Impact of lymphopenia on survival for elderly patients with glioblastoma: A secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG08.02) randomized clinical trial. Issue 1 (15th October 2021)

• Record Type: Journal Article
• Authors: Song, Andrew J; Ding, Keyue; Alnahhas, Iyad; Laperriere, Normand J; Perry, James; Mason, Warren P; Winch, Chad; O'Callaghan, Chris J; Menten, Johan J; Brandes, Alba A; Phillips, Claire; Fay, Michael F; Nishikawa, Ryo; Osoba, David; Cairncross, J Gregory; Roa, Wilson; Wick, Wolfgang; Shi, Wenyin
• Is Part Of: Neuro-oncology advances. Volume 3:Issue 1(2021)
• Publication Date: 2021-10-15
• Subjects: elderly -- glioblastoma -- lymphopenia -- short-course radiotherapy -- temozolomide; 616.99481
• DOI: 10.1093/noajnl/vdab153
• Languages: English
• ISSNs: 2632-2498

Abstract

Abstract: Background: Lymphopenia may lead to worse outcomes for glioblastoma patients. This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on lymphopenia, and effects of lymphopenia on overall survival (OS). Methods: CCTG CE.6 randomized elderly glioblastoma patients (≥ 65 years) to short-course radiation alone (RT) or short-course radiation with temozolomide (RT + TMZ). Lymphopenia (mild-moderate: grade 1–2; severe: grade 3–4) was defined per CTCAE v3.0, and measured at baseline, 1 week and 4 weeks post-RT. Preselected key factors for analysis included age, sex, ECOG, resection extent, MGMT methylation, Mini-Mental State Examination, and steroid use. Multinomial logistic regression and multivariable Cox regression models were used to identify lymphopenia-associated factors and association with survival. Results: Five hundred and sixty-two patients were analyzed (281 RT vs 281 RT+TMZ). At baseline, both arms had similar rates of mild-moderate (21.4% vs 21.4%) and severe (3.2% vs 2.9%) lymphopenia. However, at 4 weeks post-RT, RT+TMZ was more likely to develop lymphopenia (mild-moderate: 27.9% vs 18.2%; severe: 9.3% vs 1.8%; p<0.001). Developing any lymphopenia post-RT was associated with baseline lymphopenia ( P < .001). Baseline lymphopenia (hazard ratio [HR] 1.3) was associated with worse OS (HR: 1.30, 95% confidence interval [CI] 1.05–1.62; P = .02), regardless of MGMT status. Conclusions: Development of post-RT lymphopenia is associated with addition of TMZ and baseline lymphopenia and not with RT alone in patients treated with short-course radiation. However, regardless of MGMT status, only baseline lymphopenia is associated with worse OS, which may be considered as a prognostic biomarker for elderly glioblastoma patients.