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

Aaron J. Schueneman, Elizabeth A. Sugar, Jennifer Uram, Elaine Bigelow, Joseph Herman, Barish H. Edil, Elizabeth M. Jaffee, Lei Zheng, Daniel A. Laheru

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

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/mm3 (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 B1,500 cells/mm3 (49 patients). Adjuvant chemoradiation significantly reduced lymphocyte counts from baseline values. Patients with suppression of their lymphocytes to<500 cells/mm3 after chemoradiation also had shorter disease-free and OS. Conclusions. Immunosuppressive conditions associated with surgical procedures and chemoradiation may affect the efficacy of immunotherapy.

Original languageEnglish (US)
Pages (from-to)S725-S730
JournalAnnals of surgical oncology
Volume20
Issue number3 SUPPL.
DOIs
StatePublished - 2013

ASJC Scopus subject areas

  • Surgery
  • Oncology

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