Publication details

A New Prognostic Score for Elderly Patients with Diffuse Large B-Cell Lymphoma Treated with R-CHOP: The Prognostic Role of Blood Monocyte and Lymphocyte Counts Is Absent

Authors

PROCHÁZKA Vít PYTLÍK Robert JANÍKOVÁ Andrea BELADA David ŠÁLEK David PAPAJÍK Tomáš CAMPR Vít FÜRST Tomáš FURSTOVA Jana TRNĚNÝ Marek

Year of publication 2014
Type Article in Periodical
Magazine / Source Plos one
MU Faculty or unit

Faculty of Medicine

Citation
Doi http://dx.doi.org/10.1371/journal.pone.0102594
Field Oncology and hematology
Keywords NON-HODGKINS-LYMPHOMA; ABSOLUTE LYMPHOCYTE; PATIENTS OLDER; RITUXIMAB ERA; TRIAL; CHEMOTHERAPY; SURVIVAL; SUBTYPE; MARKER; IPI
Description Background: Absolute lymphocyte count (ALC) and absolute monocyte count (AMC) have been documented as independent predictors of survival in patients with newly diagnosed Diffuse Large B-cell Lymphoma (DLBCL). Analysis of the prognostic impact of ALC and AMC in the context of International Prognostic Index (IPI) and other significant variables in elderly population treated in the R-CHOP regime has not been carried out yet. Methodology/Principal Findings: In this retrospective study, a cohort of 443 newly diagnosed DLBCL patients with age >= 60 was analyzed. All patients were treated with the R-CHOP therapy. An extensive statistical analysis was performed to identify risk factors of 3-year overall survival (OS). In multivariate analysis, only three predictors proved significant: Eastern Cooperative Oncology Group performance status (ECOG), age and bulky disease presence. These predictors were dichotomized (ECOG >= 1, age >= 70, bulk >= 7.5) to create a novel four-level score. This score predicted 3-year OS of 94.0%, 77.4%, 62.7% and 35.4% in the low-, low-intermediate, high-intermediate and high-risk groups, respectively (P<0.001). Further, a three-level score was tested which stratifies the population better (3-year OS: 91.9%, 67.2%, 36.2% in the low, intermediate and high-risk groups, respectively) but is more difficult to interpret. Both the 3- and 4-level scores were compared to standard scoring systems and, in our population, were shown to be superior in terms of patients risk stratification with respect to 3-year OS prediction. The results were successfully validated on an independent cohort of 162 patients of similar group characteristics. Conclusions: The prognostic role of baseline ALC, AMC or their ratio (LMR) was not confirmed in the multivariate context in elderly population with DLBCL treated with R-CHOP. The newly proposed age-specific index stratifies the elderly population into risk groups more precisely than the conventional IPI and its existing variants.

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