Contributions
Type: Publication Only
Background
Diffuse large B-cell lymphoma (DLBCL) is a biologically heterogeneous disease with primary nodal and extranodal origin. 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 blood monocytes and lymphocytes in cancer biology. It has been assumed that baseline levels of peripheral absolute lymphocyte (ALC) and monocyte (AMC) counts have prognostic value in solid tumors. However, data regarding their impact on clinical outcomes of DLBCL patients are limited.
Aims
To evaluate the prognostic significance of baseline ALC and AMC in a cohort of newly diagnosed DLBCL patients treated with chemoimmunotherapy.
Methods
Data from 255 DLBCL patients, at a median age of 58.6 years (range, 19-82 years), diagnosed between 2007 and 2014, were evaluated retrospectively. Primary nodal and extranodal lymphoma were detected in 60.4% (154/255) and 39.6% (101/255), respectively. The patients were treated with R-CHOP. Values < 1.0 x 109/L for ALC and > 0.8 x 109/L for AMC were considered abnormal and applied to stratify patients in the present study.
The prognostic influence of the ALC and AMC, 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 ALC and AMC, univariate and multivariate Cox regression models were applied.
Results
The median ALC at diagnosis was 1.74 x 109/L (range 0.28–7.16 x 109/L) and abnormal ALC were detected in 16.8% (42/255) of the patients. A significantly higher proportion of patients with ALC < 1.0 x 109/L had elevated levels of LDH and β2 M (76.2% vs 36.1% and 86.8% vs 57.6%, respectively), advanced disease stage (III – IV) (60.9% vs 34.9%), high risk (R-IPI 3-5) disease (43.9% vs 15.8%) in comparison to patients with ALC ≥ 1.0 x 109/L. The median AMC at diagnosis was 0.59 x 109/L (range 0.28–7.16 x 109/L) and AMC > 0.8 x 109/L were detected in 24.3% (62/255). Similarly, a significantly higher proportion of patients with abnormal AMC had elevated levels of LDH and β2 M (59.7% vs 37.3% and 76% vs 60.1%, respectively), advanced disease stage (III – IV) (52.4% vs 34.9%), high risk (R-IPI 3-5) disease (36.8% vs 15.5%) in comparison to patients with AMC ≤ 0.8 x 109/L. Patients with abnormal ALC at diagnosis experienced an inferior 5-year OS (18% vs 64.7%, p<0.001) and 5-year DFS (48.9% vs 78.2%, p<0.001). Patients with abnormal AMC at diagnosis experienced an inferior 5-year OS (60% vs 79.2%, p=0.002) and 5-year DFS (53.6% vs 80.4%, p=0.001). However, regarding nodal and extranodal origin of lymphoma the analysis revealed that only primary nodal DLBCL patients with abnormal baseline ALC and AMC experienced inferior 5-year OS and 5-year DFS. Moreover, an independent significant association between abnormal ALC and poor clinical outcome in terms of OS (hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.13-4.06, p=0.019) and DFS (HR 5.88, 95% CI 2.00-17.25, p=0.001) was identified by multivariate analysis only in primary nodal DLBCL patients.
Summary
Our data suggest that ALC and AMC in peripheral blood at diagnosis predict survival in primary nodal DLBCL treated with R-CHOP. However only ALC is independent, poor prognostic factor for DFS and OS, and can be used in combination with other prognostic features to better predict the outcome of these patients.
Session topic: Publication Only
Type: Publication Only
Background
Diffuse large B-cell lymphoma (DLBCL) is a biologically heterogeneous disease with primary nodal and extranodal origin. 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 blood monocytes and lymphocytes in cancer biology. It has been assumed that baseline levels of peripheral absolute lymphocyte (ALC) and monocyte (AMC) counts have prognostic value in solid tumors. However, data regarding their impact on clinical outcomes of DLBCL patients are limited.
Aims
To evaluate the prognostic significance of baseline ALC and AMC in a cohort of newly diagnosed DLBCL patients treated with chemoimmunotherapy.
Methods
Data from 255 DLBCL patients, at a median age of 58.6 years (range, 19-82 years), diagnosed between 2007 and 2014, were evaluated retrospectively. Primary nodal and extranodal lymphoma were detected in 60.4% (154/255) and 39.6% (101/255), respectively. The patients were treated with R-CHOP. Values < 1.0 x 109/L for ALC and > 0.8 x 109/L for AMC were considered abnormal and applied to stratify patients in the present study.
The prognostic influence of the ALC and AMC, 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 ALC and AMC, univariate and multivariate Cox regression models were applied.
Results
The median ALC at diagnosis was 1.74 x 109/L (range 0.28–7.16 x 109/L) and abnormal ALC were detected in 16.8% (42/255) of the patients. A significantly higher proportion of patients with ALC < 1.0 x 109/L had elevated levels of LDH and β2 M (76.2% vs 36.1% and 86.8% vs 57.6%, respectively), advanced disease stage (III – IV) (60.9% vs 34.9%), high risk (R-IPI 3-5) disease (43.9% vs 15.8%) in comparison to patients with ALC ≥ 1.0 x 109/L. The median AMC at diagnosis was 0.59 x 109/L (range 0.28–7.16 x 109/L) and AMC > 0.8 x 109/L were detected in 24.3% (62/255). Similarly, a significantly higher proportion of patients with abnormal AMC had elevated levels of LDH and β2 M (59.7% vs 37.3% and 76% vs 60.1%, respectively), advanced disease stage (III – IV) (52.4% vs 34.9%), high risk (R-IPI 3-5) disease (36.8% vs 15.5%) in comparison to patients with AMC ≤ 0.8 x 109/L. Patients with abnormal ALC at diagnosis experienced an inferior 5-year OS (18% vs 64.7%, p<0.001) and 5-year DFS (48.9% vs 78.2%, p<0.001). Patients with abnormal AMC at diagnosis experienced an inferior 5-year OS (60% vs 79.2%, p=0.002) and 5-year DFS (53.6% vs 80.4%, p=0.001). However, regarding nodal and extranodal origin of lymphoma the analysis revealed that only primary nodal DLBCL patients with abnormal baseline ALC and AMC experienced inferior 5-year OS and 5-year DFS. Moreover, an independent significant association between abnormal ALC and poor clinical outcome in terms of OS (hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.13-4.06, p=0.019) and DFS (HR 5.88, 95% CI 2.00-17.25, p=0.001) was identified by multivariate analysis only in primary nodal DLBCL patients.
Summary
Our data suggest that ALC and AMC in peripheral blood at diagnosis predict survival in primary nodal DLBCL treated with R-CHOP. However only ALC is independent, poor prognostic factor for DFS and OS, and can be used in combination with other prognostic features to better predict the outcome of these patients.
Session topic: Publication Only