Authors
J X Zhou, L Gao, Y Xia, S C Qin, H N Tang, Y L Kong, L Fan, J Y Li, H Y Zhu
Published in
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi. Volume 47. Issue 8. Pages 754-760. Aug 14, 2026.
Abstract
Objective: To evaluate the efficacy and safety of first-line immunochemotherapy with obinutuzumab in patients with follicular lymphoma (FL), with a particular focus on the clinical characteristics and potential risk factors of obinutuzumab-induced acute thrombocytopenia (OIAT) . Methods: The present retrospective study included 167 newly diagnosed FL patients receiving G-CHOP or GB regimens at Jiangsu Provincial People's Hospital between January 2021 and December 2024. The patients' baseline clinical characteristics and serial platelet (PLT) count were collected. In patients with OIAT, the nadir PLT count and recovery time were recorded. Logistic regression analysis was performed to identify the risk factors for OIAT. Results: Among the 167 patients, 65 (38.9%) developed OIAT, including 18 (27.7%) patients with grade 3-4 thrombocytopenia. The median time to OIAT onset was 1.0 (1.0, 2.0) days after the first administration, and the median recovery time was 8.0 (6.0, 16.0) days. Compared to patients without OIAT (102/167, 61.1%), those with OIAT had lower baseline neutrophil percentage [median: 3.4 (2.5, 4.9) % vs 4.3 (3.1, 6.6) %, P=0.005], lower D-dimer levels [0.2 (0.1, 0.7) mg/L vs 0.6 (0.3, 1.3) mg/L, P=0.001], higher IL-10 levels [8.0 (3.7, 32.0) ng/L vs 4.6 (2.4, 7.9) ng/L, P=0.008], higher β2-microglobulin levels [2.7 (1.8, 3.9) mg/L vs 2.2 (1.7, 3.0) mg/L, P=0.024], lower CD4(+) T cell counts [ (32.4 ± 17.6) cells/μl, vs (37.4 ± 11.8) cells/μl, P=0.043], and lower IgA levels [1.2 (1.0, 2.1) g/L vs 1.6 (1.2, 2.2) g/L, P=0.045]. Multivariate analysis showed that extranodal involvement (OR=3.395, 95% CI: 1.229-9.378, P=0.018), FLIPI-2 score >3 (OR=3.622, 95% CI: 1.192-10.973, P=0.023), and baseline PLT count of <150×10(9)/L (OR=3.216, 95% CI: 1.122-9.215, P=0.030) were the independent risk factors for OIAT. In patients with grade 1-2 and 3-4 OIAT, the use of thrombopoietic therapy had no significant effect on prolonged PLT recovery time [grade 1-2: median: 7.1 (5.0, 12.5) days vs 7.4 (5.2, 13.0) days, P=0.338; grades 3-4: (21.0 ± 14.4) days vs (15.5 ± 9.9) days, P=0.420]. However, patients with grade 3-4 OIAT had significantly prolonged PLT recovery time [median: 16.0 (8.0, 18.5) days vs 7.0 (5.0, 12.8) days, P=0.010] and were more likely to experience non-hematologic adverse events[incidence rate: 72.2% (13/18) vs 40.4% (19/47), P<0.001]. Conclusion: OIAT commonly occurs after the initial drug administration, with the risk significantly increased in patients with high baseline tumor burden and impaired immune status. Grade 1-2 thrombocytopenia may be observed during follow-up, whereas Grade 3-4 cases require close monitoring and active intervention. Identifying high-risk patients and implementing stratified management strategies can help optimize treatment safety.
PMID:
42851176
Bibliographic data and abstract were imported from PubMed on 09 Oct 2026.
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