Low total lymphocyte count is associated with poor survival in patients with resected pancreatic adenocarcinoma receiving a GM-CSF secreting pancreatic tumor vaccine.

Abstract

BACKGROUND:

Low total lymphocyte count (TLC) and lymphocyte-to-neutrophil ratio have been found to be poor prognostic indicators in several different tumor types at various stages. Although immune-based therapies are under rapid development, it is not known whether baseline complete blood counts, particularly lymphocytes, are associated with the clinical outcomes of patients receiving immunotherapies.

METHODS:

We performed a retrospective analysis of complete blood count for 59 patients enrolled onto a phase II trial evaluating the integration of an adjuvant immunotherapy-irradiated granulocyte-macrophage colony-stimulating factor (GM-CSF) secreting allogeneic pancreatic tumor vaccine (GVAX)-with standard chemoradiation.

RESULTS:

After adjusting for nodal status, individuals with a TLC of <1,500 cells/mm(3) (10 patients) had significantly higher risk, both in terms of overall survival (OS) [adjusted hazard ratio 2.63, 95 % confidence interval (CI) 1.22-5.67, p = 0.013] and progression-free survival (adjusted hazard ratio 3.07, 95 % CI 1.03-6.93, p = 0.003), compared to those with a TLC of ≤ 1,500 cells/mm(3) (49 patients). Adjuvant chemoradiation significantly reduced lymphocyte counts from baseline values. Patients with suppression of their lymphocytes to <500 cells/mm(3) after chemoradiation also had shorter disease-free and OS.

CONCLUSIONS:

Immunosuppressive conditions associated with surgical procedures and chemoradiation may affect the efficacy of immunotherapy.

• Authors: Aaron J Schueneman, Elizabeth A Sugar, Jennifer Uram, Elaine Bigelow, Joseph M Herman, Barish H Edil, Elizabeth M Jaffee, Lei Zheng, Daniel A Laheru
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 20 Suppl 3 Pg. S725-30 (Dec 2013) ISSN: 1534-4681 [Electronic] United States
• PMID: 24046118 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Adjuvants, Immunologic
• Antimetabolites, Antineoplastic
• Cancer Vaccines
• Granulocyte-Macrophage Colony-Stimulating Factor
• Fluorouracil

Topics

• Adjuvants, Immunologic
• Adult
• Aged
• Aged, 80 and over
• Antimetabolites, Antineoplastic (therapeutic use)
• Cancer Vaccines (therapeutic use)
• Carcinoma, Pancreatic Ductal (immunology, mortality, therapy)
• Clinical Trials, Phase II as Topic
• Combined Modality Therapy
• Female
• Fluorouracil (therapeutic use)
• Follow-Up Studies
• Granulocyte-Macrophage Colony-Stimulating Factor (metabolism)
• Humans
• Immunotherapy
• Lymphocyte Count
• Male
• Middle Aged
• Neoplasm Staging
• Pancreatic Neoplasms (immunology, mortality, therapy)
• Prognosis
• Radiotherapy Dosage
• Retrospective Studies
• Survival Rate