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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 5/2022

01-05-2022 | Glioblastoma | Original Article

Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy

Authors: Roberto Mapelli, Chiara Julita, Sofia Paola Bianchi, Nicolò Gallina, MD, Raffaella Lucchini, MD, Martina Midulla, MD, Flavia Puci, MD, Jessica Saddi, MD, Sara Trivellato, PhD, Denis Panizza, PhD, Elena De Ponti, PhD, Stefano Arcangeli, MD

Published in: Strahlentherapie und Onkologie | Issue 5/2022

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Abstract

Purpose

Our study investigated the association between treatment-related lymphopenia and overall survival (OS) in a series of glioblastoma (GBM) patients. We also explored clinical and dosimetric predictors of lymphocytes depletion.

Methods

Between 2015 and 2019, 64 patients were treated at the same institution with postoperative chemoradiotherapy. Peripheral lymphocyte count (PLC) data and dose–volume histogram parameters were collected. Radiotherapy (RT) schedule consisted in standard total dose of 60 Gy in 30 daily fractions, with concomitant and adjuvant temozolomide (TMZ). Posttreatment acute absolute lymphopenia (nadir AAL) was calculated as a PLC lower than 1.0 × 103/mm3. Acute relative lymphopenia (ARL) was expressed by the nadir-PLC/baseline-PLC ratio < 0.5. Nadir-PLC was the lowest PLC registered between the end of RT and the first month of follow-up. Survival rates were estimated with Kaplan–Meier curves. Clinical and dosimetric variables related to AAL/ARL and OS were identified by univariate and multivariate analyses.

Results

A total of 57 patients were eligible and included in the analyses. The median PLC was significantly decreased following chemoradiotherapy (2180/mm3 vs 900/mm3). Median OS was 16 months (range 5–55 months), with no significant difference between patients who developed nadir AAL and those who did not (16 months vs 16.5 months; p = 0.304). When considering ARL vs non-ARL, median OS was 14 months vs 26 months (p = 0.013), respectively. In multivariate Cox regression only age, sex, extent of surgery, access to adjuvant chemotherapy and brain D98% were independently associated with OS.

Conclusion

Although iatrogenic immunosuppression could be associated with inferior clinical outcomes, our data show that treatment-related lymphopenia does not adversely affect GBM survival. Prospective studies are required to confirm these findings.
Appendix
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Metadata
Title
Association between treatment-related lymphopenia and survival in glioblastoma patients following postoperative chemoradiotherapy
Authors
Roberto Mapelli
Chiara Julita
Sofia Paola Bianchi
Nicolò Gallina, MD
Raffaella Lucchini, MD
Martina Midulla, MD
Flavia Puci, MD
Jessica Saddi, MD
Sara Trivellato, PhD
Denis Panizza, PhD
Elena De Ponti, PhD
Stefano Arcangeli, MD
Publication date
01-05-2022
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 5/2022
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-021-01855-5

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