Cells, cytokines, chemokines, and cancer stress: A biobehavioral study of patients with chronic lymphocytic leukemia

Cancer. 2018 Aug 1;124(15):3240-3248. doi: 10.1002/cncr.31538. Epub 2018 May 14.

Abstract

Background: Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia, with profound disease-related cellular, humoral, and innate immune suppression. The objective of this study was to study the correlations between stress and disease-specific, negative prognostic cellular, cytokine, and chemokine markers in patients with CLL.

Methods: A single-group, observational design was used. Patients with relapsed/refractory CLL (N = 96) who were entering a phase 2 trial of an experimental therapy (ibrutinib) were studied. Before the first dose, a validated self-report measure of stress (the Impact of Event Scale) was completed, and blood was drawn for absolute lymphocyte counts (ALCs) and for cytokine and chemokine enzyme-linked immunosorbent assays. Multiple linear regression models tested stress as a concurrent predictor of ALCs; of cytokines (tumor necrosis factor α [TNFα], a proliferation-inducing ligand [APRIL], B-cell activating factor [BAFF], interleukin 6 [IL-6], IL-10, IL-16, and vascular endothelial growth factor [VEGF]); and of the chemokine (C-C motif) ligand 3 (CCL3).

Results: Controlling for relevant demographic variables, comorbidities, CLL genetic risk (deletion of the short arm of chromosome 17 [del17p]), and correlates of inflammation, stress predicted higher ALCs (P < .05), and higher levels of TNFα (P < .05), IL-16 (P < .01), and CCL3 (P < .05). Stress was not associated with APRIL, BAFF, IL-6, IL-10, or VEGF.

Conclusions: Novel biobehavioral data from patients with relapsed/refractory CLL demonstrate that stress is related to heightened levels of cellular, cytokine, and chemokine markers associated previously with progressive disease in CLL. The current results indicate that stress is related to immune and inflammatory processes that contribute to cancer cell proliferation and survival. These data provide a first look into these processes. Cancer 2018. © 2018 American Cancer Society.

Keywords: chemokines; chronic lymphocytic leukemia; cytokines; psychological stress.

Publication types

  • Clinical Trial, Phase II
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenine / analogs & derivatives
  • Aged
  • B-Cell Activating Factor / blood
  • Biomarkers, Tumor / blood*
  • Biomarkers, Tumor / immunology
  • Cell Proliferation / genetics
  • Female
  • Humans
  • Immunity, Innate / drug effects
  • Inflammation / blood
  • Inflammation / complications
  • Inflammation / immunology
  • Inflammation / psychology*
  • Interleukin-6 / blood
  • Leukemia, Lymphocytic, Chronic, B-Cell / complications
  • Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy
  • Leukemia, Lymphocytic, Chronic, B-Cell / immunology
  • Leukemia, Lymphocytic, Chronic, B-Cell / psychology*
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Piperidines
  • Prognosis
  • Pyrazoles / administration & dosage
  • Pyrazoles / adverse effects
  • Pyrimidines / administration & dosage
  • Pyrimidines / adverse effects
  • Stress, Psychological / complications
  • Stress, Psychological / drug therapy
  • Stress, Psychological / immunology
  • Stress, Psychological / psychology*
  • Tumor Necrosis Factor Ligand Superfamily Member 13 / blood
  • Tumor Necrosis Factor-alpha / blood
  • Vascular Endothelial Growth Factor A / blood

Substances

  • B-Cell Activating Factor
  • Biomarkers, Tumor
  • Interleukin-6
  • Piperidines
  • Pyrazoles
  • Pyrimidines
  • TNFSF13B protein, human
  • Tumor Necrosis Factor Ligand Superfamily Member 13
  • Tumor Necrosis Factor-alpha
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • ibrutinib
  • Adenine