Association of CD4 lymphopenia with survival in patients with advanced cancer.

Abstract

e21145 Background: Lymphopenia (lyp) is associated with an increased risk of toxicity and early death after cytotoxic chemotherapy (CT) in cancer patients (pts) and is also a prognostic factor for overall survival (OS) and progression free survival (PFS) in lymphoma, breast, and sarcoma pts. We report here the impact of CD4 lyp on patient survival after 10 years. Methods: 220 HIV negative pts treated in 2C dept in the Centre L.Bérard (Lyon, France) were included in this study from 04/99 to11/00. 98 (45%) had lymphoma or myeloma, 58 (26%) sarcoma, 21 (9%) breast cancer and 43 (19%) for other cancers. Two groups of diseases: 1) chemocurable diseases (NHL or germ cell tumors), 2) seldom chemocurable disease (advanced carcinomas and sarcomas). Phenotypic analysis of peripheral blood lymphocyte (ly) subsets on d1 of CT was determined using flow cytometry. Prognostic factors were analyzed univariate and multivariate analysis using Cox model. Results: With a minimum follow-up of 10 years in the entire group, age>60, PS >1, stage, tumor type, baseline ly <700/uL, CD4 count<450/uL CD8<400/uL correlated to OS in univariate analysis. Using Cox model, age, PS, stage, tumor type, use of high-risk CT, and ly subsets independently correlated to OS. In lymphoma pts, baseline ly count<700/uL, CD4 count<450/uL, CD56 count <100/uL were independent prognostic factors for OS and PFS using Cox model. In sarcoma pts, baseline ly count <700/uL, CD4 count <450/uL and CD8 count <400/uL were independent risk factors for OS and PFS in multivariate analysis. In pts with seldom chemocurable diseases (advanced carcinomas and sarcomas), all pts with total ly < 400/ uL or CD4 ly < 200/ uL died within 18 months (median: 6 mos). In lymphoma and germ cell tumor pts, all pts but one with ly< 200/ uL or CD4 lymphocytes < 100/ uL relapsed and died. Conclusions: Peripheral blood lymphocyte subsets prior to initiation of CT is a strong predictor of OS and PFS in this series. All pts with advanced breast carcinoma or sarcoma and CD4 count<200/uL had a very short term survival.