Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients
Abstract Purpose/objective(s) Treatment related lymphopenia is a known toxicity for glioblastoma (GBM) patients and several single-institution studies have linked lymphopenia with poor survival outcomes. We performed a systematic review and pooled analysis to evaluate the association between lymphop...
| Egile Nagusiak: | , , , , , |
|---|---|
| Formatua: | Artikulua |
| Hizkuntza: | English |
| Argitaratua: |
BMC
2024-03-01
|
| Saila: | Radiation Oncology |
| Gaiak: | |
| Sarrera elektronikoa: | https://doi.org/10.1186/s13014-023-02393-3 |
| _version_ | 1827248500066222080 |
|---|---|
| author | Ali M. Saeed Søren M. Bentzen Haroon Ahmad Lily Pham Graeme F. Woodworth Mark V. Mishra |
| author_facet | Ali M. Saeed Søren M. Bentzen Haroon Ahmad Lily Pham Graeme F. Woodworth Mark V. Mishra |
| author_sort | Ali M. Saeed |
| collection | DOAJ |
| description | Abstract Purpose/objective(s) Treatment related lymphopenia is a known toxicity for glioblastoma (GBM) patients and several single-institution studies have linked lymphopenia with poor survival outcomes. We performed a systematic review and pooled analysis to evaluate the association between lymphopenia and overall survival (OS) for GBM patients undergoing chemotherapy and radiation therapy (RT). Materials/methods Following PRISMA guidelines, a systematic literature review of the MEDLINE database and abstracts from ASTRO, ASCO, and SNO annual meetings was conducted. A pooled analysis was performed using inverse variance-weighted random effects to generate a pooled estimate of the hazard ratio of association between lymphopenia and OS. Results Ten of 104 identified studies met inclusion criteria, representing 1,718 patients. The lymphopenia cutoff value varied (400–1100 cells/uL) and as well as the timing of its onset. Studies were grouped as time-point (i.e., lymphopenia at approximately 2-months post-RT) or time-range (any lymphopenia occurrence from treatment-start to approximately 2-months post-RT. The mean overall pooled incidence of lymphopenia for all studies was 31.8%, and 11.8% vs. 39.9% for time-point vs. time-range studies, respectively. Lymphopenia was associated with increased risk of death, with a pooled HR of 1.78 (95% CI 1.46–2.17, P < 0.00001) for the time-point studies, and a pooled HR of 1.38 (95% CI 1.24–1.55, P < 0.00001) for the time-point studies. There was no significant heterogeneity between studies. Conclusion These results strengthen observations from previous individual single-institution studies and better defines the magnitude of the association between lymphopenia with OS in GBM patients, highlighting lymphopenia as a poor prognostic factor. |
| first_indexed | 2024-04-24T23:03:57Z |
| format | Article |
| id | doaj.art-a70bbd71f5614f96acc1bdad020a8b18 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2025-03-21T23:32:44Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-a70bbd71f5614f96acc1bdad020a8b182024-05-19T11:28:30ZengBMCRadiation Oncology1748-717X2024-03-0119111010.1186/s13014-023-02393-3Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patientsAli M. Saeed0Søren M. Bentzen1Haroon Ahmad2Lily Pham3Graeme F. Woodworth4Mark V. Mishra5Department of Radiation Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland School of MedicineDepartment of Medical Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland School of MedicineDepartment of Medical Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland School of MedicineDepartment of Neurosurgery, University of Maryland School of MedicineDepartment of Radiation Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, University of Maryland School of MedicineAbstract Purpose/objective(s) Treatment related lymphopenia is a known toxicity for glioblastoma (GBM) patients and several single-institution studies have linked lymphopenia with poor survival outcomes. We performed a systematic review and pooled analysis to evaluate the association between lymphopenia and overall survival (OS) for GBM patients undergoing chemotherapy and radiation therapy (RT). Materials/methods Following PRISMA guidelines, a systematic literature review of the MEDLINE database and abstracts from ASTRO, ASCO, and SNO annual meetings was conducted. A pooled analysis was performed using inverse variance-weighted random effects to generate a pooled estimate of the hazard ratio of association between lymphopenia and OS. Results Ten of 104 identified studies met inclusion criteria, representing 1,718 patients. The lymphopenia cutoff value varied (400–1100 cells/uL) and as well as the timing of its onset. Studies were grouped as time-point (i.e., lymphopenia at approximately 2-months post-RT) or time-range (any lymphopenia occurrence from treatment-start to approximately 2-months post-RT. The mean overall pooled incidence of lymphopenia for all studies was 31.8%, and 11.8% vs. 39.9% for time-point vs. time-range studies, respectively. Lymphopenia was associated with increased risk of death, with a pooled HR of 1.78 (95% CI 1.46–2.17, P < 0.00001) for the time-point studies, and a pooled HR of 1.38 (95% CI 1.24–1.55, P < 0.00001) for the time-point studies. There was no significant heterogeneity between studies. Conclusion These results strengthen observations from previous individual single-institution studies and better defines the magnitude of the association between lymphopenia with OS in GBM patients, highlighting lymphopenia as a poor prognostic factor.https://doi.org/10.1186/s13014-023-02393-3LymphopeniaRadiation therapyGlioblastomaGliomaProton beam therapyProtons |
| spellingShingle | Ali M. Saeed Søren M. Bentzen Haroon Ahmad Lily Pham Graeme F. Woodworth Mark V. Mishra Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients Radiation Oncology Lymphopenia Radiation therapy Glioblastoma Glioma Proton beam therapy Protons |
| title | Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients |
| title_full | Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients |
| title_fullStr | Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients |
| title_full_unstemmed | Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients |
| title_short | Systematic review and pooled analysis of the impact of treatment-induced lymphopenia on survival of glioblastoma patients |
| title_sort | systematic review and pooled analysis of the impact of treatment induced lymphopenia on survival of glioblastoma patients |
| topic | Lymphopenia Radiation therapy Glioblastoma Glioma Proton beam therapy Protons |
| url | https://doi.org/10.1186/s13014-023-02393-3 |
| work_keys_str_mv | AT alimsaeed systematicreviewandpooledanalysisoftheimpactoftreatmentinducedlymphopeniaonsurvivalofglioblastomapatients AT sørenmbentzen systematicreviewandpooledanalysisoftheimpactoftreatmentinducedlymphopeniaonsurvivalofglioblastomapatients AT haroonahmad systematicreviewandpooledanalysisoftheimpactoftreatmentinducedlymphopeniaonsurvivalofglioblastomapatients AT lilypham systematicreviewandpooledanalysisoftheimpactoftreatmentinducedlymphopeniaonsurvivalofglioblastomapatients AT graemefwoodworth systematicreviewandpooledanalysisoftheimpactoftreatmentinducedlymphopeniaonsurvivalofglioblastomapatients AT markvmishra systematicreviewandpooledanalysisoftheimpactoftreatmentinducedlymphopeniaonsurvivalofglioblastomapatients |