Lymphopenia as a Prognostic Factor for Overall Survival in Advanced Carcinomas, Sarcomas, and Lymphomas

Abstract

Lymphopenia is frequent in advanced cancers and predicts the toxicity of chemotherapy. Its effect on relapse and survival is uncertain. Its prognostic value for survival was analyzed in three databases of previously reported prospective multicenter studies: (a) FEC chemotherapy in metastatic breast carcinoma; (b) CYVADIC in advanced soft tissue sarcoma (European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group 62791); and (c) prospective, consecutive phase III studies of aggressive diffuse large-cell non-Hodgkin's lymphomas conducted at Centre Léon Bérard between 1987 and 1993. Univariate and multivariate analyses of prognostic factors for survival were performed. The incidence of lymphopenia of <1,000/ML before treatment was constant among the series: 25%, 24%, and 27%, respectively. Lymphopenia was significantly more frequent (P < 0.05) in metastatic breast cancer patients with performance status (PS) of >1, non-Hodgkin's lymphoma patients with international prognostic index (IPI) of > 0, and advanced soft tissue sarcoma and metastatic breast cancer patients with bone metastases. In univariate analysis, lymphopenia of <1,000/ML significantly correlated to overall survival in patients with metastatic breast cancer (median, 10 versus 14 mo; P < 0.0001), advanced soft tissue sarcoma (median, 5 versus 10 months; P < 0.01), and nonHodgkin lymphoma (median, 11 versus 94 months; P < 0.0001). In multivariate analysis (Cox model), lymphopenia was an independent prognostic factor for overall survival in metastatic breast cancer [RR (relative risk), 1.8; 95% CI (confidence interval), 1.3-2.4] along with liver metastases and PS; in advanced soft tissue sarcoma (RR, 1.46; 95% CI, 1.0-2.1) along with liver metastases, lung metastases, and PS; and in nonHodgkin's lymphoma (RR, 1.48; 95% CI, 1.03-2.1) along with IPI. Our findings show that lymphopenia is an independent prognostic factor for overall and progression-free survival in several cancers. [Cancer Res 2009;69(13):5383-91]

A comparison of DNA methylation specific droplet digital PCR (ddPCR) and real time qPCR with flow cytometry in characterizing human T cells in peripheral blood

“…16,17 More generally, T cell lymphopenia has been shown to be a grave prognostic indicator in multiple types of cancers. [18][19][20][21][22][23] Recently, digital PCR platforms have been developed that offer advantages over real time qPCR including the capability to obtain absolute quantification without external references and to be highly robust to variations in PCR efficiency, thus improving assay precision. [25][26][27] Digital PCR is based on limiting dilution of a sample into a large number of separate PCR reactions.…”

Preoperative High Neutrophil-Lymphocyte Ratio May Be Associated with Lateral Lymph Node Metastasis in Patients with Papillary Thyroid Cancers

“…23) In different types of cancer, if a cancer patient has a lower peripheral blood lymphocyte count, he or she has a poorer chance of survival. 24,25) An association between high NLR and worse prognostic outcomes has been well demonstrated in various non-thyroid cancers, including gastric, colorectal, lung, pancreatic, hepatocellular, renal cell carcinoma, cholangiocarcinoma and breast cancer.…”

Is Absolute Lymphocyte Count Just Another Prognostic Factor in Cancer?

“…In breast cancer, women with an ALC ≥ 2.0 × 10 9 /L at diagnosis had a superior 5-year survival for stage I (80%), stage II (63%), and stage III (53%) compared with breast cancer patients with an ALC < 2.0 × 10 9 /L for stage I (74%), stage II (44%), and stage III (18%) [11]. In a large cohort of 287 hormone-resistant metastatic breast cancer patients, Ray-Coquard et al [8] showed superior overall and progression-free survival for patients with an ALC ≥ 1.0 × 10(9)/L compared with those who did not prior to treatment [median overall survival: 13.6 months versus 9.5 months, P < .0001; and median progressionfree survival: 8.5 months versus 6.8 months, P < .0001, respectively]. In a cohort of 113 women with metastatic or recurrent breast cancer, patients with a higher peripheral blood CD8 count experienced superior survival.…”

“…More recently, ALC at diagnosis appears to also predict survival in patients with in diffuse large Bcell lymphoma (DLBCL) improving the prognostic ability of the International Prognostic Index [4][5][6], as well as in follicular lymphoma, augmenting the prognostic ability of the Follicular Lymphoma International Prognostic index (FLIPI) [7]. Using an ALC cut-off values of 1.0 × 10(9)/L, Ray-Coquard et al [8] reported in a large cohort of 322 nonHodgkin's lymphoma (NHL) patients poor clinical outcomes in patients with an ALC < 1.0 × 10(9)/L. The median overall survival was 11.3 months for NHL patients with an ALC < 1.0 × 10(9)/L compared with 94.3 months for NHL patients with an ALC ≥ 1.0 × 10(9)/L.…”