Contributions
Abstract: PB1755
Type: Publication Only
Background
Recently, several inflammation-based parameters, such as lactate dehydrogenase (LDH), the neutrophil/lymphocyte ratio, the platelet/lymphocyte ratio (PLR), the absolute lymphocyte count, and serum albumin, were established for determining clinical outcomes in diffuse large B-cell lymphoma (DLBCL). However, these inflammatory parameters have been studied mainly in newly diagnosed DLBCL patients and there are few inflammation-based markers for predicting clinical outcomes of relapsed/refractory patients.
Aims
Therefore, we evaluated the usefulness of combination of serum albumin concentration and PLR (COA-PLR), as an inflammatory marker, in predicting response to salvage chemotherapy and prognosis for patients with relapsed/refractory DLBCL after R-CHOP chemotherapy.
Methods
We retrospectively reviewed data from 113 patients with relapsed/refractory DLBCL who received front-line R-CHOP chemotherapy between January 2000 and December 2016. PLR was calculated from differential count dividing the platelet measurement by the lymphocyte measurement and was recorded at first relapse or refractoriness after R-CHOP chemotherapy. A PLR of 270 was identified as the most discriminative cutoff value for overall survival (OS) and progression-free survival (PFS) from relapse or refractoriness by receiver operating characteristic curve analysis. The COA-PLR was calculated as follows: patients with both hypoalbuminemia (<3.5 g/dL) and an elevated PLR (>270) were allocated a score of 2, and patients with one or neither were allocated a score of 1 or 0, respectively.
Results
Overall, this study included 68 males and 45 females with a median age at diagnosis of 58 years (range, 23–76). Of the patients, 30 (26.5%) had refractory disease and 83 (73.5%) had relapsed disease. Of the relapsed patients, 36 (43.4%) and 47 (56.6%) showed early (≤1 year) and late relapse (>1 year) after achieving complete response (CR) or partial response (PR) at the end of R-CHOP chemotherapy, respectively. The COA-PLR score was 0 in 22 (19.4%), 1 in 55 (48.8%), and 2 in 36 (31.8%). The proportion of old patients (age >60 years) was significantly higher in the COA-PLR 2 group than in COA-PLR 1 and 0 group (61.4% vs 38.2% vs 39.5%, p <0.001). Poor Eastern Cooperative Oncology Group performance status, presence of B symptoms and high-risk international prognostic index were also observed frequently in the COA-PLR 2 group. ICE (ifosfamide, carboplatin, and etoposide) and DHAP (dexamethasone, cytarabine, and cisplatin) were the two most commonly used salvage chemotherapies resulting in overall response rate (ORR, CR+PR) of 68.1% with 46% of CR patients (n=53). The ORR after salvage chemotherapy decreased according to COA-PLR score: 82.1% at COA-PLR 0, 61.2% at COA-PLR 1, and 41.2% at COA-PLR 2 (p<0.001). Among the responders, 47 (62%) received autologous stem cell transplantation after salvage chemotherapy. Of a median follow-up of 42 months (range, 14-72), the 3-year PFS and OS rates were 32.5% and 44.2%, respectively. In multivariate analysis, early relapse (hazard ratio [HR] 2.108, 95% confidence interval [CI] 1.277-3.579), high LDH (HR 1.536, 95% CI 1.195-3.158), and COA-PLR 2 (HR 1.902, 95% CI 1.270-3.468) were independent poor prognostic factors for PFS. The independent poor prognostic factors for OS were early relapse (HR 2.104, 95% CI 1.178-3.768) and COA-PLR 2 (HR 1.976, 95% CI 1.370-2.852).
Conclusion
This study suggests that the COA-PLR maybe a potentially useful and easily available tool for predicting clinical outcomes in relapsed/refractory DLBCL patients.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Diffuse large B cell lymphoma, Prognostic factor, Relapse
Abstract: PB1755
Type: Publication Only
Background
Recently, several inflammation-based parameters, such as lactate dehydrogenase (LDH), the neutrophil/lymphocyte ratio, the platelet/lymphocyte ratio (PLR), the absolute lymphocyte count, and serum albumin, were established for determining clinical outcomes in diffuse large B-cell lymphoma (DLBCL). However, these inflammatory parameters have been studied mainly in newly diagnosed DLBCL patients and there are few inflammation-based markers for predicting clinical outcomes of relapsed/refractory patients.
Aims
Therefore, we evaluated the usefulness of combination of serum albumin concentration and PLR (COA-PLR), as an inflammatory marker, in predicting response to salvage chemotherapy and prognosis for patients with relapsed/refractory DLBCL after R-CHOP chemotherapy.
Methods
We retrospectively reviewed data from 113 patients with relapsed/refractory DLBCL who received front-line R-CHOP chemotherapy between January 2000 and December 2016. PLR was calculated from differential count dividing the platelet measurement by the lymphocyte measurement and was recorded at first relapse or refractoriness after R-CHOP chemotherapy. A PLR of 270 was identified as the most discriminative cutoff value for overall survival (OS) and progression-free survival (PFS) from relapse or refractoriness by receiver operating characteristic curve analysis. The COA-PLR was calculated as follows: patients with both hypoalbuminemia (<3.5 g/dL) and an elevated PLR (>270) were allocated a score of 2, and patients with one or neither were allocated a score of 1 or 0, respectively.
Results
Overall, this study included 68 males and 45 females with a median age at diagnosis of 58 years (range, 23–76). Of the patients, 30 (26.5%) had refractory disease and 83 (73.5%) had relapsed disease. Of the relapsed patients, 36 (43.4%) and 47 (56.6%) showed early (≤1 year) and late relapse (>1 year) after achieving complete response (CR) or partial response (PR) at the end of R-CHOP chemotherapy, respectively. The COA-PLR score was 0 in 22 (19.4%), 1 in 55 (48.8%), and 2 in 36 (31.8%). The proportion of old patients (age >60 years) was significantly higher in the COA-PLR 2 group than in COA-PLR 1 and 0 group (61.4% vs 38.2% vs 39.5%, p <0.001). Poor Eastern Cooperative Oncology Group performance status, presence of B symptoms and high-risk international prognostic index were also observed frequently in the COA-PLR 2 group. ICE (ifosfamide, carboplatin, and etoposide) and DHAP (dexamethasone, cytarabine, and cisplatin) were the two most commonly used salvage chemotherapies resulting in overall response rate (ORR, CR+PR) of 68.1% with 46% of CR patients (n=53). The ORR after salvage chemotherapy decreased according to COA-PLR score: 82.1% at COA-PLR 0, 61.2% at COA-PLR 1, and 41.2% at COA-PLR 2 (p<0.001). Among the responders, 47 (62%) received autologous stem cell transplantation after salvage chemotherapy. Of a median follow-up of 42 months (range, 14-72), the 3-year PFS and OS rates were 32.5% and 44.2%, respectively. In multivariate analysis, early relapse (hazard ratio [HR] 2.108, 95% confidence interval [CI] 1.277-3.579), high LDH (HR 1.536, 95% CI 1.195-3.158), and COA-PLR 2 (HR 1.902, 95% CI 1.270-3.468) were independent poor prognostic factors for PFS. The independent poor prognostic factors for OS were early relapse (HR 2.104, 95% CI 1.178-3.768) and COA-PLR 2 (HR 1.976, 95% CI 1.370-2.852).
Conclusion
This study suggests that the COA-PLR maybe a potentially useful and easily available tool for predicting clinical outcomes in relapsed/refractory DLBCL patients.
Session topic: 21. Aggressive Non-Hodgkin lymphoma - Clinical
Keyword(s): Diffuse large B cell lymphoma, Prognostic factor, Relapse