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The absolute lymphocyte count can predict the overall survival of patients with non-small cell lung cancer on nivolumab: a clinical study

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Abstract

Introduction

The neutrophil-to-lymphocyte (ANC/ALC) ratio is associated with worse prognosis in patients with NSCLC on immunotherapies, but the role of ALC remains unclear. The previous radiation therapy causes lymphopenia, and given approaches of combining radiation with immunotherapies, it is critical to better understand the impact of peripheral lymphocytes.

Patients and methods

We evaluated retrospectively 22 patients with advanced NSCLC treated with nivolumab at Boston Medical Center from January 2014 to September 2016 and correlated the peripheral blood counts with the overall survival (OS) and overall time on treatment. We assessed the effect of the previous radiation on peripheral blood counts and clinical outcomes.

Results

Baseline ALC and ANC/ALC ratios are positively and negatively correlated, respectively, with the OS on nivolumab. The ALC and ALC/WBC ratios at 6 weeks on treatment are positively associated with the OS. Kaplan–Meier analysis at baseline and at 6 weeks showed significantly increased OS in the group of patients with the highest ALC. The previous radiation therapy was positively correlated with the ANC and negatively correlated with the ALC/WBC ratio at 8 weeks after the initiation of nivolumab.

Conclusion

Our finding that ALC at baseline and at 6 weeks on treatment is positively correlated with the OS provides an easily obtained predictive marker. Our result that the previous radiation is associated with higher ANC and lower ALC during treatment supports that the combination of radiation therapy with immunotherapy should be carefully applied and potentially peripheral blood counts can be utilized to stratify patients for this approach.

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Author notes

  1. T. Karantanos and S. Karanika contributed equally to this work.

Authors and Affiliations

  1. Medical Oncology Department, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University Hospital, 401 North Broadway Ave, Baltimore, MD, 21287, USA

    T. Karantanos

  2. General Internal Medicine Department, Boston Medical Center, Boston University School of Medicine, 850 Harrison Ave, Boston, MA, 02118, USA

    T. Karantanos, S. Karanika & B. Seth

  3. Hematology-Oncology, Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 1st Floor, Boston, MA, 02118, USA

    G. Gignac

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  1. T. Karantanos
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Correspondence to T. Karantanos.

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Research involving human participants and/or animals

Our research did not involve human participants or animals.

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No informed consent was needed based on the IRB approval (H-35716) of our retrospective study by the office of the institutional review board of Boston University.

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Karantanos, T., Karanika, S., Seth, B. et al. The absolute lymphocyte count can predict the overall survival of patients with non-small cell lung cancer on nivolumab: a clinical study. Clin Transl Oncol 21, 206–212 (2019). https://doi.org/10.1007/s12094-018-1908-2

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  • DOI: https://doi.org/10.1007/s12094-018-1908-2

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