title: CD4 lymphopenia to identify end-of-life metastatic cancer patients.
abstract: BACKGROUND
  Cancer patients with CD4 lymphopenia have an increased risk of severe toxicity after administration of cytotoxic chemotherapy. The impact of CD4 lymphopenia on long term overall survival (OS) of cancer patients was explored in this work.
  
  
  METHODS
  The first prospective series (test series) included 219 patients with solid tumours, lymphomas or myelomas receiving chemotherapy within an oncology department in 1999 and 2000. A phenotypic analysis of lymphocyte subsets by flow cytometry was performed before chemotherapy on day 1. The prognostic value of total, CD4, CD8 and CD56 lymphocyte count for OS was tested in a multivariate analysis. The prognostic value of low CD4 counts was then tested in a validation series of 269 patients with metastatic solid tumours in second line treatment included in a prospective observational study in the Centre Leon Berard.
  
  
  RESULTS
  In the test series, all patients with metastatic cancers and CD4 lymphopenia ≤ 200/μL (12% of metastatic patients) died within 18 months with a median OS of 5.9 months. CD4 count was an independent prognostic factor for OS and PFS in multivariate analysis. In the validation series, 83 (30%) of patients had CD4 count ≤ 200/μL: their median overall survival was 3.9 months with an 18-month survival rate of 6%. CD4 count was also an independent prognostic factor for overall survival in this series.
  
  
  CONCLUSIONS
  CD4 lymphopenia <200/μL is frequent in advanced cancer patients and associated with a very short life expectancy. These patients should be proposed for specific treatment and research approaches.
authors.affiliation: Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Péron
authors.forename: Claire
authors.initials: C
authors.lastname: Cropet
authors.forename: Olivier
authors.initials: O
authors.lastname: Tredan
authors.forename: Thomas
authors.initials: T
authors.lastname: Bachelot
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
authors.forename: Gilles
authors.initials: G
authors.lastname: Clapisson
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chabaud
authors.forename: Irene
authors.initials: I
authors.lastname: Philip
authors.forename: Christophe
authors.initials: C
authors.lastname: Borg
authors.forename: Philippe
authors.initials: P
authors.lastname: Cassier
authors.forename: Inthidar
authors.initials: I
authors.lastname: Labidi Galy
authors.forename: Catherine
authors.initials: C
authors.lastname: Sebban
authors.forename: David
authors.initials: D
authors.lastname: Perol
authors.forename: Pierre
authors.initials: P
authors.lastname: Biron
authors.forename: Christophe
authors.initials: C
authors.lastname: Caux
authors.forename: Christine
authors.initials: C
authors.lastname: Menetrier-Caux
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology* / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D008231:Lymphopenia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate