title: Association between severe treatment-related lymphopenia and progression-free survival in patients with newly diagnosed squamous cell head and neck cancer.
abstract: BACKGROUND
  Severe treatment-related lymphopenia occurs commonly in many cancers and is associated with early tumor progression. Data are lacking as to whether this occurs in squamous cell head and neck cancer.
  
  
  METHODS
  Serial total lymphocyte counts were retrospectively reviewed in patients with newly diagnosed squamous head and neck cancer undergoing chemoradiation and associated with treatment outcomes.
  
  
  RESULTS
  The median baseline total lymphocyte count in 56 patients was 1660 cells/mm(3) , which fell by 73% to 445 cells/mm(3) 2 months after initiating chemoradiation (p < .0001). Human papillomavirus negative (HPV-) patients with a total lymphocyte count <500 cells/mm(3) at 2 months had significantly earlier disease progression than those with higher total lymphocyte counts (hazard ratio [HR], 5.75; p = .045).
  
  
  CONCLUSIONS
  Baseline total lymphocyte counts were normal, but at 2 months approximately 60% of patients had severe treatment-related lymphopenia regardless of HPV status. Severe treatment-related lymphopenia in HPV- patients is independently associated with earlier disease progression. Prospective studies are needed to confirm these findings, which suggest that immune preservation is important in this cancer.
authors.affiliation: Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jian L
authors.initials: JL
authors.lastname: Campian
authors.forename: Guneet
authors.initials: G
authors.lastname: Sarai
authors.forename: Xiaobu
authors.initials: X
authors.lastname: Ye
authors.forename: Shanthi
authors.initials: S
authors.lastname: Marur
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Grossman
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate
keywords: chemotherapy; head and neck squamous cell carcinoma; lymphopenia; radiation; treatment-related toxicities