Comparison of absolute neutrophil to CD4 lymphocyte values as a marker of immunosuppression in cancer patients on cytotoxic chemotherapy

A Madu, S Ocheni, O Ibegbulam, A Chukwura, K Madu

Abstract

Background: The absolute neutrophil count (ANC) is currently used to assess immune status of patients on cytotoxic therapy. The CD4 lymphocytes have also been shown to be of importance in protection against opportunistic infections. In people of African descent a low baseline ANC has been recorded and the currently accepted neutropaenic threshold may not be appropriate.

Objective: This study was aimed at comparing the change in ANC to CD4 lymphocyte count in adult cancer patients following chemotherapy.

Patients and methods: Eighty chemotherapy-naive patients with various malignancies had their ANC and CD4 lymphocyte counts done at days 0 and 12 of the first cycle of various chemotherapeutic regimens. The paired sample t-test was done to assess the significance between these values. Socio-demographic data was obtained using questionnaires.

Results: ANC and CD4 pre-chemotherapy differed significantly from their post-chemotherapy values (p=0.001) for both parameters). The CD4 count showed significant reduction in patients with Non-Hodgkin’s lymphoma (p=0.043), colorectal carcinoma (p=0.037) and other malignancies (p=0.030), while the ANC did not. Patients who had received COPP for Hodgkin’s lymphoma also had significant CD4 depletion (p=0.037).

Conclusion: The CD4 lymphocyte count may be a more suitable parameter than ANC, for monitoring immuno-depletion in cancer patients on cytotoxic chemotherapy. Further studies are required to validate these findings, especially in the Negroid population.

Keywords: cancer, chemotherapy, immunosuppression, absolute neutrophil count, CD4 lymphocytes