Abstract
BackgroundRecent research has shown a correlation between immune microenvironment and lymphoma biology. This study aims to investigate the prognostic significance of the immunologically relevant lymphocyte-to-monocyte ratio (LMR), in diffuse large B-cell lymphoma (DLBCL) in the rituximab era.Methodology/Principal FindingsWe analyzed retrospective data from 438 newly diagnosed DLBCL patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. We randomly selected 200 patients (training set) to generate a cutoff value for LMR by receiver operating characteristic (ROC) curve analysis. LMR was then analyzed in a testing set (n = 238) and in all patients (n = 438) for validation. The LMR cutoff value for survival analysis determined by ROC curve in the training set was 2.6. Patients with low LMR tended to have more adverse clinical characteristics. Low LMR at diagnosis was associated with worse survival in DLBCL, and could also identify high-risk patients in the low-risk IPI category. Multivariate analysis identified LMR as an independent prognostic factor of survival in the testing set and in all patients.Conclusions/SignificanceBaseline LMR, a surrogate biomarker of the immune microenvironment, is an effective prognostic factor in DLBCL patients treated with R-CHOP therapy. Future prospective studies are required to confirm our findings.
Highlights
Diffuse large B-cell lymphoma (DLBCL), the most common subtype of lymphoid neoplasm, is characterized as an aggressive lymphoma with heterogeneous clinical behaviors [1,2]
Gene-expression profiling (GEP) studies showed a relationship between lymphoma biology and the host immune system, and suggested that gene signatures related to nonmalignant tumor microenvironment played an important role in the clinical outcomes of patients with non-Hodgkin lymphoma (NHL) [7,8,9]
This study aimed to investigate the impact of peripheral blood lymphocyte-to-monocyte ratio (LMR) on survival in diffuse large B-cell lymphoma (DLBCL) patients receiving rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy
Summary
Diffuse large B-cell lymphoma (DLBCL), the most common subtype of lymphoid neoplasm, is characterized as an aggressive lymphoma with heterogeneous clinical behaviors [1,2]. DLBCL accounts for 25–30% of non-Hodgkin lymphoma (NHL) among adults in the west, and it is even more prevalent in developing countries [1,2,3]. Gene-expression profiling (GEP) studies showed a relationship between lymphoma biology and the host immune system, and suggested that gene signatures related to nonmalignant tumor microenvironment played an important role in the clinical outcomes of patients with NHL [7,8,9]. The gene expression-based prognostic model in DLBCL patients showed that DLBCL survival outcomes were determined by clinical parameters, and by the genes regulating tumor microenvironment interactions [8]. This study aims to investigate the prognostic significance of the immunologically relevant lymphocyte-to-monocyte ratio (LMR), in diffuse large B-cell lymphoma (DLBCL) in the rituximab era
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