The Analysis of Prognostic Significance of Absolute Lymphocyte Count and Lymphocyte-to-Monocyte Ratio in Diffuse Large B-Cell Lymphoma

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5379-5379
Author(s):  
Haiwen Huang ◽  
Ying Liu ◽  
Zhengming Jin ◽  
Wu Depei

Abstract 【Objective】 To evaluate the prognostic value of absolute lymphocyte count (ALC)and lymphocyte-to-monocyte ratio (LMR) in Diffuse large B-cell lymphoma(DLBCL) when they are diagnosised. 【Methods】 Sixty-nine cases were analyzed retrospectively, including sex, age, stage, B symptoms, absolute lymphocyte count, absolute monocyte count, lymphocyte-to-monocyte ratio, lactate dehydrogenase, IPI score, bulky disease, ECOG performance status, number of extranodal involvement. Thirty-four received CHOP treatment (cyclophosphamide, vincristine, adriamycin, dexamethasone) , thirty-five received R-CHOP (rituximab plus CHOP). The ALC, AMC, LMR cutoff value for survival analysis were 1.0×109/L, 0.3×109/L, 2.6 respectively. All data were analyzed by statistical package for the social sciences (SPSS) software ‘‘version 18.’’ Chi-square test wasused to compare the difference between two groups of means. The Kaplan–Meier method was used to summarize OS and PFS and the logrank test was used for univariable analysis. The Cox proportional hazards model was used for multivariable analyses of measured factors. 【Results】 1. Patients with ALC<1.0×109/L had a high incidence of advanced Ann Arbor stage (P=0.003) , B symptoms (P=0.001) , elevated LDH level (P<0.001), high IPI score (P<0.001) and high ECOG score (P=0.001). Similar results were observed in patients with LMR<2.6. Patients with LMR<2.6 had a high incidence of advanced Ann Arbor stage (P<0.001) , B symptoms (P=0.005) , elevated LDH level (P<0.001), high IPI score (P<0.001) and high ECOG score (P=0.006). 2. In comparison with CHOP and RCHOP treatment, OS was significant longer with rituximab, as well as PFS(P<0.05). 3. After a median 41.5 months follow-up, K-M analysis showed that lower ALC and LMR associated with inferior overall survival (OS) and progression free survival (PFS) (P<0.001). In CHOP treatment group, patients with lower ALC and LMR seemed to have worse OS and PFS ( ALC: P=0.002 in OS,and P=0.005 in PFS; LMR: P=0.011 in OS, and P=0.027 in PFS). We got the same results in RCHOP set (ALC: P=0.001 in OS ; P=0.001 in PFS / LMR: P=0.001 in OS ; P=0.002 in PFS). 4. In multivariate analysis, only ALC were proven as an independent prognosis factor of survival(P<0.05). 【Conclusions】 the ALC and LMR at diagnosis were independent prognostic factors of both OS and PFS for patients with DLBCL. These data suggest that ALC can be used in combination with other prognostic features to better predict the outcome of DLBCL. Disclosures No relevant conflicts of interest to declare.

2008 ◽  
Vol 141 (2) ◽  
pp. 265-268 ◽  
Author(s):  
M. Christina Cox ◽  
Italo Nofroni ◽  
Giacinto Laverde ◽  
Antonella Ferrari ◽  
Rachele Amodeo ◽  
...  

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e19521-e19521
Author(s):  
Ayham Deeb ◽  
Mahender Yellu ◽  
Tahir Latif ◽  
Gunjan Guha ◽  
Arun Sendilnathan ◽  
...  

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2882-2882
Author(s):  
Vit Prochazka ◽  
Marek Trneny ◽  
David Salek ◽  
David Belada ◽  
Tomas Kozak ◽  
...  

Abstract Abstract 2882 Absolute lymphocyte count (ALC) at time of diagnosis has been documented as an independent predictor of survival in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). The optimal cut-off values of ALC are still a matter of debate. An extensive analysis of the prognostic impact of ALC in the elderly population treated with rituximab has not yet been carried out. Thus, we assessed the prognostic significance of different ALCs in unselected, newly diagnosed elderly patients with DLBCL in the population of the Central European region (the Czech Lymphoma Project registry). We analyzed data of 651 patients with confirmed DLBCL older than 59 years. Those with CNS involvement were excluded. The median age at diagnosis was 69 years (range, 60–97); the Ann Arbor stages were as follows: I (16.5%), II (26.1%), III (15.9%), and IV (41.5%). The IPI scores were: low (L) 19.8%, low-intermediate (LI) 26.6%, intermediate-high (IH) 24.3%, and high (H) 29.3%. We analyzed the prognostic value of lymphopenia with 3 different cut-off values. Values of ALC < 1.0 × 109/L and ALC < 0.84 × 109/L were chosen according to the previously published data, the third value was the median ALC at diagnosis (ALC 1.35 × 109/L). ALC < 1.0 × 109/L was observed in 201 (31%) and ALC < 0.84 × 109/L in 159 (24%) patients. ALCs below predefined levels were associated with higher (IH, H) IPI scores: ALC < 0.84 × 109/L (78% vs 46%, p < 0.001), ALC < 1.0 × 109/L (77% vs 43%, p < 0.001), and ALC < 1.35 × 109/L (68% vs 38%, p < 0.001); advanced disease (stages III/IV): ALC < 0.84 × 109/L (72% vs 53%, p < 0.001), ALC < 1.0 × 109/L (72% vs 51%, p < 0.001), and ALC < 1.35 × 109/L (66% vs 48%, p < 0.001); and low performance status (ECOG ≥ 2): ALC < 0.84 × 109/L (52% vs 27%, p < 0.001), ALC < 1.0 × 109/L (50% vs 25%, p < 0.001), and ALC < 1.35 × 109/L (43% vs 22%, p < 0.001). In 85% of patients, treatment was initiated with an anthracycline-containing regimen (CHOP), i.e. only 15% of patients recieved a non-anthracycline-based regimen (COP). The median number of chemotherapy cycles was 6. Chemotherapy was combined with rituximab in all patients (a median of 6 doses). Generally, treatment response was assessed in 544 (83.6%) patients. Complete remission (CR) or unconfirmed CR was achieved in 79.8% and partial remission in 12.5% of patients, with 7.7% of patients being classified as having stable disease or disease progression. CR rates were significantly higher in patients with higher lymphocyte counts: ALC > 0.84 × 109/L (82% vs 71%, p = 0.006), ALC >1.0 × 109/L (83.1% vs 71.7%, p = 0.008), and ALC > 1.35 × 109/L (85% vs 75%, p = 0.027). The overall survival (OS) and event-free survival (EFS) rates were superior in all subgroups of patients with higher ALC levels. The 3-year OS rates stratified by lymphocyte count: ALC > 0.84 × 109/L (67% vs 51%, p = 0.0002), ALC > 1.0 × 109/L (67% vs 52%, p = 0.0017), and ALC > 1.35 × 109/L (71% vs 55%, p = 0.0001). The 3-year EFS rates stratified by lymphocyte count: ALC > 0.84 × 109/L (61% vs 44%, p = 0.0002), ALC > 1.0 × 109/L (62% vs 44%, p = 0.0002), and ALC > 1.35 × 109/L (66% vs 47%, p < 0.0001). Only ALC < 1.35 × 109/L was found to be an independent negative prognostic factor for the OS (RR = 1.53, p = 0.006) and EFS (RR = 1.43, p = 0.013) in a multivariate analysis when compared with the LDH level, clinical stage, performance status and age (above median). In summary, the data support the hypothesis that host innate immunity is critical in tumor growth control and is a limiting factor for the efficacy of immunochemotherapy in elderly patients with DLBCL. The optimal cut-off levels of ALC may be different in various populations. This fact should be taken into account when designing new ALC-based prognostic schemes. Disclosures: Prochazka: ROCHE: Honoraria. Pytlik:ROCHE: Honoraria.


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