1. Frieder Keller Nephrology
“Fall in Leukocyte Count for Monitoring of (1) Anti-Cancer, (2) Anti-Infective and (3) Immunosuppressive Drug Therapy“
Disclosures: NO
Frieder Keller
Nephrology

2. F Stegmeier Targeted Cancer Therapies in the Twenty-First Century: Lessons From Imatinib Clin Pharmacol Ther. 2010; 87:

3. Effectivity and Toxicity

4. Effectivity and Toxicity

5. Gurney H How to calculate the dose of chemotherapy British Journal of Cancer (2002) 86, 1297 – 1302
CAF = cyclophosphamide, adriamycin/ doxorubicin, 5FU

6. Carus A. Impact of baseline and nadir neutrophil index in non-small cell lung cancer and ovarian cancer patients: Assessment of carbopoplatin chemotherapy for resolution of unfavourable neutrophilia J Translational Med. 2013, 11: 189
Survial benefit
<= neutropenia < 1.0 x 10^9 /L
<= neutrophils > 3.0 x 10^9 /L

7. Kohei Shitara Meta-analysis of leukopenia as a prognostic factor in patients with malignant disease undergoing chemotherapy Cancer Chemother Pharmacol. 2011; 68: 301–307

8. Mayer RJ; RECOURSE Study Group
Mayer RJ; RECOURSE Study Group. Randomized trial of TAS-102 Trifluridine / Tipiracil for refractory metastatic colorectal cancer. N Engl J Med. 2015; 372:

9. Fall in Platelet count x 1000 / mm3
Sung C. A Randomized, Placebo-Controlled Trial of Celgosivir in Dengue Fever Patients. PLoS Negl Trop Dis. 2016; 10: e
Fall in Platelet count x 1000 / mm3
Rise in Hematocrit %
„ … celgosivir activity in treating dengue fever based on hematological endpoints.”

10. Stevens DR, Sawinski D, Blumberg E, Galanakis N, Bloom RD, Trofe-Clark J. Increased risk of breakthrough infection among cytomegalovirus donor-positive/recipient-negative kidney transplant recipients receiving LD lower-dose valganciclovir prophylaxis. Transpl Infect Dis. 2015; 17:

11. Fauci AS. Cyclophosphamide therapy of severe systemic necrotizing vasculitis. N Engl J Med. 1979; 301:

12. Rasche FM. Cyclophosphamide pulse therapy in advanced progressive IgA nephropathy. Nephron Clin Pract. 2003; 93: c131-6.
Kidney Dysfunction vs
cell count nadir

13. Cyclophosphamie: Balance between efficacy and toxicity
Survival without Death
from vasculitis
from infection

14. □ with CD19 B-cell suppression
Sellier-Leclerc AL. Rituximab in steroid-dependent idiopathic nephrotic syndrome in childhood--follow-up after CD19 recovery. Nephrol Dial Transplant. 2012; 27:
□ with CD19 B-cell suppression
CD19 recovery
Nephrotic syndrome YES NO Relaps

15. Mélet J. Rituximab-induced T cell depletion in patients with rheumatoid arthritis: association with clinical response. Arthritis Rheum. 2013; 65:
T cell
CD3+
CD4+
CD8+
Response
= T cell depletion
ARC Response NO ? YES

16. Moreso F.
Incidence of leukopenia and cytomegalovirus disease in kidney transplants treated with mycophenolate mofetil combined with low cyclosporine and steroid doses.
Clin Transplant. 1998; 12:
„ … Patients receiving MMF showed a low incidence of biopsy proven rejection …
... All patients … who presented leukopenia recovered after MMF reduction dose … „

17. Conclusion: Titration Dose !
Titration curve
Conclusion: Titration Dose !
Leukocyte count
← Dose NO
YES
Standard or high normal Dose
Leukopenia
Continue previous Dose
Decrease Dose
Candidates:
… cyclophosphamide, adriamycin/ doxorubicin, cisplatin, carboplatin, trifluridine … celgosivir, valganciclovir … rituximab, mycophenolate … … azathioprine, lenalidomide …