Association between treatment-related lymphopenia and overall survival in elderly patients with newly diagnosed glioblastoma.
Association between treatment-related lymphopenia and overall survival in elderly patients with newly diagnosed glioblastoma.
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DOI：
10.1007/s11060-015-2037-1
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发表时间：
2016-04
影响因子：
3.9
通讯作者：
Campian JL
中科院分区：
文献类型：
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作者：
Mendez JS;Govindan A;Leong J;Gao F;Huang J;Campian JL
胶质母细胞瘤（GBM）患者的管理通常包括放疗（RT）和替莫唑胺（TMZ）。在中位年龄为57岁的GBM患者中报告了标准放化疗后严重治疗相关淋巴细胞减少症（TRL）与生存率降低之间的相关性。在头颈癌、非小细胞肺癌和胰腺癌患者中也有类似的发现。这项回顾性研究旨在评估老年GBM患者（年龄≥65岁）在RT/TMZ后是否发生类似的TRL，以及此类TRL是否与生存率降低相关。回顾性分析了接受RT/ TMZ治疗的新诊断GBM患者（年龄≥65岁）的系列总淋巴细胞计数（TLC），并与治疗结局相关。72例患者符合条件：中位KPS 70，中位年龄71岁（范围65-86），56%的患者>70岁，53%为女性，31%接受RT ≤45戈伊。基线中值TLC为1100个细胞/mm 3，在开始RT/TMZ后2个月下降41%至650个细胞/mm 3（p < 0.0001）。2个月时TLC <500个细胞/mm 3的患者的生存期短于TLC较高的患者，中位总生存期分别为4.6个月和11.6个月。多变量分析显示TRL与生存率之间存在显着相关性（HR 2.76，95%CI 1.30-5.86，p = 0.008）。治疗相关的淋巴细胞减少症是常见的，严重的，是老年GBM患者生存的独立预测因素。这些发现为放化疗诱导的免疫抑制与较差的临床结局相关提供了证据。需要前瞻性研究来证实这些发现，这表明免疫保护在这种癌症中很重要。
Management of patients with glioblastoma (GBM) often includes radiation (RT) and temozolomide (TMZ). The association between severe treatment-related lymphopenia (TRL) after the standard chemoradiation and reduced survival has been reported in GBM patients with the median age of 57. Similar findings were described in patients with head and neck, non-small cell lung, and pancreatic cancers. This retrospective study is designed to evaluate whether elderly GBM patients (age ≥65) develop similar TRL after RT/TMZ and whether such TRL is associated with decreased survival. Serial total lymphocyte counts (TLC) were retrospectively reviewed in patients (age ≥65) with newly diagnosed GBM undergoing RT/ TMZ and associated with treatment outcomes. Seventy-two patients were eligible: median KPS 70, median age 71 years (range 65–86) with 56 % of patients >70 years, 53 % female, 31 % received RT ≤45 Gy. Baseline median TLC was 1100 cells/mm3 which fell by 41 % to 650 cells/ mm3 2 months after initiating RT/TMZ (p < 0.0001). Patients with TLC <500 cells/mm3 at 2 months had a shorter survival than those with higher TLCs with a median overall survival of 4.6 versus 11.6 months, respectively. Multivariate analysis revealed a significant association between TRL and survival (HR 2.76, 95 % CI 1.30–5.86, p = 0.008). Treatment-related lymphopenia is frequent, severe, and an independent predictor for survival in elderly patients with GBM. These findings add to the body of evidence that immunosuppression induced by chemoradiation is associated with inferior clinical outcomes. Prospective studies are needed to confirm these findings suggesting that immune preservation is important in this cancer.