Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 18;2(1):31.
doi: 10.1038/s44276-024-00058-6.

Exploring the prognostic impact of absolute lymphocyte count in patients treated with immune-checkpoint inhibitors

M R Conroy  1   2 , H O'Sullivan  1   2 , D C Collins  1   2 , R M Bambury  1   2 , D Power  1   2   3 , S Grossman  4 , S O'Reilly  5   6   7
Affiliations

Exploring the prognostic impact of absolute lymphocyte count in patients treated with immune-checkpoint inhibitors

M R Conroy et al. BJC Rep. .

Abstract

Background: The role of immune checkpoint inhibitors (ICI) expands but affordable and reproducible prognostic biomarkers are needed. We investigated the association between baseline and 3-month absolute lymphocyte count (ALC) and survival for patients on ICI.

Methods: A retrospective study investigated patients who received ICI July 2014-August 2019. Survival probabilities were calculated for lymphocyte subsets. Univariate and multivariate analyses were performed to investigate risk factors for lymphopenia.

Results: Among 179 patients, median age was 62 and 41% were female. The most common diagnoses were melanoma (41%) and lung cancer (40%). Median PFS was 6.5 months. 27% had baseline lymphopenia (ALC < 1 × 109cells/L) and no significant difference in PFS or OS to those with normal ALC. However, 31% had lymphopenia at 3 months and significantly shorter OS than those without (9.8 vs 18.3 months, p < 0.001). Those with baseline lymphopenia who recovered counts at 3 months had no difference in PFS (median NR vs 13.0 months, p = 0.48) or OS (22 vs 18.3 months, p = 0.548) to those never lymphopenic. The strongest risk factor for lymphopenia on multivariable analysis was previous radiation therapy (RT).

Conclusions: 3-month lymphopenia is a negative prognostic marker in cancer patients on ICI. Previous RT is significantly associated with lymphopenia.

PubMed Disclaimer

Conflict of interest statement

RB reports travel funding from Bayer, Janssen, Ipsen, BMS and Pfizer. HOS reports honoraria from Takeda and Amgen. SOR is Deputy Editor of this journal, and recused himself from all decisions about this paper. The other authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1. Change in proportion of patients with lymphopenia.
Stacked barchart demonstrating percentage of cohort with normal ALCs, with decreased lymphocytes 0.51–1.0 × 109cells/L and with lymphocytes less than 0.5 × 109cells/L, at baseline and at 3 months from treatment initiation.
Fig. 2
Fig. 2. Kaplan–Meier survival plots for lymphocyte subsets.
a Plot comparing patients with no baseline lymphopenia to those with baseline lymphopenia (<1 × 109cells/L). b Plot comparing those who were lymphopenic at 3 months to those who were not. c Plot comparing patient groups NN, LN, NL, LL. ALC absolute lymphocyte count, NN normal ALC at baseline and at 3 months. LN low ALC at baseline, normal at 3 months. NL normal ALC at baseline, low at 3 months. LL low ALC at baseline and at 3 months.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Smith SM, Wachter K, Burris HA 3rd, Schilsky RL, George DJ, et al. Clinical cancer advances 2021: ASCO’s report on progress against cancer. J Clin Oncol. 2021;39:1165–84. 10.1200/jco.20.03420. - PubMed
    1. Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An arm and a leg: the rising cost of cancer drugs and impact on access. Am Soc Clin Oncol Educ Book. 2021:e1–e12. 10.1200/edbk_100028. - PubMed
    1. Reck M, Rodriguez-Abreu D, Robinson AG, Hui R, Csoszi T, Fulop A. et al. Five-year outcomes with pembrolizumab versus chemotherapy for metastatic non-small-cell lung cancer with PD-L1 tumor proportion score >/= 50. J Clin Oncol. 2021;39:2339–49. 10.1200/JCO.21.00174. - PMC - PubMed
    1. Hodi FS, Chiarion-Sileni V, Gonzalez R, Grob JJ, Rutkowski P, Cowey CL, et al. Nivolumab plus ipilimumab or nivolumab alone versus ipilimumab alone in advanced melanoma (CheckMate 067): 4-year outcomes of a multicentre, randomised, phase 3 trial. Lancet Oncol. 2018;19:1480–92. 10.1016/S1470-2045(18)30700-9. - PubMed
    1. Haslam A, Prasad V. Estimation of the percentage of US patients with cancer who are eligible for and respond to checkpoint inhibitor immunotherapy drugs. JAMA Netw Open. 2019;2:e192535. 10.1001/jamanetworkopen.2019.2535. - PMC - PubMed

LinkOut - more resources