title: Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans.
abstract: Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95% CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95% CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95% CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95%CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.
authors.affiliation: Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mantzaris
authors.affiliation: Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Yiting
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, New York, USA.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Msaouel
authors.affiliation: Department of Oncology, Stanford University, Stanford, CA, USA.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Lam
authors.affiliation: Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Murali
authors.initials: M
authors.lastname: Janakiram
authors.affiliation: Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Friedman
authors.affiliation: Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steidl
authors.affiliation: Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Verma
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D015999:Multivariate Analysis; D009503:Neutropenia / Q000097:blood / Q000175:diagnosis* / Q000208:ethnology; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D044465:White People / Q000706:statistics & numerical data*
keywords: ethnicity; neutropenia; race; survival; African American