Can the Prognosis of Diffuse Large B-Cell  Lymphoma be Predicted by a Simple CBC Count?

Handan Haydaroğlu Şahin

doi:10.5152/EurJTher.2019.19007

Authors

Handan Haydaroğlu Şahin Department of Hematology, Gaziantep University, School of Medicine, Gaziantep https://orcid.org/0000-0002-3467-8819

DOI:

https://doi.org/10.5152/EurJTher.2019.19007

Keywords:

Diffuse large B-cell lymphoma, score system, neutrophil-to-lymphocyte ratio, prognosis

Abstract

Objective: In this study, we aimed to develop a new prognostic model using the neutrophil-to-lymphocyte ratio (NLR) and defined prognostic indexes to improve the results in patients with diffuse large B-cell lymphoma (DLBCL).
Methods: The data of 340 newly diagnosed patients with DLBCL, who underwent at least two cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), were evaluated retrospectively. A receiver operating characteristic (ROC) curve analysis was used to determine the NLR cut-off value. The NLR cut-off value was 4.76. In the study, a total of 231 patients (67.9%) were in the low NLR ≤4.76 group, while 109 patients (32.1%) were in the high NLR (NLR >4.76) group.
Results: The 5-year overall survival (OS) was 37.1%, and 78.9% in the high NLR group, and low NLR group, respectively. A high pre-treatment NLR was associated with a worse OS and progression-free survival (PFS) (both p<0.001, respectively). In the multivariate analysis, a high pre-treatment NLR and a high National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) status were found to be as an independent risk factors of poor OS (hazard ratio [HR]= 2.28; 95% confidence interval [CI]= 1.51-3.45; p= 0.001; HR= 5.59; 95% CI= 3.22-9.70; p= 0.001, respectively) and PFS.
Conclusion: The study found that a high NLR was associated with a poor treatment response, poor PFS, and OS. In view of these data, we believe that the creation of an inflammation-based cumulative prognostic score system (IBCPSS), by adding NLR among the factors whose prognostic importance has been proven in DLBCL, can especially shed light on the early diagnosis of patients with a poor prognosis, aggressive treatment decision, and individualization of treatment.

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References

Cultrera JL, Dalia SM. Diffuse large B-cell lymphoma: current strategies and future directions. Cancer Control 2012; 19: 204-13.

Habermann TM, Weller EA, Morrison VA, Gascoyne RD, Cassileth PA, Cohn JB, et al. Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol 2006; 24: 3121-7.

Tilly H, Gomes da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A, et al. Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26(Suppl 5): v116-25.

International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med 1993; 329: 987-94.

Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, et al. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2007; 109: 1857-61.

Zhou Z, Sehn LH, Rademaker AW, Gordon LI, Lacasce AS, Crosby-Thompson A, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era. Blood 2014; 123: 837-42.

Jia B, Shi Y, Kang S, Yang S, Hu S, Li Y, et al. Addition of rituximab is not associated with survival benefit compared with CHOP alone for patients with stage I diffuse large B-cell lymphoma. Chin J Cancer Res 2015; 27: 516-23.

Wang J, Zhou M, Wang X, Xu J, Chen B, Ouyang J. Pretreatment C-reactive protein was an independent prognostic factor for patients with diffuse large B-cell lymphoma treated with RCHOP. Clin Chim Acta 2016; 459: 150-4.

Yan-Li L, Kang-Sheng G, Yue-Yin P, Yang J, Zhi-Min Z. The lower peripheral blood lymphocyte/monocyte ratio assessed during routine follow-up after standard first-line chemotherapy is a risk factor for predicting relapse in patients with diffuse large B-cell lymphoma. Leuk Res 2014; 38: 323-8.

Miyashita K, Tomita N, Taguri M, Suzuki T, Ishiyama Y, Ishii Y, et al. Beta-2 microglobulin is a strong prognostic factor in patients with DLBCL receiving R-CHOP therapy. Leuk Res 2015; pii: S0145-2126(15)30368-4.

Chen Y, Neelapu S, Feng L, Bi W, Yang TH, Wang M, et al. Prognostic significance of baseline peripheral absolute neutrophil, monocyte and serum β2-microglobulin level in patients with diffuse large b-cell lymphoma: a new prognostic model. Br J Haematol 2016; 175: 290-9.

Kim DH, Baek JH, Chae YS, Kim YK, Kim HJ, Park YH, et al. Absolute lymphocyte counts predicts response to chemotherapy and survival in diffuse large B-cell lymphoma. Leukemia 2007; 21: 2227-30.

Shehata AMF, Aldesoky AI, Gohar SF. Plasma fibrinogen level as possible prognostic biomarker in diffuse large B-cell lymphoma. Hematology 2019; 24: 103-7.

Baecklund E, Smedby KE, Sutton LA, Askling J, Rosenquist R. Lymphoma development in patients with autoimmune and inflammatory disorders--what are the driving forces? Semin Cancer Biol 2014; 24: 61-70.

Yutong H, Xiaoli X, Shumei L, Shan S, Di L, Baoen S. Increased Neutrophil-Lymphocyte Ratio Is a Poor Prognostic Factor in Patients with Esophageal Cancer in a High Incidence Area in China. Arch Med Res 2015; 46: 557-63.

Huang J, Dahl DM, Dong L, Liu Q, Cornejo K, Wang Q, et al. Preoperative Neutrophil-to-Lymphocyte Ratio and Neutrophilia Are Independent Predictors of Recurrence in Patients with Localized Papillary Renal Cell Carcinoma. Biomed Res Int 2015; 2015: 891045.

Porrata LF, Ristow K, Habermann T, Inwards DJ, Micallef IN, Markovic SN. Predicting survival for diffuse large B-cell lymphoma patients using baseline neutrophil/lymphocyte ratio. Am J Hematol 2010; 85: 896-9.

Wang J, Zhou M, Xu JY, Yang YG, Zhang QG, Zhou RF, et al. Prognostic role of pretreatment neutrophil-lymphocyte ratio in patients with diffuse large B-cell lymphoma treated with RCHOP. Medicine (Baltimore) 2016; 95: e4893.

Go SI, Park S, Kim JH, Kim HR, Kim M, Moon K, et al. A new prognostic model using the NCCN-IPI and neutrophil-to-lymphocyte ratio in diffuse large B-cell lymphoma. Tumori 2018; 104: 292-9.

Kang MH, Go SI, Song HN, Lee A, Kim SH, Kang JH, et al. The prognostic impact of the neutrophil-to-lymphocyte ratio in patients with small-cell lung cancer. Br J Cancer 2014; 111: 452-60.

Koh CH, Bhoo-Pathy N, Ng KL, Jabir RS, Tan GH, See MH, et al. Utility of pre-treatment neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as prognostic factors in breast cancer. Br J Cancer 2015; 113: 150-8.

Keam B, Ha H, Kim TM, Jeon YK, Lee SH, Kim DW, et al. Neutrophil to lymphocyte ratio improves prognostic prediction of International Prognostic Index for patients with diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone. Leuk Lymphoma 2015; 56: 2032-8.

Beltrán BE, Paredes S, Cotrina E, Sotomayor EM, Castillo JJ. The impact of the neutrophil:lymphocyte ratio in response and survival of patients with de novo diffuse large B-cell lymphoma. Leuk Res 2018; 67: 82-5.

Sun F, Zhu J, Lu S, Zhen Z, Wang J, Huang J, et al. An inflammation-based cumulative prognostic score system in patients with diffuse large B cell lymphoma in rituximab era. BMC Cancer 2018; 18: 5.

Motomura T, Shirabe K, Mano Y, Muto J, Toshima T, Umemoto Y, et al. Neutrophil-lymphocyte ratio reflects hepatocellular carcinoma recurrence after liver transplantation via inflammatory microenvironment. J Hepatol 2013; 58: 58-64.

Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 2013; 88: 218-30.

Li X, Xing YF, Lei AH, Xiao Q, Lin ZH, Hong YF, et al. Neutrophil count is associated with myeloid derived suppressor cell level and presents prognostic value of for hepatocellular carcinoma patients. Oncotarget 2017; 8: 24380-8.

Fridlender ZG, Albelda SM. Tumor-associated neutrophils: friend or foe? Carcinogenesis 2012; 33: 949-55.

Wu S, Zhou Y, Hua HY, Zhang Y, Zhu WY, Wang ZQ, et al. Inflammation marker ESR is effective in predicting outcome of diffuse large B-cell lymphoma. BMC Cancer 2018; 18: 997.

Seo S, Hong JY, Yoon S, Yoo C, Park JH, Lee JB, et al. Prognostic significance of serum beta-2 microglobulin in patients with diffuse large B-cell lymphoma in the rituximab era. Oncotarget 2016; 7: 76934-43.