. Developing mild-mod and severe LMP post-RT were both associated with baseline LMP (p &lt; 0.001) and RT+TMZ (p &lt; 0.001). Severe LMP at 4 wks post-RT was also associated with biopsy only (p &lt; 0.02). After adjusting for confounding factors, 4 wks post-RT LMP was not significantly associated with PFS or OS regardless of severity. However, baseline LMP (HR 1.3) was significantly associated with worse OS (HR: 1.30, 95% C.I.: 1.05-1.62, p = 0.02), regardless of MGMT status. Other factors significantly associated with worse outcome included: males (HR 1.41), biopsy only (HR 1.59), and lower MMSE (HR 1.03). Conclusions: Short course RT alone does not lead to LMP after treatment. Development of LMP post-RT is associated with addition of TMZ and baseline LMP. However, only baseline LMP is associated with worse OS regardless of MGMT status. This may be considered as a prognostic biomarker for elderly GBM patients and warrants further validation. Clinical trial information: NCT00482677 .

Characteristics of peripheral blood leukocyte differential counts in patients with COVID-19

To investigate the early changes of peripheral blood leukocyte differential counts in patients with COVID-19. Ten patients with COVID-19 and 30 patients with other viral pneumonia (non-COVID-19) admitted to The Sixth People's Hospital of Shanghai and Jinshan Branch Hospital from January 22 to February 17, 2020 were enrolled in this study. The differential counts of white blood cells (WBC) were analyzed. Patients in COVID-19 group showed relatively lower absolute WBC count 4.95(3.90,6.03)×10(9)/L, lymphocyte absolute count 1.20(0.98,1.50)×10(9)/L and eosinophil absolute count 0.01(0.01,0.01)×10(9)/L. Leukopenia developed in two patients(2/10), lymphocytopenia also in two patients(2/10). Seven over ten patients presented with eosinophil cytopenia. In non-COVID-19 group, absolute WBC count was 8.20(6.78,9.03)×10(9)/L (P<0.001), lymphocyte absolute count 1.75(1.20,2.53)×10(9)/L(P=0.036), eosinophil absolute count 0.02(0.01,0.03)×10(9)/L(P=0.005). Lymphocytopenia occurred in 16.7% patients, eosinophil cytopenia in 16.7% patients too. In conclusion, leukopenia, lymphocytopenia and eosinophil cytopenia are more common in COVID-19 patients than those in non-COVID-19 patients.

Vital role of chest CT in diagnosis of coronavirus disease 2019 (COVID-19).

In December 2019, a new virus called coronavirus disease 2019 (COVID-19) causing severe acute respiratory syndrome emerged in Wuhan, China, and rapidly spread to other areas of China and other regions of the world. Since it was a discovery, COVID-19 has spread to several countries and to this date, affecting about 2,329,651 people and caused about 160,721 deaths. Since most COVID-19 infected cases were diagnosed with pneumonia and characteristic chest computed tomography (CT) scan patterns, radiological examinations have become an important tool in early diagnosis. Nowadays, CT findings combined with normal blood cells (WBCs), lymphopenia and a history of epidemiological exposure have been used as criteria for clinical diagnosis of COVID-19. It is noteworthy that reverse transcription polymerase chain reaction (RT-PCR) test is still gold standard for the diagnosis. This review focuses on role of chest CT in the clinical evaluation of disease progression and more accurate diagnosis.

Coagulopathy Associated with COVID-19

Lymphopenia is a common hematological abnormality among patients with COVID-19. In addition to respiratory failure, patients with severe illness are

SAT-340 ANTI-THYMOCYTE GLOBULINS AND LONG-TERM LYMPHOPENIA IN KIDNEY TRANSPLANTATION

Induction with anti-thymocyte globulin (ATG) during solid organ transplantation is associated with an improved clinical course and leads to prolonged lymphopenia, Absolute lymphocyte count (ALC) has been identified as a prognostic factor in renal transplantation, indeed Persistent lymphopenia after kidney transplantation has been associated with an increased occurrence of opportunistic infections, malignancies and even mortality. This study aims to investigate whether prolonged lymphopenia, caused by ATG induction, has an impact on patient and graft survival following kidney transplantation. This was a single-center, retrospective study, examining the consequences and risk factors of persistent long-term lymphopenia after kidney transplantation defined by persistance of lymphopenia after 2 year post-transplant. A total of 27 kidney transplants from 2008 to 2011 were performed with ATG induction and the transplant recipients were followed for 7 years. The population was divided into 2 groups, the first one defined by patients with persistent lymphopenia (average lymphocytopenia <1000) : 17 ( 62%) patient, this population was divided into 2 sub groups according to the average of lymphopenia : moderate lymphopenia [500-1000 lym/mm3 ] 11 cases (64%) and Severe lymphopenia 6 (36%) cases ( <500 lymphocytes/mm3). The second group is the control group without persistent lymphopenia included 10 patients ( 38%). Clinical and demographic data were collected from 2008 to 2018 from medical records. There were 17 (62%) renal transplant recipients who achieved prolonged lymphopenia whereas the remaining 10(38%) recipients did not. Mean patient age were 41 years. There was no significant difference in the average age between the 2 subgroups G1: lymphopenic patients 34.9 years G2: control group 33.6 as , with a slight male predominance for two groups concerning lymphopenic group 33% of patients had lymphopenia that lasted 2 years, 22% between 2 and 5 years and 3.7% of cases prolonged lym phopenia beyond 5 yearscalculated GFR one year post-transplant was 79.85 ± 30.5 ml/min /1,73m²using MDRD formula 82 ml/min/1,73m² for lymphopenic group and 74 ml /min/1,73m² for control group. The overall time spent on dialysis before the current transplantation was significantly longer inthe lymphopenic group (8 years versus 3 years ).The rate of infectious complications was markedly higher in lymphopenic group : 35% presented pnemonia v s 10%, 29% with pyelonephritis vs 5% and 11% opportunisticinfections vs 0% , only one lymphopenic patient presented CMV infection. the same findings were retained for malignant complications : one case of Skin carcinomas.For cardiovascular events There was also a significant difference in the cardiovascular risk factors of the lymphopenic group : hypertension( 29% vs10% ) graft artery stenosis (17% vs 0%) and acute coronary syndrome (11%vs 0%). In conclusion, our study demonstrates that late lymphopenia is associated with a greater risk of malignancies and infections compared with non-lymphopenic patients, This study should prompt clinicians to evaluate thymic function in patients who have undergone long-term dialysis treatment and doing Further investigation of risk factors for persistent post-transplant lymphopenia to improve long-term outcome