PURPOSE: Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters. METHODS AND MATERIALS: From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL. RESULTS: Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006). CONCLUSIONS: Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL.
PURPOSE: Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters. METHODS AND MATERIALS: From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL. RESULTS: Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006). CONCLUSIONS: Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL.
Authors: Neha Kamran; Mahmoud S Alghamri; Felipe J Nunez; Diana Shah; Antonela S Asad; Marianela Candolfi; David Altshuler; Pedro R Lowenstein; Maria G Castro Journal: Immunotherapy Date: 2018-02-01 Impact factor: 4.196
Authors: Sweet Ping Ng; Houda Bahig; Amit Jethanandani; Courtney Pollard; Joel Berends; Erich M Sturgis; Faye M Johnson; Baher Elgohari; Hesham Elhalawani; David I Rosenthal; Heath D Skinner; G Brandon Gunn; Jack Phan; Steven J Frank; Abdallah S R Mohamed; Clifton D Fuller; Adam S Garden Journal: Radiother Oncol Date: 2020-01-10 Impact factor: 6.280
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