This observation is in line with results reported by Pierga et al. [ 9], showing that OS was better in patients with persistently low CTC counts (< 5 CTCs/7.5 ml blood) than in initially CTC positive patients with low CTC counts after one treatment cycle.
Interestingly, 27% of the patients were not on HAART and had persistently low CD4 counts for more than 6 months and did not develop any ocular lesion attributable to HIV.
Three patients had severe lymphopenia, with lymphocyte counts persistently <200 × 10 cells/L.
Complicating factors, such as immune thrombocytopenia, may result in persistently low-platelet counts (Haratz et al, 1990).
Although persistently low leukocyte counts have certainly contributed to the severe infection, immunosuppression by an incipient lymphoma relapse cannot be excluded.
Candidiasis is the most common opportunistic infection seen in HIV-infected children, particularly in HIV-infected children with persistently low CD4+ counts [ 16].
About 30% of HIV-infected adults receiving HAART exhibit a sustained CD4+ increase despite therapy failure, or they have persistently low CD4+ counts despite a significant decrease in VL [ 17].
The DIC patients with the fibrinolytic phenotype exhibited persistently lower platelet counts and fibrinogen levels, increased prothrombin time ratios, higher FDP and D-dimer levels, and lower antithrombin levels compared with the non-DIC patients on arrival to the emergency department and during the early stage of trauma.
However, a recent prospective randomized phase III clinical trial of patients with metastatic breast cancer (SWOG S0500) showed that early change in therapy based on persistently elevated CTC counts three weeks after starting a drug did not change patient outcome - likely due to poor efficacy of the drugs these metastatic patients received after switching therapy [ 36].
Consistent with the results of previous studies on DIC after trauma, persistently lower platelet counts and fibrinogen levels, higher prothrombin time ratios, higher levels of FDP and D-dimer, and lower levels of antithrombin were observed in the DIC patients compared with those observed in the non-DIC patients from day 0 to day 2 [ 3].
Our data demonstrate that patients with favorable CTC kinetics, i.e. those whose CTC status after one cycle of therapy (CTC1C) was negative, were more likely to respond to therapy as determined by RECIST criteria than patients with persistently high CTC counts [ 5, 8, 16, 17].
