Immune modulation effects of concomitant temozolomide and radiation therapy on peripheral blood mononuclear cells in patients with glioblastoma multiforme

Neuro Oncol. 2011 Apr;13(4):393-400. doi: 10.1093/neuonc/noq204. Epub 2011 Feb 20.


Concomitant radiation therapy (RT) and temozolomide (TMZ) therapy after surgery is the standard treatment for glioblastoma multiforme (GBM). Radiation and chemotherapy can affect the immune system with implications on subsequent immune therapy. Therefore, we examined the phenotype and function of peripheral blood mononuclear cells in 25 patients with GBM prior to and 4 weeks after treatment with RT-TMZ using multicolor flow cytometry, as well as in vitro CD4(+) regulatory T cell (T(reg)) suppressor and dendritic cell maturation assays. RT-TMZ induced significant lymphopenia, with a decrease in total CD4(+) T cells, but did not significantly change monocyte counts. The proportion of functional T(reg) cells increased after treatment, whereas their absolute numbers remained stable. There was also a measurable decrease in the proportion of CD8(+)CD56(+) and absolute number of CD3(-)CD56(+) effector cells. Posttherapy monocytes retained the ability to mature into dendritic cells. Treatment with RT-TMZ is associated with changes in regulatory and effector peripheral blood mononuclear cells that tilt the balance towards an immune suppressive state. This shift can affect the outcome of immune therapy following RT-TMZ treatment and should be considered in the design of future combination therapy regimens.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Alkylating / therapeutic use*
  • Blood Cells / drug effects
  • Blood Cells / immunology*
  • Blood Cells / radiation effects
  • Brain Neoplasms / drug therapy
  • Brain Neoplasms / immunology
  • Brain Neoplasms / radiotherapy
  • Combined Modality Therapy
  • Dacarbazine / analogs & derivatives*
  • Dacarbazine / therapeutic use
  • Dendritic Cells / drug effects
  • Dendritic Cells / immunology
  • Dendritic Cells / radiation effects
  • Female
  • Flow Cytometry
  • Glioblastoma / drug therapy*
  • Glioblastoma / immunology*
  • Glioblastoma / radiotherapy*
  • Humans
  • Lymphocyte Subsets
  • Male
  • Middle Aged
  • Prognosis
  • Radiotherapy Dosage
  • T-Lymphocytes, Regulatory / drug effects
  • T-Lymphocytes, Regulatory / immunology*
  • T-Lymphocytes, Regulatory / radiation effects
  • Temozolomide
  • Young Adult


  • Antineoplastic Agents, Alkylating
  • Dacarbazine
  • Temozolomide