The maximum chemiluminescence intensity predicts severe neutropenia in gemcitabine-treated patients with pancreatic or biliary tract cancer

PURPOSE: To assess the predictive ability of the maximum chemiluminescence intensity (CI(max)) for severe neutropenia (SN) during neoadjuvant chemo(radio)therapy [NAC(RT)] in patients with advanced pancreatic or biliary tract cancer. METHODS: Clinicopathological variables and blood test data before NAC(RT) were evaluated in 64 patients with advanced pancreatic or biliary tract cancer who received gemcitabine plus tegafur/gimeracil/oteracil as NAC(RT). RESULTS: Thirty-nine patients (60.9%) developed Grade 3–4 SN. The median time between commencing NAC(RT) and the onset of SN was 15 (range 10–36) days. SN occurred during the NAC period, not the RT period. The CI(max), neutrophil count, serum interleukin-6 level, C-reactive protein level, complement C3 titer, serum complement titer, and 50.0% hemolytic unit of complement before NAC(RT) were significantly lower in patients with SN than in those without SN (P < 0.05). Multivariate analysis confirmed the CI(max) to be the sole independent predictor of SN (P < 0.05). The optimal threshold for the CI(max) was 46,000 RLU/s. The sensitivity and specificity were 46.2% and 80.0%, respectively. Majority of the patients (81.8%) with a low CI(max) before NAC(RT) experienced SN during NAC(RT). CONCLUSIONS: CI(max) before NAC(RT) predicts SN during NAC(RT) in patients with advanced pancreatic or biliary tract cancer.