Abstract
Objective:Pro-inflammatory and pro-angiogenic cytokines play an important role in the pathogenesis of lymphoma, and recent studies have shown that cytokines can be used as prognostic markers. Non-Hodgkin lymphoma (NHL) patients with high levels of serum interleukin-6 (s-IL6) and serum vascular endothelial growth factor (s-VEGF) have poor prognosis and shorter survival time. We aimed to determine pre-treatment levels of s-IL6 and s-VEGF and their relation with known prognostic markers, especially International Prognostic Index (IPI) scores, and to examine their effects on overall survival in newly diagnosed, untreated aggressive NHL patients. Materials and Methods:The study included 51 newly diagnosed NHL patients and 17 healthy controls. Blood samples were obtained to study s-IL6 and s-VEGF cytokine levels. Results:Patients with aggressive NHL diagnosis had higher s-VEGF and s-IL6 levels than the healthy population. If the s-IL6 levels of patients were above the cut-off levels, the overall survival time was shorter. There was no relation between s-VEGF and overall survival time. Conclusion:s-IL6 is an independent prognostic factor that may be included in IPI risk classification. In addition to the s-IL6 level, age, erythrocyte sedimentation rate, beta-2 microglobulin, WHO performance status, and IPI score are independent prognostic factors that are effective, especially for overall survival, in the clinical follow-up of NHL patients.
Highlights
Various clinical and laboratory parameters were included in the prognostic definition of non-Hodgkin lymphoma (NHL) and are used in clinical follow-up
When the serum vascular endothelial growth factor (s-vascular endothelial growth factor (VEGF)) median value (11 pg/mL) was taken as the cut-off value, there was no difference between the groups that were above and below the cut-off for B symptoms, age, stage, erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH) level, mortality, beta-2 microglobulin level, or International Prognostic Index (IPI) score (p>0.05)
In patients with IPI scores of H-I and H, while there was no difference between the groups with s-VEGF levels above and below the cut-off (p=0.420), significantly lower survival was seen in the group of patients with serum interleukin-6 (s-IL6) levels above the cut-off (p=0.035; Figures 7 and 8)
Summary
Various clinical and laboratory parameters were included in the prognostic definition of non-Hodgkin lymphoma (NHL) and are used in clinical follow-up. Interleukin (IL)-6, which is one of these cytokines, is a lymphoid growth factor and is an important protein for the immune system, hematopoiesis, and inflammation. It is responsible for the B symptoms in lymphoma [1,2,3]. The most capable and the most important angiogenic molecule is vascular endothelial growth factor (VEGF). NHL patients with high levels of serum (s)-IL6 and s-VEGF have poor prognosis and short survival [6]. The pre-treatment s-IL6 and s-VEGF levels of NHL patients are correlated with life expectancy, and both of these are independent and important prognostic indicators for all International Prognostic Index (IPI) groups [6,7]. There is no information available for patients from the Turkish population
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