Association between severe treatment-related lymphopenia and progression-free survival in patients with newly diagnosed squamous cell head and neck cancer

• Published in: Head & neck Vol. 36; no. 12; pp. 1747 - 1753
• Main Authors: Campian, Jian L., Sarai, Guneet, Ye, Xiaobu, Marur, Shanthi, Grossman, Stuart A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2014; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - blood; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy - adverse effects; chemotherapy; Disease-Free Survival; Female; Head and Neck Neoplasms - blood; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - therapy; head and neck squamous cell carcinoma; Humans; Lymphocyte Count; lymphopenia; Lymphopenia - epidemiology; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; radiation; Retrospective Studies; Squamous Cell Carcinoma of Head and Neck; Survival Rate; treatment-related toxicities; treatment-related toxicities; radiation; chemotherapy; lymphopenia; head and neck squamous cell carcinoma
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.23535

Background Severe treatment‐related lymphopenia occurs commonly in many cancers and is associated with early tumor progression. Data are lacking as to whether this occurs in squamous cell head and neck cancer. Methods Serial total lymphocyte counts were retrospectively reviewed in patients with newly diagnosed squamous head and neck cancer undergoing chemoradiation and associated with treatment outcomes. Results The median baseline total lymphocyte count in 56 patients was 1660 cells/mm3, which fell by 73% to 445 cells/mm3 2 months after initiating chemoradiation (p < .0001). Human papillomavirus negative (HPV‐) patients with a total lymphocyte count <500 cells/mm3 at 2 months had significantly earlier disease progression than those with higher total lymphocyte counts (hazard ratio [HR], 5.75; p = .045). Conclusion Baseline total lymphocyte counts were normal, but at 2 months approximately 60% of patients had severe treatment‐related lymphopenia regardless of HPV status. Severe treatment‐related lymphopenia in HPV‐ patients is independently associated with earlier disease progression. Prospective studies are needed to confirm these findings, which suggest that immune preservation is important in this cancer. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1747–1753, 2014