OBJECTIVES: Lymphopenia is a common consequence of chemoradiation therapy yet is seldom addressed clinically. This study was conducted to determine if patients with locally advanced pancreatic cancer (LAPC) treated with definitive chemoradiation develop significant lymphopenia and if this affects clinical outcomes. METHODS: A retrospective analysis of patients with LAPC treated with chemoradiation at a single institution from 1997 to 2011 was performed. Total lymphocyte counts (TLCs) were recorded at baseline and then monthly during and after chemoradiation. The correlation between treatment-induced lymphopenia, established prognostic factors, and overall survival was analyzed using univariate Cox regression analysis. Important factors identified by univariate analysis were selected as covariates to construct a multivariate proportional hazards model for survival. RESULTS: A total of 101 patients met eligibility criteria. TLCs were normal in 86% before chemoradiation. The mean reduction in TLC per patient was 50.6% (SD, 40.6%) 2 months after starting chemoradiation (P<0.00001), and 46% had TLC<500 cells/mm. Patients with TLC<500 cells/mm 2 months after starting chemoradiation had inferior median survival (8.7 vs. 13.3 mo, P=0.03) and PFS (4.9 vs. 9.0 mo, P=0.15). Multivariate analysis revealed TLC<500 cells/mm to be an independent predictor of inferior survival (HR=2.879, P=0.001) along with baseline serum albumin (HR=3.584, P=0.0002), BUN (HR=1.060, P=0.02), platelet count (HR=1.004, P=0.005), and radiation planning target volume (HR=1.003, P=0.0006). CONCLUSIONS: Severe treatment-related lymphopenia occurs frequently after chemoradiation for LAPC and is an independent predictor of inferior survival.
OBJECTIVES: Lymphopenia is a common consequence of chemoradiation therapy yet is seldom addressed clinically. This study was conducted to determine if patients with locally advanced pancreatic cancer (LAPC) treated with definitive chemoradiation develop significant lymphopenia and if this affects clinical outcomes. METHODS: A retrospective analysis of patients with LAPC treated with chemoradiation at a single institution from 1997 to 2011 was performed. Total lymphocyte counts (TLCs) were recorded at baseline and then monthly during and after chemoradiation. The correlation between treatment-induced lymphopenia, established prognostic factors, and overall survival was analyzed using univariate Cox regression analysis. Important factors identified by univariate analysis were selected as covariates to construct a multivariate proportional hazards model for survival. RESULTS: A total of 101 patients met eligibility criteria. TLCs were normal in 86% before chemoradiation. The mean reduction in TLC per patient was 50.6% (SD, 40.6%) 2 months after starting chemoradiation (P<0.00001), and 46% had TLC<500 cells/mm. Patients with TLC<500 cells/mm 2 months after starting chemoradiation had inferior median survival (8.7 vs. 13.3 mo, P=0.03) and PFS (4.9 vs. 9.0 mo, P=0.15). Multivariate analysis revealed TLC<500 cells/mm to be an independent predictor of inferior survival (HR=2.879, P=0.001) along with baseline serum albumin (HR=3.584, P=0.0002), BUN (HR=1.060, P=0.02), platelet count (HR=1.004, P=0.005), and radiation planning target volume (HR=1.003, P=0.0006). CONCLUSIONS: Severe treatment-related lymphopenia occurs frequently after chemoradiation for LAPC and is an independent predictor of inferior survival.
Authors: A Elnemr; T Ohta; A Yachie; M Kayahara; H Kitagawa; I Ninomiya; S Fushida; T Fujimura; G Nishimura; K Shimizu; K Miwa Journal: Int J Oncol Date: 2001-01 Impact factor: 5.650
Authors: Jian L Campian; Anna F Piotrowski; Xiaobu Ye; Frances T Hakim; Jeremy Rose; Xiao-Yi Yan; Yao Lu; Ronald Gress; Stuart A Grossman Journal: J Neurooncol Date: 2017-07-29 Impact factor: 4.130
Authors: Ryoko Suzuki; Steven H Lin; Xiong Wei; Pamela K Allen; James W Welsh; Lauren A Byers; Ritsuko Komaki Journal: Radiother Oncol Date: 2018-02-02 Impact factor: 6.280
Authors: Anna F Piotrowski; Thomas R Nirschl; Esteban Velarde; Lee Blosser; Sudipto Ganguly; Kathleen H Burns; Leo Luznik; John Wong; Charles G Drake; Stuart A Grossman Journal: Oncoimmunology Date: 2018-05-09 Impact factor: 8.110
Authors: Emily S Wu; Titilope Oduyebo; Lauren P Cobb; Diana Cholakian; Xiangrong Kong; Amanda N Fader; Kimberly L Levinson; Edward J Tanner; Rebecca L Stone; Anna Piotrowski; Stuart Grossman; Kara Long Roche Journal: Gynecol Oncol Date: 2015-11-11 Impact factor: 5.482
Authors: Radhe Mohan; Amy Y Liu; Paul D Brown; Anita Mahajan; Jeffrey Dinh; Caroline Chung; Sarah McAvoy; Mary Frances McAleer; Steven H Lin; Jing Li; Amol J Ghia; Cong Zhu; Erik P Sulman; John F de Groot; Amy B Heimberger; Susan L McGovern; Clemens Grassberger; Helen Shih; Susannah Ellsworth; David R Grosshans Journal: Neuro Oncol Date: 2021-02-25 Impact factor: 12.300