title: Early lymphocyte recovery as a prognostic indicator for high-risk Ewing sarcoma.
abstract: BACKGROUND
  Increasing evidence suggests that lymphocyte recovery plays a major part in tumor control. Facilitating immune reconstitution might be a novel direction of cancer therapy. The purpose of this study was to determine if early lymphocyte recovery is an independent prognostic indicator for high-risk Ewing sarcoma outcome.
  
  
  RESULTS
  Data of 24 Ewing sarcoma patients were analyzed (age, 3 to 50 y; median, 16.5; male to female, 16:8). The 5-year overall survival (OS) of the total population was 47.9% [10.6 standard error (SE)]. Patients were separated into 2 groups: prolonged lymphopenia versus early lymphocyte recovery, using a threshold absolute lymphocyte count (ALC) of > or =500 cells/microL on day 15. The majority (67%; n=16) of the patients had an ALC > or =500 cells/microL, and of these 10/16 are alive with a 5-year OS of 58.7% (13.2 SE). In contrast, 33% (n=8) of patients had an ALC <500 cells/microL on day 15 and only 2/8 are alive with a 5-year OS of 25% (15.3 SE). This difference was significant (P=0.007 using the log rank test). When comparing patients with metastatic disease, patients with an ALC-15 < 500 cells/microL had a median survival of 13 months, whereas patients with an ALC-15 > or =500 cells/microL had a median survival of 29.5 months. All patients had an ALC before chemotherapy of >1000 cells/microL. The difference was significant (P value=0.001 using the log rank test). Univariate analysis of platelet counts, age, sex, and absolute neutrophil count showed no statistically significant association with OS.
  
  
  CONCLUSIONS
  The data demonstrate that an ALC > or =500 cells/microL on day 15 of the first course of chemotherapy is an independent prognostic factor associated with superior OS in high-risk Ewing sarcoma.
authors.affiliation: Department of Biostatistics and Mathematics, University of Texas M.D. Anderson Cancer Center/Children's Cancer Hospital, 1515 Holcombe Boulevard, Houston, TX 77030, USA. grdeangu@mdanderson.org
authors.forename: Guillermo
authors.initials: G
authors.lastname: De Angulo
authors.forename: Mike
authors.initials: M
authors.lastname: Hernandez
authors.forename: Jaime
authors.initials: J
authors.lastname: Morales-Arias
authors.forename: Cynthia E
authors.initials: CE
authors.lastname: Herzog
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolff
authors.forename: Eugenie S
authors.initials: ES
authors.lastname: Kleinerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012512:Sarcoma, Ewing / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D012737:Sex Factors; D015996:Survival Rate