PROGNOSTIC VALUE OF PRETREATMENT ADVANCED LUNG CANCER INFLAMMATION INDEX (ALI) IN DIFFUSE LARGE B-CELL LYMPHOMA PATIENTS TREATED WITH R-CHOP CHEMOTHERAPY
(Abstract release date: 05/19/16)
EHA Library. Park Y. 06/09/16; 134584; PB1684
Prof. Young Hoon Park
Contributions
Contributions
Abstract
Abstract: PB1684
Type: Publication Only
Background
It has become evident that cancer-related inflammation plays an important role in the development and progression of various types of cancer and adversely influences response to anti-cancer therapy. Advanced lung cancer inflammation index (ALI), a novel inflammation-based prognostic system, has been demonstrated to be a prognostic factor of survival in some solid cancers. However, the prognostic usefulness of ALI has not been investigated in lymphoma.
Aims
The authors investigated the ability of ALI to predict response to chemotherapy and survival in patients with diffuse large B-cell lymphoma (DLBCL).
Methods
The records of 212 patients with newly diagnosed DLBCL treated by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were reviewed. ALI values were calculated by dividing the product of body mass index and blood albumin level by peripheral blood neutrophil/lymphocyte ratio. Patients were allocated to a low pretreatment ALI group (n=82, 38.7%) or a high pretreatment ALI group (n=130, 61.3%) using on optimal ALI discriminatory cutoff value for survival of 15.5 as determined by receiver operating curve analysis.
Results
The proportion of older patients (aged >60 years) was significantly higher in the low ALI group than in the high ALI group (63.4% vs. 36.2%, p<0.001). More patients had advanced disease (Ann Arbor stage III/IV) in low ALI group at initial diagnosis (72% vs. 54.6%, p=0.014). Poor Eastern Cooperative Oncology Group performance status (ECOG PS, p=0.001), presence of B symptoms (p=0.002), and high-risk of International Prognostic Index (IPI, p=0.029) were observed more frequently in the low ALI group. Complete remission rates in the low and high ALI groups after completing R-CHOP chemotherapy (after 6 to 8 cycles) were 54.9% (45/82) and 75.4% (98/130), respectively (p=0.008). During a median follow-up of 54 months (range, 6-92 months), patients in the low ALI group had shorter 5-year PFS (58.1% vs. 77.3%, p=0.006) and OS (64.2% vs. 80.2%, p=0.008) than patients in the high ALI group. Multivariate analysis showed advanced disease (hazard ratio [HR] 2.425, 95% confidence interval [CI] 1.514-3.128, p=0.013), bulky disease (diameter ≥10 cm, HR 1.568, 95% CI 0.678-4.287, p=0.043) and low pretreatment ALI (HR 1.927, 95% CI 0.893-3.598, p=0.021) were significantly associated with poorer PFS. Regarding OS, age >60 (HR 2.298, 95% CI 1.628-6.118, p=0.015), ECOG PS ≥2 (HR 1.814, 95% CI 0.874-6.521, p=0.024), high-risk IPI (HR 2.872, 95% CI 1.658-5.723, p<0.001), advanced disease (HR 2.431, 95% CI 1.422-6.249, p=0.002) and low pretreatment ALI (HR 2.645, 95% CI 1.542-5.974, p=0.001) were all found to be independently associated with shorter OS. Interestingly, a low ALI before R-CHOP chemotherapy reverted to a high ALI during treatment in 58 patients (27.4%) and median OS of these patients (not reached) was better than that of patients whose ALI remained low (n=24, 25 months; p<0.001). Conversely, patients with a persistent low ALI during treatment showed worse survival.
Conclusion
This study shows a significant association exists between pretreatment ALI and response to R-CHOP chemotherapy and prognosis in DLBCL. Changes in ALI during the course of chemotherapy might also provide additional information about survival, particularly for patients with a low pretreatment ALI. Our findings suggest ALI is an inexpensive, potential prognostic marker in patients with DLBCL that can be readily used in routine practice.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Inflammation, Prognostic factor
Type: Publication Only
Background
It has become evident that cancer-related inflammation plays an important role in the development and progression of various types of cancer and adversely influences response to anti-cancer therapy. Advanced lung cancer inflammation index (ALI), a novel inflammation-based prognostic system, has been demonstrated to be a prognostic factor of survival in some solid cancers. However, the prognostic usefulness of ALI has not been investigated in lymphoma.
Aims
The authors investigated the ability of ALI to predict response to chemotherapy and survival in patients with diffuse large B-cell lymphoma (DLBCL).
Methods
The records of 212 patients with newly diagnosed DLBCL treated by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were reviewed. ALI values were calculated by dividing the product of body mass index and blood albumin level by peripheral blood neutrophil/lymphocyte ratio. Patients were allocated to a low pretreatment ALI group (n=82, 38.7%) or a high pretreatment ALI group (n=130, 61.3%) using on optimal ALI discriminatory cutoff value for survival of 15.5 as determined by receiver operating curve analysis.
Results
The proportion of older patients (aged >60 years) was significantly higher in the low ALI group than in the high ALI group (63.4% vs. 36.2%, p<0.001). More patients had advanced disease (Ann Arbor stage III/IV) in low ALI group at initial diagnosis (72% vs. 54.6%, p=0.014). Poor Eastern Cooperative Oncology Group performance status (ECOG PS, p=0.001), presence of B symptoms (p=0.002), and high-risk of International Prognostic Index (IPI, p=0.029) were observed more frequently in the low ALI group. Complete remission rates in the low and high ALI groups after completing R-CHOP chemotherapy (after 6 to 8 cycles) were 54.9% (45/82) and 75.4% (98/130), respectively (p=0.008). During a median follow-up of 54 months (range, 6-92 months), patients in the low ALI group had shorter 5-year PFS (58.1% vs. 77.3%, p=0.006) and OS (64.2% vs. 80.2%, p=0.008) than patients in the high ALI group. Multivariate analysis showed advanced disease (hazard ratio [HR] 2.425, 95% confidence interval [CI] 1.514-3.128, p=0.013), bulky disease (diameter ≥10 cm, HR 1.568, 95% CI 0.678-4.287, p=0.043) and low pretreatment ALI (HR 1.927, 95% CI 0.893-3.598, p=0.021) were significantly associated with poorer PFS. Regarding OS, age >60 (HR 2.298, 95% CI 1.628-6.118, p=0.015), ECOG PS ≥2 (HR 1.814, 95% CI 0.874-6.521, p=0.024), high-risk IPI (HR 2.872, 95% CI 1.658-5.723, p<0.001), advanced disease (HR 2.431, 95% CI 1.422-6.249, p=0.002) and low pretreatment ALI (HR 2.645, 95% CI 1.542-5.974, p=0.001) were all found to be independently associated with shorter OS. Interestingly, a low ALI before R-CHOP chemotherapy reverted to a high ALI during treatment in 58 patients (27.4%) and median OS of these patients (not reached) was better than that of patients whose ALI remained low (n=24, 25 months; p<0.001). Conversely, patients with a persistent low ALI during treatment showed worse survival.
Conclusion
This study shows a significant association exists between pretreatment ALI and response to R-CHOP chemotherapy and prognosis in DLBCL. Changes in ALI during the course of chemotherapy might also provide additional information about survival, particularly for patients with a low pretreatment ALI. Our findings suggest ALI is an inexpensive, potential prognostic marker in patients with DLBCL that can be readily used in routine practice.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Inflammation, Prognostic factor
Abstract: PB1684
Type: Publication Only
Background
It has become evident that cancer-related inflammation plays an important role in the development and progression of various types of cancer and adversely influences response to anti-cancer therapy. Advanced lung cancer inflammation index (ALI), a novel inflammation-based prognostic system, has been demonstrated to be a prognostic factor of survival in some solid cancers. However, the prognostic usefulness of ALI has not been investigated in lymphoma.
Aims
The authors investigated the ability of ALI to predict response to chemotherapy and survival in patients with diffuse large B-cell lymphoma (DLBCL).
Methods
The records of 212 patients with newly diagnosed DLBCL treated by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were reviewed. ALI values were calculated by dividing the product of body mass index and blood albumin level by peripheral blood neutrophil/lymphocyte ratio. Patients were allocated to a low pretreatment ALI group (n=82, 38.7%) or a high pretreatment ALI group (n=130, 61.3%) using on optimal ALI discriminatory cutoff value for survival of 15.5 as determined by receiver operating curve analysis.
Results
The proportion of older patients (aged >60 years) was significantly higher in the low ALI group than in the high ALI group (63.4% vs. 36.2%, p<0.001). More patients had advanced disease (Ann Arbor stage III/IV) in low ALI group at initial diagnosis (72% vs. 54.6%, p=0.014). Poor Eastern Cooperative Oncology Group performance status (ECOG PS, p=0.001), presence of B symptoms (p=0.002), and high-risk of International Prognostic Index (IPI, p=0.029) were observed more frequently in the low ALI group. Complete remission rates in the low and high ALI groups after completing R-CHOP chemotherapy (after 6 to 8 cycles) were 54.9% (45/82) and 75.4% (98/130), respectively (p=0.008). During a median follow-up of 54 months (range, 6-92 months), patients in the low ALI group had shorter 5-year PFS (58.1% vs. 77.3%, p=0.006) and OS (64.2% vs. 80.2%, p=0.008) than patients in the high ALI group. Multivariate analysis showed advanced disease (hazard ratio [HR] 2.425, 95% confidence interval [CI] 1.514-3.128, p=0.013), bulky disease (diameter ≥10 cm, HR 1.568, 95% CI 0.678-4.287, p=0.043) and low pretreatment ALI (HR 1.927, 95% CI 0.893-3.598, p=0.021) were significantly associated with poorer PFS. Regarding OS, age >60 (HR 2.298, 95% CI 1.628-6.118, p=0.015), ECOG PS ≥2 (HR 1.814, 95% CI 0.874-6.521, p=0.024), high-risk IPI (HR 2.872, 95% CI 1.658-5.723, p<0.001), advanced disease (HR 2.431, 95% CI 1.422-6.249, p=0.002) and low pretreatment ALI (HR 2.645, 95% CI 1.542-5.974, p=0.001) were all found to be independently associated with shorter OS. Interestingly, a low ALI before R-CHOP chemotherapy reverted to a high ALI during treatment in 58 patients (27.4%) and median OS of these patients (not reached) was better than that of patients whose ALI remained low (n=24, 25 months; p<0.001). Conversely, patients with a persistent low ALI during treatment showed worse survival.
Conclusion
This study shows a significant association exists between pretreatment ALI and response to R-CHOP chemotherapy and prognosis in DLBCL. Changes in ALI during the course of chemotherapy might also provide additional information about survival, particularly for patients with a low pretreatment ALI. Our findings suggest ALI is an inexpensive, potential prognostic marker in patients with DLBCL that can be readily used in routine practice.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Inflammation, Prognostic factor
Type: Publication Only
Background
It has become evident that cancer-related inflammation plays an important role in the development and progression of various types of cancer and adversely influences response to anti-cancer therapy. Advanced lung cancer inflammation index (ALI), a novel inflammation-based prognostic system, has been demonstrated to be a prognostic factor of survival in some solid cancers. However, the prognostic usefulness of ALI has not been investigated in lymphoma.
Aims
The authors investigated the ability of ALI to predict response to chemotherapy and survival in patients with diffuse large B-cell lymphoma (DLBCL).
Methods
The records of 212 patients with newly diagnosed DLBCL treated by R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy were reviewed. ALI values were calculated by dividing the product of body mass index and blood albumin level by peripheral blood neutrophil/lymphocyte ratio. Patients were allocated to a low pretreatment ALI group (n=82, 38.7%) or a high pretreatment ALI group (n=130, 61.3%) using on optimal ALI discriminatory cutoff value for survival of 15.5 as determined by receiver operating curve analysis.
Results
The proportion of older patients (aged >60 years) was significantly higher in the low ALI group than in the high ALI group (63.4% vs. 36.2%, p<0.001). More patients had advanced disease (Ann Arbor stage III/IV) in low ALI group at initial diagnosis (72% vs. 54.6%, p=0.014). Poor Eastern Cooperative Oncology Group performance status (ECOG PS, p=0.001), presence of B symptoms (p=0.002), and high-risk of International Prognostic Index (IPI, p=0.029) were observed more frequently in the low ALI group. Complete remission rates in the low and high ALI groups after completing R-CHOP chemotherapy (after 6 to 8 cycles) were 54.9% (45/82) and 75.4% (98/130), respectively (p=0.008). During a median follow-up of 54 months (range, 6-92 months), patients in the low ALI group had shorter 5-year PFS (58.1% vs. 77.3%, p=0.006) and OS (64.2% vs. 80.2%, p=0.008) than patients in the high ALI group. Multivariate analysis showed advanced disease (hazard ratio [HR] 2.425, 95% confidence interval [CI] 1.514-3.128, p=0.013), bulky disease (diameter ≥10 cm, HR 1.568, 95% CI 0.678-4.287, p=0.043) and low pretreatment ALI (HR 1.927, 95% CI 0.893-3.598, p=0.021) were significantly associated with poorer PFS. Regarding OS, age >60 (HR 2.298, 95% CI 1.628-6.118, p=0.015), ECOG PS ≥2 (HR 1.814, 95% CI 0.874-6.521, p=0.024), high-risk IPI (HR 2.872, 95% CI 1.658-5.723, p<0.001), advanced disease (HR 2.431, 95% CI 1.422-6.249, p=0.002) and low pretreatment ALI (HR 2.645, 95% CI 1.542-5.974, p=0.001) were all found to be independently associated with shorter OS. Interestingly, a low ALI before R-CHOP chemotherapy reverted to a high ALI during treatment in 58 patients (27.4%) and median OS of these patients (not reached) was better than that of patients whose ALI remained low (n=24, 25 months; p<0.001). Conversely, patients with a persistent low ALI during treatment showed worse survival.
Conclusion
This study shows a significant association exists between pretreatment ALI and response to R-CHOP chemotherapy and prognosis in DLBCL. Changes in ALI during the course of chemotherapy might also provide additional information about survival, particularly for patients with a low pretreatment ALI. Our findings suggest ALI is an inexpensive, potential prognostic marker in patients with DLBCL that can be readily used in routine practice.
Session topic: E-poster
Keyword(s): Diffuse large B cell lymphoma, Inflammation, Prognostic factor
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