Abstract
e17552 Background: Severe treatment-related lymphopenia (TRL) is associated with shorter survival in patients with glioblastoma and pancreatic cancer treated with concurrent chemotherapy and radiation (chemo/RT). This retrospective study sought to determine if patients with stage III NSCLC develop TRL and if this results from chemotherapy or radiation. Methods: Patients selected for this retrospective analysis had newly diagnosed stage III NSCLC, Karnofsky performance status >60, and chemo/RT and follow-up blood counts at Johns Hopkins Hospital. Patients were divided into those who received neoadjuvant chemotherapy followed by chemo/RT and those who received only chemo/RT. Serial lymphocyte counts were analyzed. Results: Forty-six adults met the above eligibility criteria. Their median age was 62 years (range 43-79), 65% were female, 74% were stage IIIA and 26% were IIIB, 72% had adenocarcinoma, and 68% were poorly differentiated. Surgery included pneumonectomy (7%), lobectomy (43%), wedge resection (7%), or biopsy (43%). Twenty patients received neoadjuvant chemotherapy consisting of 2 cycles of taxol/carboplatin (85%) or gemcitabine/carboplatin (15%). Their mean total lymphocyte count (TLC) prior to chemotherapy was 1416 cells/mm3 (SD 899). TLC remained unchanged after the neoadjuvant chemotherapy (mean 1519, SD 553). These patients then received concurrent chemo/RT (mean dose 58.4 Gy). TLC fell 68% at two months from a mean of 1519 (SD 553) to 490 (SD 305) (p<0.00001) with 55% having TLC ≤500 cells/mm3. The remaining 26 patients received only concurrent chemo/RT. Their initial TLCs were normal (mean 1807, SD 644) but two months later had fallen by 70% (mean 545, SD 397) (p<0.00001) with 54% having TLC ≤500 cells/mm3. Reductions in TLCs occurred irrespective of the chemotherapy administered with RT. Conclusions: TLCs are normal in patients with newly diagnosed stage III NSCLC and are unaffected by 2 cycles of neoadjuvant chemotherapy. However, with the addition of radiation TLCs drop in ~50% of patients to levels associated with severe immunosuppression. Further studies are needed to determine if this is associated with reduced survival as reported in other malignancies.
Published Version
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