Hematology
The Role of Complete Blood Cell Count in Prognosis—Watch this Space!
Nicole M Rochet, BS, 1 Svetomir N Markovic, MD, PhD 2 and Luis F Porrata, MD 3
1. MD/MS Student, Division of Hematology; 2. Professor of Medicine and Oncology, Department of Medical Oncology and Division of Hematology;
3. Assistant Professor, Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine, Rochester
Abstract Prognostic factors in cancer patients provide information about possible clinical outcomes and help classify patients into different risk groups.
Treatment and clinical management decisions are often challenging, thus the availability of reliable and accessible prognostic markers is vital
when designing treatment plans and discussing them with patients. This article discusses the prognostic value of the complete blood cell
count components (i.e., white blood cell count, absolute neutrophil count, absolute lymphocyte count, absolute monocyte count, hemoglobin
level, and platelet count) in regard to clinical outcomes in patients with malignant disorders.
Keywords Complete blood cell count, white blood cell count, hemoglobin level, platelet count, neutrophil count, lymphocyte count, monocyte count, survival,
cancer, prognosis
Disclosure: The authors have no conflicts of interest to declare.
Received: January 3, 2012 Accepted: January 16, 2012 Citation: Oncology & Hematology Review, 2012;8(1):76–82
Correspondence: Luis F Porrata, MD, Assistant Professor, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. E: porrata.luis@mayo.edu
Prognostic factors of clinical outcomes in patients with cancer are a
useful tool in the practice of medicine, especially in the fields of
oncology and malignant hematology. A good prognostic factor should
reflect the biology of its targeted disease, be inexpensive, reliable,
reproducible, and standardized. Furthermore, a universal prognostic
factor that can predict survival regardless of the type of cancer will help
to simplify the management of cancer patients. In this article, we
describe the undermined universal prognostic value of a low-cost,
standardized, reliable, and reproducible prognostic factor in cancer: the
complete blood cell (CBC) count and its components.
White Blood Cell Count
The absolute white blood cell (WBC) count obtained from the CBC count
has been historically used as a marker of infection and inflammation. It
is a widely available tool for clinicians to identify the presence of
infection and monitor the patient’s response to treatment, such as
antibiotics. Nonetheless, the role of the WBC count has gone beyond the
assessment of infectious processes and it has become an important
prognostic measurement of outcomes in cancer treatment. The
inflammatory process that takes place during cancer development and
progression are, in part, reflected in abnormalities of the WBC count.
In hematologic malignancies, the WBC count is a prognostic factor for
clinical outcomes included in international prognostic systems. For
example, in advanced Hodgkin’s lymphoma (HL), the International
Prognostic Score (IPS) alerts cancer specialists of worse clinical
outcomes in patients presenting with a WBC count ≥15,000/mm 3 . 1
Another international prognostic system that associates a higher WBC
76 count count with adverse clinical outcomes is the Mantle Cell
Lymphoma International Prognostic Index (MIPI). The MIPI has been
validated in several population-based cohorts, confirming that a high
WBC count is a negative predictor of survival. 2,3
In addition to hematologic malignancies, the WBC count has been
reported to be of prognostic value in solid tumors. Pre-treatment
leukocytosis, defined as a WBC count >10,000/μl, has been shown to be
an independent prognostic factor of survival in cervical cancer patients. 4
In non-small cell lung cancer (NSCLC), the prognostic importance of the
WBC count has been studied in patients before the initiation of systemic
treatment and as a pre-operative measure, in both cases showing that
an elevated WBC count is a significant predictor of overall survival (OS)
and time to progression of disease. 5–7 Mandrekar et al. 5 developed a
survival prediction model for newly diagnosed advanced-stage NSCLC
that incorporates WBC count as one of the variables. Additionally,
patients with metastatic melanoma who exhibit a high pre-treatment
leukocyte count (>10 x 109/l) have poor clinical outcomes following
biochemotherapy in both OS (hazard ratio [HR]=1.7; p=0.0005) and
progression-free survival (PFS) (HR=1.5; p=0.008). 8
Interestingly, 143,748 post-menopausal women were studied, as part
of the Women Health Initiative, to determine the association of WBC
count with the incidence of cancer and cancer mortality. The study
concluded that within this population, women with higher WBC counts
have an increased risk of developing invasive breast, colorectal,
endometrial, and lung cancer, as well as a higher risk of overall
mortality in breast and lung cancer. 9 As a biomarker of inflammation,
© TOUCH BRIEFINGS 2012