Prognostic relevance of urinary neopterin in non-Hodgkin's lymphomas

Abstract

Neopterin excretion levels were assessed in 66 consecutive patients affected by non-Hodgkin's lymphomas (NHL). The logarithm of the mean value of the whole series was 2.71 (log [mumol neopterin/mol creatinine]), significantly higher (P less than 0.001) than the control value (2.12). Fifty-six of 66 patients had a raised excretion of neopterin in amounts statistically related to the stage of disease. The mean value (2.51) of patients in Stages I-II was lower than the mean value (2.86) of patients in Stage III-IV (P less than 0.001). The 2-year probability of survival was 64% for patients in Stages I-II and 34% for patients in Stages III-IV. However, patients with lower neopterin excretion (less than 2.65) fared better than patients with higher neopterin excretion, regardless of the stage. Longitudinal analysis showed a trend toward a correlation between response to therapy and neopterin excretion. In NHL, the raised neopterin excretion appears to be a consequence of activation of the host immune system rather than a product of the malignant cells. But this excessive activation of the monocytes-macrophages, as reflected by urinary neopterin levels, is not accompanied by a better outcome. In conclusion, although neopterin cannot be considered a typical tumor marker, nevertheless it is an useful prognostic marker in NHL.

Predictive Value of Urinary Neopterin in Patients with Lung Cancer

“…Thus, neopterin as an indicator of activation of cell-mediated immune mechanism differs from a selection of several routine laboratory variables which carry practically no predictive information. This major result of the present study on lung cancer patients agrees with analogous observations in other malignancies: neopterin was found to be a significant and independent predictor in carcinoma of the uterine cervix (11) or of the ovaries (12), in prostatic carcinoma (13), in patients with hepatocellular carcinoma (14), in various haematological neoplasms (15)(16)(17), and in colon carcinoma (18).…”

Serum neopterin levels in children with hepatitis-B-related chronic liver disease and its relationship to disease severity

“…It has been reported that neopterin levels increase in body fluids and change in parallel to the activity of the disease in many infectious diseases and various malign disorders in which activation of the cellular immune system plays an important role in the pathogenesis [7,16,17] . It has been shown that the activation of cellular immune system stimulates the secretion of γ-interferon from the T lymphocytes, and γ-interferon is an effective inducer of neopterin release by monocytes/macrophages [10] .…”

“…It has been demonstrated that there is a relation between neopterin levels in biological materials, the changes in their elimination rates and various pathological conditions. In addition to its association with activation of cell-mediated immunity and with cell expansion, significant changes were seen in neopterin levels and elimination rates in viral diseases (for example viral hepatitis) [2,3] , atypical phenylketonuria [4] , organ and tissue rejection [5] , autoimmune diseases (such as rheumatoid arthritis and systemic lupus erythematosus [6] ), genital cancer and hematologic neoplastic disorders [7,8] . In all these cases, enhanced concentrations of neopterin have been shown to have prognostic significance [9] .…”

Urinary Neopterin in Monoclonal Gammopathies

“…Thi s effect can be sy nergisticall y enhanced by tumor necrosis factor alpha (6). Neopterin has been shown to be of prognostic value in Hodgkin's disease, nonHodgkin's lymphoma and chronic myelogenous leukemia (7,8).…”