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Postoperative chemoradiation with temozolomide is the standard treatment for glioblastoma. The severe treatment-related lymphopenia has been studied to be associated with a poor prognosis in elderly glioblastoma patients. This study aims to evaluate the impact of peri-chemoradiation lymphopenia on survival. 

We retrospectively enrolled 139 glioblastoma patients who underwent surgery and were postoperatively treated with temozolomide chemoradiation between January 2012 and June 2018. Adjuvant monthly temozolomide was given for all patients. The severity of lymphopenia is according to Common Terminology Criteria for Adverse Events (CTCAE) 4.0.

Among 139 patients, the median progression-free time (PFS) and overall survival time (OST) are 7.2 and 24.0 months. Grade III and IV lymphopenia were found in 19 and 2 patients during chemoradiation. The patients who experienced at least once grade III or above lymphopenia (n=23) had significantly worse median OST when compared with those who did not (95% CI: 8.4-13.4 vs. 16.2-26.0 months, p <0.001). Seventy-seven patients received bevacizumab monotherapy after progression. The OST is significantly better in the patients treated with bevacizumab monotherapy, with a median of 28.7months compared to 10.5 months in the non-bevacizumab-treated patients (95% CI: 24.1-33.3 vs. 9.0-12.0 months, p <0.001). The Cox multivariate analysis indicated age, bevacizumab, and grade III or above lymphopenia are significantly independent factors for OST (p=0.025, p<0.001, and p=0.001, respectively)

Peri-chemoradiation lymphopenia is a prognostic predictor for glioblastoma. These findings provided evidence that immunosuppression induced by chemoradiation is associated with poor clinical outcomes