Lymphopenia during chemoradiation—foe or friend

Abstract

Background Severe lymphopenia during treatment is considered to be a poor prognostic factor. The current literature lacks information regarding its impact on various outcomes in locally advanced head-and-neck cancer patients in a prospective setting. Methods We recently published a randomised study comparing cisplatin–radiation with nimotuzumab cisplatin–radiation. The database of this study was used for the present analysis. The impact of severe lymphopenia (grade 4 lymphopenia) on progression-free survival (PFS), locoregional control (LRC) and overall survival (OS) was studied using the Kaplan–Meier method and Cox regression analysis. The binary logistic regression analysis was used to see the effect of various factors on the development of severe lymphopenia. Results We had a total of 536 patients, of which 521 patients (97.7%) developed lymphopenia. Grade 1 lymphopenia was noted in 10 (1.9%) patients, grade 2 in 100 (18.8%), grade 3 in 338 (63.1%) and grade 4 in 73 (13.7%) patients. The median PFS was 20.53 and 60.33 months in severe and non-severe lymphopenia, respectively (hazard ratio, 0.797; p -value = 0.208). The median duration of LRC was 56.3 months in severe lymphopenia, whereas it was not reached in non-severe lymphopenia (hazard ratio, 0.81; p -value = 0.337). The median OS was 28.46 versus 47.13 months in severe and non-severe lymphopenia, respectively (hazard ratio, 0.76; p -value = 0.11). Of various risk factors, gender was significantly associated with severe lymphopenia. Conclusion The occurrence of severe lymphopenia was not significantly associated with the outcomes. Gender is the only risk factor significantly linked to severe lymphopenia.

Cancer and tuberculosis: A lethal duo

“…The presence of lymphopenia (Lymphocytes: 9%) suggested the immunocompromised condition of the patient at presentation. This could potentially be related to the chemo-radiotherapy that the patient had received for cancer treatment in the past [3,4]. The pulmonary parenchyma, pleura, airways, pulmonary vascular system, mediastinum, or the neuromuscular system that con-trols breathing can all be affected by chemotherapy-induced lung damage [5].…”

“…Our patient had lymphopenia. Lymphopenia in cancer patients might be functional or caused by treatment [4]. Because lymphocytes are essential in the anti-tumour immune response; cancer treatments can typically suppress reservoir lymphoid organs, resulting in lymphopenia, linked to an increased risk of opportunistic infections and worse oncologic outcomes.…”

Metastatic patterns and treatment options for head and neck cutaneous squamous cell carcinoma (Review)

“…Immune checkpoints facilitate an appropriate immune response while preventing the death of healthy tissues and immune hyperactivation, as seen in autoimmune disorders ( 60 ). A compromised immune system promotes mutations; therefore, subsets of cancer cells are able to evade immune detection owing to the compromised antitumor response of the immune system ( 61 ). This evasion is referred to as the escape mode, which permits unregulated tumor growth and progression ( 62 ).…”

Head and neck carcinoma in patients not eligible for platinum

“…Este estudio demostró una SG a 2 años del 69 % para el grupo de cisplatino y del 79 % para el grupo de docetaxel; la SLP a 2 años fue del 57 y del 66 %, respectivamente (33). Si bien existen resultados positivos de la adición del docetaxel a RDT en pacientes inelegibles para cisplatino en un estudio de fase III, estos datos provienen de un estudio con solo un 31 % de pacientes tratados en adyuvancia, sin datos específicos sólidos reportados para esta población (25). Por ello, en los pacientes con CECC-LA intervenidos con margen afecto o próximo (< 5 mm) o extensión extracapsular, el tratamiento estándar en paciente unfit para cisplatino continúa siendo la RDT adyuvante hasta 66 Gy a 2 Gy/Fx sin tratamiento sistémico, dado que no existen resultados positivos de estudios de fase III aleatorizados específicos en esta población (19).…”

“…La SLP y la SG a 2 años fue superior en el grupo de docetaxel: el 42 frente al 30 % (HR: 0,673; IC 95 %, 0,52-0,87, p = 0,002) y el 50,8 frente al 41,7 % (HR: 0,747; IC 95 %, 0,569-0,980; p = 0,035), respectivamente. La combinación con docetaxel presenta una mayor toxicidad, a expensas de mucositis y odinodisfagia(25). Este estudio presenta importantes limitaciones: estudio unicéntrico realizado en La India, incluye población mixta (69 %, tratamiento radical basado en RDT; 31 %, adyuvante pos-IQ), 70 % RDT 2D y se realizó un cierre precoz del reclutamiento, por lo que sus resultados deben interpretarse con cautela.…”