Early lymphocyte recovery as a prognostic indicator for high-risk Ewing sarcoma

J Pediatr Hematol Oncol. 2007 Jan;29(1):48-52. doi: 10.1097/MPH.0b013e31802d3e3e.


Background: Increasing evidence suggests that lymphocyte recovery plays a major part in tumor control. Facilitating immune reconstitution might be a novel direction of cancer therapy. The purpose of this study was to determine if early lymphocyte recovery is an independent prognostic indicator for high-risk Ewing sarcoma outcome.

Results: Data of 24 Ewing sarcoma patients were analyzed (age, 3 to 50 y; median, 16.5; male to female, 16:8). The 5-year overall survival (OS) of the total population was 47.9% [10.6 standard error (SE)]. Patients were separated into 2 groups: prolonged lymphopenia versus early lymphocyte recovery, using a threshold absolute lymphocyte count (ALC) of > or =500 cells/microL on day 15. The majority (67%; n=16) of the patients had an ALC > or =500 cells/microL, and of these 10/16 are alive with a 5-year OS of 58.7% (13.2 SE). In contrast, 33% (n=8) of patients had an ALC <500 cells/microL on day 15 and only 2/8 are alive with a 5-year OS of 25% (15.3 SE). This difference was significant (P=0.007 using the log rank test). When comparing patients with metastatic disease, patients with an ALC-15 < 500 cells/microL had a median survival of 13 months, whereas patients with an ALC-15 > or =500 cells/microL had a median survival of 29.5 months. All patients had an ALC before chemotherapy of >1000 cells/microL. The difference was significant (P value=0.001 using the log rank test). Univariate analysis of platelet counts, age, sex, and absolute neutrophil count showed no statistically significant association with OS.

Conclusions: The data demonstrate that an ALC > or =500 cells/microL on day 15 of the first course of chemotherapy is an independent prognostic factor associated with superior OS in high-risk Ewing sarcoma.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Child
  • Child, Preschool
  • Combined Modality Therapy / mortality
  • Disease-Free Survival
  • Female
  • Humans
  • Leukocyte Count
  • Lymphocytes*
  • Male
  • Middle Aged
  • Platelet Count
  • Recovery of Function*
  • Retrospective Studies
  • Risk Factors
  • Sarcoma, Ewing / blood*
  • Sarcoma, Ewing / mortality*
  • Sarcoma, Ewing / therapy
  • Sex Factors
  • Survival Rate