Low Total Lymphocyte Count Is Associated with Poor Survival in Patients with Resected Pancreatic Adenocarcinoma Receiving a GM-CSF Secreting Pancreatic Tumor Vaccine

• Published in: Annals of surgical oncology Vol. 20; no. Suppl 3; pp. 725 - 730
• Main Authors: Schueneman, Aaron J., Sugar, Elizabeth A., Uram, Jennifer, Bigelow, Elaine, Herman, Joseph M., Edil, Barish H., Jaffee, Elizabeth M., Zheng, Lei, Laheru, Daniel A.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.12.2013; Springer Nature B.V
• Subjects: Adjuvants, Immunologic; Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Cancer Vaccines - therapeutic use; Carcinoma, Pancreatic Ductal - immunology; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - therapy; Clinical Trials, Phase II as Topic; Combined Modality Therapy; Female; Fluorouracil - therapeutic use; Follow-Up Studies; Granulocyte-Macrophage Colony-Stimulating Factor - secretion; Humans; Immunotherapy; Lymphocyte Count; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Pancreatic Neoplasms - immunology; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - therapy; Prognosis; Radiotherapy Dosage; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Translational Research and Biomarkers; Lymphocyte Count; Pancreatic Cancer; Complete Blood Count; Overall Survival; Ipilimumab
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-013-3262-5

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.