Clinical and Dosimetric Predictors of Acute Severe Lymphopenia During Radiation Therapy and Concurrent Temozolomide for High-Grade Glioma
Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dos...
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| Published in | International journal of radiation oncology, biology, physics Vol. 92; no. 5; pp. 1000 - 1007 |
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| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.08.2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0360-3016 1879-355X 1879-355X |
| DOI | 10.1016/j.ijrobp.2015.04.005 |
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| Abstract | Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters.
From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL.
Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006).
Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL. |
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| AbstractList | Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters.
From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL.
Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006).
Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL. Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters.PURPOSEAcute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters.From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL.METHODS AND MATERIALSFrom January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL.Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006).RESULTSFifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006).Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL.CONCLUSIONSFemale sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL. Purpose: Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters. Methods and Materials: From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL. Results: Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P<.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V{sub 25Gy}) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V{sub 25Gy} <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively (P=.006). Conclusions: Female sex, older age, lower baseline TLC, and higher brain V{sub 25Gy} are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V{sub 25Gy} of brain below 56% may reduce the risk of ASL. Purpose Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is associated with decreased survival. The current study was designed to identify potential predictors of ASL, with a focus on actionable RT-specific dosimetric parameters. Methods and Materials From January 2007 to December 2012, 183 patients with HGG were treated with RT+TMZ and had available data including total lymphocyte count (TLC) and radiation dose-volume histogram parameters. ASL was defined as TLC of <500/μL within the first 3 months from the start of RT. Stepwise logistic regression analysis was used to determine the most important predictors of ASL. Results Fifty-three patients (29%) developed ASL. Patients with ASL had significantly worse overall survival than those without (median: 12.5 vs 20.2 months, respectively, P <.001). Stepwise logistic regression analysis identified female sex (odds ratio [OR]: 5.30; 95% confidence interval [CI]: 2.46-11.41), older age (OR: 1.05; 95% CI: 1.02-1.09), lower baseline TLC (OR: 0.92; 95% CI: 0.87-0.98), and higher brain volume receiving 25 Gy (V25Gy ) (OR: 1.03; 95% CI: 1.003-1.05) as the most significant predictors for ASL. Brain V25Gy <56% appeared to be the optimal threshold (OR: 2.36; 95% CI: 1.11-5.01), with an ASL rate of 38% versus 20% above and below this threshold, respectively ( P =.006). Conclusions Female sex, older age, lower baseline TLC, and higher brain V25Gy are significant predictors of ASL during RT+TMZ therapy for HGG. Maintaining the V25Gy of brain below 56% may reduce the risk of ASL. |
| Author | Dunn, Gavin Simpson, Joseph R. Mullen, Daniel F. DeWees, Todd A. Speirs, Christina K. Tran, David D. Robinson, Clifford G. Huang, Jiayi Badiyan, Shahed N. Fergus, Sandra Chicoine, Michael R. Linette, Gerry Campian, Jian L. Kim, Albert H. |
| Author_xml | – sequence: 1 givenname: Jiayi orcidid: 0000-0002-5153-506X surname: Huang fullname: Huang, Jiayi email: jhuang@radonc.wustl.edu organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 2 givenname: Todd A. surname: DeWees fullname: DeWees, Todd A. organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 3 givenname: Shahed N. surname: Badiyan fullname: Badiyan, Shahed N. organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 4 givenname: Christina K. surname: Speirs fullname: Speirs, Christina K. organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 5 givenname: Daniel F. surname: Mullen fullname: Mullen, Daniel F. organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 6 givenname: Sandra surname: Fergus fullname: Fergus, Sandra organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 7 givenname: David D. surname: Tran fullname: Tran, David D. organization: Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri – sequence: 8 givenname: Gerry surname: Linette fullname: Linette, Gerry organization: Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri – sequence: 9 givenname: Jian L. surname: Campian fullname: Campian, Jian L. organization: Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St Louis, Missouri – sequence: 10 givenname: Michael R. surname: Chicoine fullname: Chicoine, Michael R. organization: Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri – sequence: 11 givenname: Albert H. surname: Kim fullname: Kim, Albert H. organization: Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri – sequence: 12 givenname: Gavin surname: Dunn fullname: Dunn, Gavin organization: Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri – sequence: 13 givenname: Joseph R. surname: Simpson fullname: Simpson, Joseph R. organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri – sequence: 14 givenname: Clifford G. surname: Robinson fullname: Robinson, Clifford G. organization: Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri |
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| Snippet | Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is... Purpose Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is... Purpose: Acute severe lymphopenia (ASL) frequently develops during radiation therapy (RT) and concurrent temozolomide (TMZ) for high-grade glioma (HGG) and is... |
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| SubjectTerms | Acute Disease Adult Age Factors Aged Aged, 80 and over Antineoplastic Agents, Alkylating - adverse effects BRAIN Brain - radiation effects Brain Neoplasms - drug therapy Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - radiotherapy Chemotherapy, Adjuvant Cranial Irradiation - adverse effects Cranial Irradiation - methods Dacarbazine - adverse effects Dacarbazine - analogs & derivatives Female Glioma - drug therapy Glioma - mortality Glioma - pathology Glioma - radiotherapy GLIOMAS Hematology, Oncology and Palliative Medicine Humans Lymphocyte Count LYMPHOCYTES LYMPHOPENIA Lymphopenia - etiology Lymphopenia - mortality Male Middle Aged Odds Ratio PATIENTS RADIATION DOSES Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy Dosage REGRESSION ANALYSIS Sex Factors Young Adult |
| Title | Clinical and Dosimetric Predictors of Acute Severe Lymphopenia During Radiation Therapy and Concurrent Temozolomide for High-Grade Glioma |
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