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Late-onset lymphopenia during radiation is associated with an increased risk of tumor recurrence in newly-diagnosed pediatric medulloblastoma
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  • Holly B. Lindsay,
  • Michael Scheurer,
  • Anthony K. Allam,
  • Susan McGovern,
  • Murali Chintagumpala,
  • Arnold Paulino
Holly B. Lindsay
University of Colorado Anschutz Medical Campus

Corresponding Author:[email protected]

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Michael Scheurer
Texas Children's Cancer Center and Hematology Centers
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Anthony K. Allam
Baylor College of Medicine
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Susan McGovern
The University of Texas MD Anderson Cancer Center Division of Radiation Oncology
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Murali Chintagumpala
Texas Children's Cancer Center and Hematology Centers
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Arnold Paulino
The University of Texas MD Anderson Cancer Center Division of Radiation Oncology
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Abstract

Background: Recent data found a correlation between lymphopenia occurring early during craniospinal irradiation (CSI) and risk of disease recurrence in newly-diagnosed childhood medulloblastoma. 1 However, the population included patients that received myelosuppressive chemotherapy prior to or during RT. Here we investigate the effect of lymphopenia during RT in patients with newly-diagnosed pediatric medulloblastoma who did not receive myelosuppressive chemotherapy with RT. Procedure: We analyzed 54 patients with newly-diagnosed medulloblastoma (ages 2-21 years) treated between 1997-2013 with CSI. Log-rank tests were used to determine survival differences, and Cox proportional hazards regression was used to assess associations between patient characteristics and lymphopenia with disease recurrence risk. Results: 78% of patients (40/51) had grade ≥3 lymphopenia by RT week 3; 49% (23/47) improved to grade ≤2 lymphopenia by week 5. Similarly, the lowest median absolute lymphocyte count (ALC) occurred during RT week 3. Sixteen of 54 (30%) patients recurred an average of 30.2 months post-diagnosis. There was higher risk of disease recurrence in patients with grade ≥3 lymphopenia during weeks 4 (log-rank p=0.015; Cox p=0.03) and 5 (log-rank p=0.0009; Cox p=0.004) of RT. Recurrence-free survival was lower in patients with ALC Conclusions: Lymphopenia during RT weeks 4 and 5 correlates with increased risk of tumor recurrence in pediatric patients with newly-diagnosed medulloblastoma. Future studies should correlate baseline numbers of tumor-infiltrating lymphocytes with risks of lymphopenia during RT and tumor recurrence.
17 Oct 2023Submission Checks Completed
17 Oct 2023Assigned to Editor
17 Oct 2023Submitted to Pediatric Blood & Cancer
18 Oct 2023Review(s) Completed, Editorial Evaluation Pending
19 Oct 2023Reviewer(s) Assigned
10 Nov 2023Editorial Decision: Revise Major
07 Mar 2024Submission Checks Completed
07 Mar 2024Assigned to Editor
07 Mar 20241st Revision Received
13 Mar 2024Review(s) Completed, Editorial Evaluation Pending
13 Mar 2024Reviewer(s) Assigned
28 Mar 2024Editorial Decision: Accept