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HIGH NEUTROPHIL LYMPHOCYTE RATIO AT DIAGNOSIS IDENTIFIES DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS WITH POOR CLINICAL OUTCOME
Author(s): ,
Branimir Spassov
Affiliations:
Department of Clinical Hematology,National Hospital for Active Treatment of Hematological Diseases,Sofia,Bulgaria
,
Gueorgui Balatzenko
Affiliations:
Laboratory of Cytogenetics and Molecular Biology,National Hospital for Active Treatment of Hematological Diseases,Sofia,Bulgaria
,
Donka Vassileva
Affiliations:
Laboratory of Nuclear Medicine,National Hospital for Active Treatment of Hematological Diseases,Sofia,Bulgaria
,
Georgi Mihaylov
Affiliations:
Department of Clinical Hematology,National Hospital for Active Treatment of Hematological Diseases,Sofia,Bulgaria
,
Stavri Toshkov
Affiliations:
Laboratory of Cytogenetics and Molecular Biology,National Hospital for Active Treatment of Hematological Diseases,Sofia,Bulgaria
Margarita Guenova
Affiliations:
Laboratory of Hematopathology and Immunology,National Hospital for Active Treatment of Hematological Diseases,Sofia,Bulgaria
(Abstract release date: 05/21/15) EHA Library. Spassov B. 06/12/15; 102928; PB1669 Disclosure(s): National Specialized Hospital for Active Treatment of Hematological Diseases
Dr. Branimir Spassov
Dr. Branimir Spassov
Contributions
Abstract
Abstract: PB1669

Type: Publication Only

Background
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) and is a biologically heterogeneous disease. At present, the stratification of DLBCL patients is performed by the revised international prognostic index (R-IPI). However, some preliminary data suggest the important role of inflammation in cancer biology. It has been assumed that systemic inflammatory response has prognostic significance in a wide range of different cancer types including NHL. The neutrophil to lymphocyte ratio (NLR) in the peripheral blood has been proposed as a prognostic factor in cancer patients. However data regarding the prognostic significance of NLR in DLBCL patients is quite limited.

Aims
To evaluate the prognostic significance of baseline NLR in a cohort of newly diagnosed DLBCL patients treated with chemoimmunotherapy.

Methods
Data from 254 DLBCL patients, at a median age of 58.6 years (range, 19-82 years), diagnosed between 2007 and 2014, were evaluated retrospectively. The patients were treated with R-CHOP. The NLR cutoff value for survival analysis determined by receiver operation characteristics (ROC) curve in the whole patients’ cohort was 3,01. The prognostic influence of the NLR and other factors including age, lactate dehydrogenase (LDH), β2 microglobulin (β2 M), R-IPI and Ann Arbor stage at diagnosis on 5-year overall- (OS) and disease-free (DFS) survival was studied by Kaplan–Meier curves. To evaluate the independent prognostic relevance of NLR, univariate and multivariate Cox regression models were applied.

Results
A significantly higher proportion of patients with NLR above 3,01 had elevated levels of LDH and β2 M (64% vs 28.8% and 75% vs 53.1%, respectively), advanced disease stage (III – IV) (48.2% vs 31.1%), high risk (R-IPI 3-5) disease (9.3% vs 32.2%) in comparison to patients with NLR below the cutoff value. Patients with high NLR at diagnosis experienced an inferior 5-year OS (38.5% vs 74.4%, P < 0.001) and 5-year DFS (61.8% vs 77.7%, P < 0.001). By multivariate analysis, an independent significant association between high NLR and poor clinical outcome in terms of OS (harard ratio [HR] = 1.99, 95% confidence interval [CI], 1.07-3.71, p=0.03) and DFS (HR = 2.58, 95% CI, 1.04-6.43, p=0.04) was identified.

Summary
Our data suggest that NLR at diagnosis provides useful independent prognostic information to assess clinical outcomes in DLBCL patients treated with R-CHOP. Further studies are required to confirm these results.

Session topic: Publication Only
Abstract: PB1669

Type: Publication Only

Background
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL) and is a biologically heterogeneous disease. At present, the stratification of DLBCL patients is performed by the revised international prognostic index (R-IPI). However, some preliminary data suggest the important role of inflammation in cancer biology. It has been assumed that systemic inflammatory response has prognostic significance in a wide range of different cancer types including NHL. The neutrophil to lymphocyte ratio (NLR) in the peripheral blood has been proposed as a prognostic factor in cancer patients. However data regarding the prognostic significance of NLR in DLBCL patients is quite limited.

Aims
To evaluate the prognostic significance of baseline NLR in a cohort of newly diagnosed DLBCL patients treated with chemoimmunotherapy.

Methods
Data from 254 DLBCL patients, at a median age of 58.6 years (range, 19-82 years), diagnosed between 2007 and 2014, were evaluated retrospectively. The patients were treated with R-CHOP. The NLR cutoff value for survival analysis determined by receiver operation characteristics (ROC) curve in the whole patients’ cohort was 3,01. The prognostic influence of the NLR and other factors including age, lactate dehydrogenase (LDH), β2 microglobulin (β2 M), R-IPI and Ann Arbor stage at diagnosis on 5-year overall- (OS) and disease-free (DFS) survival was studied by Kaplan–Meier curves. To evaluate the independent prognostic relevance of NLR, univariate and multivariate Cox regression models were applied.

Results
A significantly higher proportion of patients with NLR above 3,01 had elevated levels of LDH and β2 M (64% vs 28.8% and 75% vs 53.1%, respectively), advanced disease stage (III – IV) (48.2% vs 31.1%), high risk (R-IPI 3-5) disease (9.3% vs 32.2%) in comparison to patients with NLR below the cutoff value. Patients with high NLR at diagnosis experienced an inferior 5-year OS (38.5% vs 74.4%, P < 0.001) and 5-year DFS (61.8% vs 77.7%, P < 0.001). By multivariate analysis, an independent significant association between high NLR and poor clinical outcome in terms of OS (harard ratio [HR] = 1.99, 95% confidence interval [CI], 1.07-3.71, p=0.03) and DFS (HR = 2.58, 95% CI, 1.04-6.43, p=0.04) was identified.

Summary
Our data suggest that NLR at diagnosis provides useful independent prognostic information to assess clinical outcomes in DLBCL patients treated with R-CHOP. Further studies are required to confirm these results.

Session topic: Publication Only

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