RT Journal Article
SR Electronic
T1 Sex-Dependent Analysis of Temozolomide-Induced Myelosuppression and Effects on Survival in a Large Real-life Cohort of Patients With Glioma
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e2073
OP e2083
DO 10.1212/WNL.0000000000200254
VO 98
IS 20
A1 Pia S. Zeiner
A1 Katharina Filipski
A1 Natalie Filmann
A1 Marie-Thérèse Forster
A1 Martin Voss
A1 Emmanouil Fokas
A1 Ulrich Herrlinger
A1 Patrick N. Harter
A1 Joachim P. Steinbach
A1 Michael W. Ronellenfitsch
YR 2022
UL http://n.neurology.org/content/98/20/e2073.abstract
AB Background and Objective To investigate the association of radiochemotherapy-induced cytopenia with sex and its potential effect on survival in patients with glioma.Methods We retrospectively analyzed cytopenia during temozolomide-based concomitant radiochemotherapy in 492 patients with glioma. Histologic grading, molecular pathology, surgical procedures, adjuvant chemotherapy subsequent to the radiochemotherapy phase, and overall survival (OS) were recorded. The extent of cytopenia was correlated with sex and outcome.Results Treatment-induced severe cytopenia (leukocytopenia, lymphocytopenia, neutropenia, and thrombocytopenia) was more frequent in women than men (44 vs 18%; p = 0.0002). In women with IDH-wt high-grade astrocytomas, there was a negative correlation of severe cytopenia in general and thrombocytopenia in particular during temozolomide radiochemotherapy with OS independent from other predictors (92 [77–111] vs 73 [21–127] weeks; p < 0.05). In men, there was also a trend for this unfavorable effect. In addition, severe cytopenia in all blood cell lineages correlated with reduced temozolomide dose exposure during radiochemotherapy (all p < 0.05 in the total cohort) and reduced dose exposure was independently associated with worse OS (hazard ratios for OS in complete vs reduced temozolomide dose in the total and female cohort 0.66 [0.47–0.92] and 0.4 [0.24–0.69], p < 0.05).Discussion Our analysis of treatment-induced cytopenia in a large cohort of patients with glioma confirms that women are at higher risk and demonstrates an association of cytopenia with shortened survival in women.Classification of Evidence This study provides Class II evidence that women with glioma treated with temozolomide-based concomitant radiochemotherapy have more frequent treatment-induced severe cytopenia than men and that severe myelosuppression correlates with worse OS in women.BMI=body mass index; CTCAE=Common Terminology Criteria for Adverse Events; IDH=isocitrate dehydrogenase; LBM=lean body mass; MGMT=O6-methylguanine methyltransferase; OS=overall survival; TMZ-RCT=temozolomide radiochemotherapy