Survival in Patients With Severe Lymphopenia Following Treatment With Radiation and Chemotherapy for Newly Diagnosed Solid Tumors.
BACKGROUND
The immune system plays an important role in cancer surveillance and therapy. Chemoradiation can cause severe treatment-related lymphopenia (TRL) (<500 cells/mm3) that is associated with reduced survival.


METHODS
Data from 4 independent solid tumor studies on serial lymphocyte counts, prognostic factors, treatment, and survival were collected and analyzed. The data set included 297 patients with newly diagnosed malignant glioma (N=96), resected pancreatic cancer (N=53), unresectable pancreatic cancer (N=101), and non-small cell lung cancer (N=47).


RESULTS
Pretreatment lymphocyte counts were normal in 83% of the patient population, and no patient had severe baseline lymphopenia. Two months after initiating chemoradiation, 43% developed severe and persistent lymphopenia (P=.001). An increased risk for death was attributable to TRL in each cancer cohort (gliomas: hazard rate [HR], 1.8; 95% CI, 1.13-2.87; resected pancreas: HR, 2.2; 95% CI, 1.17-4.12; unresected pancreas: HR, 2.9; 95% CI, 1.53-5.42; and lung: HR, 1.7; 95% CI, 0.8-3.61) and in the entire study population regardless of pathologic findings (HR, 2.1; 95% CI, 1.54-2.78; P<.0001). Severe TRL was observed in more than 40% of patients 2 months after initiating chemoradiation, regardless of histology or chemotherapy regimen, and was independently associated with shorter survival from tumor progression.


CONCLUSIONS
Increased attention and research should be focused on the cause, prevention, and reversal of this unintended consequence of cancer treatment that seems to be related to survival in patients with solid tumors.
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Stuart A
SA
Grossman
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Susannah
S
Ellsworth
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Jian
J
Campian
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Aaron T
AT
Wild
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Joseph M
JM
Herman
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Dan
D
Laheru
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Malcolm
M
Brock
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Ani
A
Balmanoukian
From The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland; Washington University, St. Louis, Missouri; Memorial Sloan Kettering Cancer Center, New York, New York; and The Angeles Clinic and Research Institute, Los Angeles, California.
Xiaobu
X
Ye
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D059248:Chemoradiotherapy / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D018655:Lymphocyte Count; D008231:Lymphopenia / Q000139:chemically induced / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy