A Systematic Review and Meta-analysis of the Impact of Radiation-Related Lymphopenia on Outcomes in High-Grade Gliomas

Authors

Supriya Mallick
Anjali V R
Prashanth Giridhar
Rituraj Upadhyay
Byung-Kyu Kim
Amrish Sharma
Hagar Elghazawy
Thiraviyam Elumalai
Vinod Solipuram
Cheng En Hsieh
Courtney Hentz
Abhishek A Solanki
Jing Li
Dennis Pai Chan
Emily Ness
Bhanu Prasad Venkatesulu
David R Grosshans

Publication Date

10-1-2022

Journal

South Asian Journal of Cancer

Abstract

Introduction  Malignant gliomas are the most common primary malignant brain tumors and are typically treated with maximal safe surgical resection followed by chemoradiation. One of the unintended effects of radiation is depletion of circulating lymphocyte pool, which has been correlated with inferior overall survival outcomes.

Methods  A comprehensive and systematic searches of the PubMed, Cochrane Central, and Embase databases were done to assess the studies that have reported radiation-related lymphopenia in high-grade gliomas. Hazard ratios (HRs), odds ratios (OR), and mean differences were represented with Forest plots comparing patients with severe lymphopenia and no severe lymphopenia. Review Manager Version 5.3 (The Nordic Cochrane Centre, Copenhagen, Denmark) was used for the analysis.

Results  Nineteen studies were included in the final systematic review and 12 studies were included in the meta-analysis. The odds of developing severe lymphopenia were 0.39 (95% CI:0.19, 0.81, I 2  = 94%, p  = 0.01). Patients with severe lymphopenia were at increased risk of death with a pooled HR = 2.19 (95% CI: 1.70, 2.83, I 2  = 0%, p <0.00001) compared to patients with no severe lymphopenia. The mean difference in survival between patients with severe lymphopenia and no severe lymphopenia was −6.72 months (95% CI: −8.95, −4.49, I 2  = 99%, p <0.00001), with a better mean survival in the no severe lymphopenia group.

Conclusion  Radiation-induced severe lymphopenia was associated with poor overall survival and increased risk of death. Photon therapy, larger planning target volume, higher brain dose, higher hypothalamus dose, and female gender were associated with increased risk of severe lymphopenia.

Keywords

radiation, lymphopenia, high-grade gliomas, systematic review

Comments

Supplementary Materials

PMID: 36756098