Three-year post-recurrence survival outcome by leukopenia grade 2+ during systemic chemotherapy in recurrent cervical...

This study aimed to evaluate the association between grade ≥2 chemotherapy-induced leukopenia (CIL) and 3-year post-recurrence survival (PRS) in patients with recurrent cervical cancer (CC) undergoing systemic chemotherapy.

We conducted a retrospective comparative cohort study of patients with recurrent CC who received ≥3 cycles of systemic chemotherapy at a tertiary referral center between January 2000 and June 2022. Complete serial blood counts were performed for each cycle. Patients were classified according to the development of grade ≥2 leukopenia (white blood cell count <3,000 cells/μL) within the first three cycles. Three-year PRS was analyzed using Kaplan-Meier estimates and Cox proportional hazards models.

Among 164 patients (mean age 52.4±11.0 years), leukopenia G2+ occurred in 29 patients (17.7%). Median 3-year PRS was significantly longer in the leukopenia G2+ group than in the non-leukopenia G2+ group (28.9 vs. 17.5 months). The 3-year PRS rates were 38.8% and 16.9%, respectively (P=0.022). On univariate analysis, longer intervals from complete clinical remission to recurrence, platinum regimens, and grade ≥2 leukopenia were associated with improved survival. Multivariate analysis confirmed that leukopenia conferred a 47% reduction in mortality risk (hazard ratio, 0.53; 95% confidence interval, 0.31-0.91; P=0.021).

CIL during early treatment cycles was independently associated with superior survival in patients with recurrent CC. In the absence of infectious complications, leukopenia may reflect adequate pharmacodynamic drug exposure and host treatment response. It should be interpreted as a post-hoc prognostic indicator, supporting its potential role as a pragmatic surrogate marker of chemotherapy efficacy.