Search tips
Search criteria 


Logo of brjcancerBJC HomepageBJC Advance online publicationBJC Current IssueSubmitting an article to BJCWeb feeds
Br J Cancer. 2001 September; 85(6): 816–822.
PMCID: PMC2375083

Identification of patients at risk for early death after conventional chemotherapy in solid tumours and lymphomas


1–5% of cancer patients treated with cytotoxic chemotherapy die within a month after the administration of chemotherapy. Risk factors for these early deaths (ED) are not well known. The purpose of this study was to establish a risk model for ED after chemotherapy applicable to all tumour types. The model was delineated in a series of 1051 cancer patients receiving a first course of chemotherapy in the Department of Medicine of the Centre Léon Bérard (CLB) in 1996 (CLB-1996 cohort), and then validated in a series of patients treated in the same department in 1997 (CLB-1997), in a prospective cohort of patients with aggressive non-Hodgkin's lymphoma (NHL) (CLB-NHL), and in a prospective cohort of patients with metastatic breast cancer (MBC series) receiving first-line chemotherapy. In the CLB-1996 series, 43 patients (4.1%) experienced early. In univariate analysis, age > 60, PS > 1, lymphocyte (ly) count ≤ 700 μl−1 immediately prior to chemotherapy (d1), d1-platelet count ≤ 150 Gl−1, and the type of chemotherapy were significantly correlated to the risk of early death (P ≤ 0.01). Using logistic regression, PS > 1 (hazard ratio 3.9 (95% Cl 2.0–7.5)) and d1-ly count ≤ 700 μl−1 (3.1 (95% Cl 1.6–5.8)) were identified as independent risk factors for ED. The calculated probability of ED was 20% (95% Cl 10–31) in patients with both risk factors, 6% (95% Cl 4–9) for patients with only 1 risk factor, and 1.7% (95% Cl 0.9–3) for patients with none of these 2 risk factors. In the CLB-97, CLB-NHL and MBC validation series, the observed incidences of early death in patients with both risk factors were 19%, 25% and 40% respectively and did not differ significantly from those calculated in the model. In conclusion, poor performance status and lymphopenia identify a subgroup of patients at high risk for early death after chemotherapy. © 2001 Cancer Research Campaign

Keywords: lymphopenia, treatment-related death, cancer, risk factors, chemotherapy, cancer, palliative

Full Text

The Full Text of this article is available as a PDF (75K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Antman K, Crowley J, Balcerzak SP, Rivkin SE, Weiss GR, Elias A, Natale RB, Cooper RM, Barlogie B, Trump DL, et al. An intergroup phase III randomized study of doxorubicin and dacarbazine with or without ifosfamide and mesna in advanced soft tissue and bone sarcomas. J Clin Oncol. 1993 Jul;11(7):1276–1285. [PubMed]
  • Blay JY, Chauvin F, Le Cesne A, Anglaret B, Bouhour D, Lasset C, Freyer G, Philip T, Biron P. Early lymphopenia after cytotoxic chemotherapy as a risk factor for febrile neutropenia. J Clin Oncol. 1996 Feb;14(2):636–643. [PubMed]
  • Blay JY, Le Cesne A, Mermet C, Maugard C, Ravaud A, Chevreau C, Sebban C, Guastalla J, Biron P, Ray-Coquard I. A risk model for thrombocytopenia requiring platelet transfusion after cytotoxic chemotherapy. Blood. 1998 Jul 15;92(2):405–410. [PubMed]
  • Chauvin F, Magnet M, Lasset C, Catimel G, Mayer M, Chevarier P, Jacquin JP, Peaud P, Clavel M. Etude des facteurs pronostiques de la réponse à une chimiothérapie de première ligne dans le cancer du sein en phase avancée. Groupe ERASME. Bull Cancer. 1990;77(9):941–947. [PubMed]
  • Fisher RI, Gaynor ER, Dahlberg S, Oken MM, Grogan TM, Mize EM, Glick JH, Coltman CA, Jr, Miller TP. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med. 1993 Apr 8;328(14):1002–1006. [PubMed]
  • Gómez H, Hidalgo M, Casanova L, Colomer R, Pen DL, Otero J, Rodríguez W, Carracedo C, Cortés-Funes H, Vallejos C. Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin's lymphoma: results of a multivariate analysis. J Clin Oncol. 1998 Jun;16(6):2065–2069. [PubMed]
  • Grant JP, Custer PB, Thurlow J. Current techniques of nutritional assessment. Surg Clin North Am. 1981 Jun;61(3):437–463. [PubMed]
  • Hussain M, Kish JA, Crane L, Uwayda A, Cummings G, Ensley JF, Tapazoglou E, al-Sarraf M. The role of infection in the morbidity and mortality of patients with head and neck cancer undergoing multimodality therapy. Cancer. 1991 Feb 1;67(3):716–721. [PubMed]
  • Kimmick GG, Fleming R, Muss HB, Balducci L. Cancer chemotherapy in older adults. A tolerability perspective. Drugs Aging. 1997 Jan;10(1):34–49. [PubMed]
  • Komaki R, Pajak TF, Byhardt RW, Emami B, Asbell SO, Roach M, 3rd, Pedersen JE, Curran WJ, Jr, Lattin P, Russell AH, et al. Analysis of early and late deaths on RTOG non-small cell carcinoma of the lung trials: comparison with CALGB 8433. Lung Cancer. 1993 Dec;10(3-4):189–197. [PubMed]
  • Kramer MS, Leventhal JM, Hutchinson TA, Feinstein AR. An algorithm for the operational assessment of adverse drug reactions. I. Background, description, and instructions for use. JAMA. 1979 Aug 17;242(7):623–632. [PubMed]
  • Lilenbaum RC, Langenberg P, Dickersin K. Single agent versus combination chemotherapy in patients with advanced nonsmall cell lung carcinoma: a meta-analysis of response, toxicity, and survival. Cancer. 1998 Jan 1;82(1):116–126. [PubMed]
  • Marks PA. Nutrition and the cancer problem. Curr Concepts Nutr. 1977;6:7–13. [PubMed]
  • Morittu L, Earl HM, Souhami RL, Ash CM, Tobias JS, Geddes DM, Harper PG, Spiro SG. Patients at risk of chemotherapy-associated toxicity in small cell lung cancer. Br J Cancer. 1989 May;59(5):801–804. [PMC free article] [PubMed]
  • Ray-Coquard I, Le Cesne A, Rubio MT, Mermet J, Maugard C, Ravaud A, Chevreau C, Sebban C, Bachelot T, Biron P, et al. Risk model for severe anemia requiring red blood cell transfusion after cytotoxic conventional chemotherapy regimens. The Elypse 1 Study Group. J Clin Oncol. 1999 Sep;17(9):2840–2846. [PubMed]
  • Restifo NP. Not so Fas: Re-evaluating the mechanisms of immune privilege and tumor escape. Nat Med. 2000 May;6(5):493–495. [PMC free article] [PubMed]
  • Riesco A. Five-year cancer cure: relation to total amount of peripheral lymphocytes and neutrophils. Cancer. 1970 Jan;25(1):135–140. [PubMed]
  • Saito T, Dworacki G, Gooding W, Lotze MT, Whiteside TL. Spontaneous apoptosis of CD8+ T lymphocytes in peripheral blood of patients with advanced melanoma. Clin Cancer Res. 2000 Apr;6(4):1351–1364. [PubMed]
  • Sculier JP, Weerts D, Klastersky J. Causes of death in febrile granulocytopenic cancer patients receiving empiric antibiotic therapy. Eur J Cancer Clin Oncol. 1984 Jan;20(1):55–60. [PubMed]
  • A predictive model for aggressive non-Hodgkin's lymphoma. The International Non-Hodgkin's Lymphoma Prognostic Factors Project. N Engl J Med. 1993 Sep 30;329(14):987–994. [PubMed]
  • Strand S, Hofmann WJ, Hug H, Müller M, Otto G, Strand D, Mariani SM, Stremmel W, Krammer PH, Galle PR. Lymphocyte apoptosis induced by CD95 (APO-1/Fas) ligand-expressing tumor cells--a mechanism of immune evasion? Nat Med. 1996 Dec;2(12):1361–1366. [PubMed]
  • Tanaka M, Suda T, Haze K, Nakamura N, Sato K, Kimura F, Motoyoshi K, Mizuki M, Tagawa S, Ohga S, et al. Fas ligand in human serum. Nat Med. 1996 Mar;2(3):317–322. [PubMed]
  • Voorzanger N, Touitou R, Garcia E, Delecluse HJ, Rousset F, Joab I, Favrot MC, Blay JY. Interleukin (IL)-10 and IL-6 are produced in vivo by non-Hodgkin's lymphoma cells and act as cooperative growth factors. Cancer Res. 1996 Dec 1;56(23):5499–5505. [PubMed]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK