Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans
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Ioannis Mantzaris1, Yiting Yu1, Pavlos Msaouel2, Anthony P. Lam3, Murali Janakiram1, Ellen W. Friedman1, Ulrich Steidl1, Amit K. Verma1
1Department of Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
2Department of Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, New York, USA
3Department of Oncology, Stanford University, Stanford, CA, USA
Ioannis Mantzaris, email: firstname.lastname@example.org
Amit K. Verma, email: email@example.com
Keywords: neutropenia, survival, African American, ethnicity, race
Received: February 14, 2016 Accepted: March 31, 2016 Published: April 26, 2016
Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.
A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.
The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95% CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95% CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95% CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95%CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.
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