(S040) Nadir White Blood Cell, Absolute Neutrophil, and Absolute Lymphocyte Counts During Concurrent Chemoradiation Therapy Predicted Worse Outcomes in Patients With Limited-Stage Small-Cell Lung Cancer

Article

This retrospective study showed that lower WBC, ANC, and ALC nadirs during CCRT for LSCLC were associated with worse treatment outcomes.

Ritsuko Komaki, MD, Xiong Wei, MD, Pamela K. Allen, PhD, Zhongxing Liao, MD, Heath D. Skinner, MD, PhD, James W. Welsh, MD, Daniel R. Gomez, MD, Quynh-Nhu Nguyen, MD, Steven H. Lin, MD, PhD, John V. Heymach, MD, PhD, James D. Cox, MD; UT MD Anderson Cancer Center

PURPOSE: Studies have suggested that small-cell lung cancer (SCLC) may affect the immune system. We hypothesize that baseline or nadir complete blood count during the course of concurrent chemoradiation therapy (CCRT) is associated with treatment outcomes for limited-stage small-cell lung cancer (LSCLC).

METHODS: A total of 130 patients with biopsy-proven LSCLC, staged with thoracic CT and brain magnetic resonance imaging, received thoracic radiation therapy (RT) with etoposide and cisplatin at a single institution from 1995 to 2009. Radiation doses ranged from 45 Gy to 61.2 Gy and were given in either once-daily or twice-daily fractions. Patients who achieved a complete response were given prophylactic cranial irradiation (PCI). Cox regression was used for univariate and multivariate analyses, with P ≤ .05 indicating significance.

RESULTS: The median follow-up time was 19.4 months (range: 3.8–91.4 mo). Eighty-six percent of patients in the study group had Karnofsky performance status scores ≥ 80; 34 patients received induction chemotherapy followed by CCRT, and 96 patients received CCRT only; 72 patients received PCI. In the univariate analysis, local-regional failure (LRF) was associated with baseline neutropenia (76.9% [10 of 13] vs 33.6% [39 of 116] normal absolute neutrophil count [ANC]; P = .01), lower ANC nadirs (43.9% [36 of 82] vs 27.1% [13 of 48]; P = .05), and lower white blood cell (WBC) nadirs (43.8% [42 of 96] vs 20.6% [7 of 34]; P = .02). Distant metastasis (DM) was associated with lower WBC nadirs (91.7% [88 of 96] vs 58.8% [20 of 34]; P < .01), lower hemoglobin (Hb) nadirs (86.8% [99 of 114] vs 81.8% [9 of 11]; P < .01), lower ANC nadirs (91.5% [75 of 82] vs 68.8% [33 of 48]; P < .01), and lower absolute lymphocyte count (ALC) nadirs (86.8% [105 of 121] vs 25% [2 of 8]; P < .01). In multivariate analyses, lower WBC nadir was associated with disease-free survival (DFS) (hazard ratio [HR], 2.39; P = .001) and LRF-free survival (HR, 2.24; P = .05). Lower Hb nadir was associated with DFS (HR, 1.99; P = .044) and DM-free survival (HR, 2.89; P = .003), as was lower ALC nadir (DFS HR, 3.78, P = .029; DMFS HR, 6.81; P = .008).

CONCLUSION: This retrospective study showed that lower WBC, ANC, and ALC nadirs during CCRT for LSCLC were associated with worse treatment outcomes.

Proceedings of the 98th Annual Meeting of the American Radium Society -americanradiumsociety.org

Newsletter

Stay at the forefront of cutting-edge science with CGT—your direct line to expert insights, breakthrough data, and real-time coverage of the latest advancements in cell and gene therapy.

Recent Videos
Derek Jackson, BS, MA, the vice president of cell & gene therapy product development at Pacira, and Kilian Guse, PhD, the vice president of genetic medicine platforms at Pacira
Derek Jackson, BS, MA, the vice president of cell & gene therapy product development at Pacira
Jeffrey Chamberlain, PhD
Tami John, MD
Tami John, MD
Tami John, MD
Matthew Ku, MBBS, FRACP, RACP, FRCPA/RCPA, PhD, an associate professor and the lymphoma stream lead at St Vincent’s Hospital
Saurabh Dahiya, MD, FACP, an associate professor of medicine at Stanford University School of Medicine; as well as clinical director of Cancer Cell Therapy in the Division of Blood and Marrow Transplantation and Cell Therapy at Stanford Medicine
Shahzad Raza, MD, a hematologist/oncologist at the Cleveland Clinic
Manali Kamdar, MD, the associate professor of medicine–hematology and clinical director of lymphoma services at the University of Colorado
Related Content
© 2025 MJH Life Sciences

All rights reserved.