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MO_13_2806 - Severe lymphopenia after chemoradiation treatment is associated with worse survival in patients with newly diagnosed GBM

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Severe lymphopenia after chemoradiation treatment is associated with worse survival in patients with newly diagnosed GBM
A. J. Song1, S. Gowda2, L. Kim3, M. Werner-Wasik1, D. W. Andrews3, J. Glass3, K. Judy3, C. Farrell3, and W. Shi1; 1Dept of Radiation Oncology, Thomas Jefferson University Sidney Kimmel Cancer Center, Philadelphia, PA, 2Drexel University College of Medicine, Philadelphia, PA, 3Dept of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA

Purpose/Objective(s): To investigate the rate of lymphopenia after receiving definitive adjuvant chemoradiation therapy (CRT) for glioblastoma (GBM) patients and potential effects on clinical outcomes.

Materials/Methods: We conducted a retrospective review of GBM patients treated with definitive adjuvant CRT at our institution covering a period from 2008 to 2016. We identified 96 patients with sufficient details regarding their treatment course as well as complete blood count with differential at approximately 1 month after completion of adjuvant CRT and subsequent follow-up information. Lymphopenia was determined as lymphocyte count <850 cells/µL (severe lymphophenia defined as lymphocyte count <400 cells/µL, mild-moderate lymphopenia≥400 cells/ µL and <850 cells/µL), while pancytopenia was determined as lymphopenia plus leukopenia (WBC<3.8x103/µL), anemia (RBC<4.2x106/µL), and thrombocytopenia (platelet<140x103). We measured overall survival (OS) as well as progression-free survival (PFS). We performed summary statistics on baseline patient characteristics as well as Kaplan-Meier analysis for outcomes with log-rank test to compare subgroups.

Results: Of the 96 patients, 51 (53.5%) were male, and 45 (46.9%) were female. Median age at start of RT was 61 years old (range 33 to 88). Median follow-up was 16.8 months (range 2.3 to 61.1). Seven (7.3%) patients were still alive at time of writing, of which five had evidence of recurrence, leaving only two (2.1%) which remained disease free. Lymphopenia at 1 month post-RT was observed in 55 (57.3%) of patients, of which 13 patients (13.5%) had severe lymphopenia. Four patients (4.2%) had lymphopenia occurring in the setting of pancytopenia. Median OS for all patients was 16.5 months, with 1 year OS at 69.8% and 2 year OS at 29.9%. When comparing subgroups of patients with lymphopenia vs without, there was no significant difference in OS or PFS. The median OS was 16.5 mos vs 18 mos, with 1 year OS at 67.3% vs 73.2%, and 2 year OS at 32.5% vs 26.9%, respectively (p=0.68). Median PFS for all patients was 6.7 months, with 1 year PFS at 25% and 2 year PFS at 7.3%. For patients with lymphopenia vs without, median PFS was 6.2 mos vs 6.9 mos, with 1 year PFS at 30.9% vs 17.1%, and 2 year PFS at 9.1% vs 4.9%, respectively (p=0.34). For patients with severe lymphopenia, overall survival was worse, with median OS of 8.4 mos, 1 year OS was 46.1% and 2 year OS was 15.3%, with significantly worse prognosis when compared to patients without lymphopenia (p=0.041) as well as with those with mild-moderate lymphopenia (p=0.024). Median PFS for severe lymphopenia patients was 5.5 mos, with 1 year PFS of 23.1% and 2 year PFS at 7.7% with no statistically significant difference amongst subgroup comparison (p>0.05).

Conclusion: Severe lymphopenia appears to have a negative impact on overall survival for GBM patients and should be considered as a prognostic factor for clinical outcomes.

Author Disclosure: A.J. Song: None. S. Gowda: None. L. Kim: None. M. Werner-Wasik: Stock; Illumina. D.W. Andrews: None. K. Judy: None. C. Farrell: None.

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