Abstract
The prognostic value of albumin changes between diagnosis and end-of-treatment (EoT) in diffuse large B-cell lymphoma (DLBCL) remains unknown. We retrospectively analyzed 574 de novo DLBCL patients treated with R-CHOP from our and two other centers. All patients were divided into a training cohort (n = 278) and validation cohort (n = 296) depending on the source of the patients. Overall survival (OS) and progression-free survival (PFS) were analyzed by the method of Kaplan–Meier and Cox proportional hazard regression model. In the training cohort, 163 (58.6%) patients had low serum albumin at diagnosis, and 80 of them were present with consecutive hypoalbuminemia at EoT. Patients with consecutive hypoalbuminemia showed inferior OS and PFS (p = 0.010 and p = 0.079, respectively). Similar survival differences were also observed in the independent validation cohort (p = 0.006 and p = 0.030, respectively). Multivariable analysis revealed that consecutive hypoalbuminemia was an independent prognostic factor OS [relative risk (RR), 2.249; 95% confidence interval (CI), 1.441–3.509, p < 0.001] and PFS (RR, 2.001; 95% CI, 1.443–2.773, p < 0.001) in all DLBCL patients independent of IPI. In conclusion, consecutive hypoalbuminemia is a simple and effective adverse prognostic factor in patients with DLBCL, which reminds us to pay more attention to patients with low serum albumin at EoT during follow-up.
Highlights
The introduction of rituximab into the CHOP regimen has markedly improved the outcome of diffuse large B-cell lymphoma (DLBCL) [1, 2]
There were 356 patients (62.0%) with low serum albumin at the time of diagnosis, and these patients tended to present with older age (p = 0.021), poor performance status (p = 0.039), B symptoms (p < 0.011), high lactate dehydrogenase (LDH) (p < 0.001), advanced stage (p = 0.029), more extranodal sites (p = 0.034), and high international prognostic index (IPI) scores (p < 0.001)
Low serum albumin at diagnosis has been identified as a simple prognostic factor in DLBCL before and after rituximab era [20, 21]
Summary
The introduction of rituximab into the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) has markedly improved the outcome of diffuse large B-cell lymphoma (DLBCL) [1, 2]. Albumin Changes for DLBCL prognostic marker to identify these DLBCL patients with different outcomes throughout the entire treatment. Our and previous other studies showed that albumin at diagnosis could be used to predict outcome in DLBCL [15,16,17]. The prognostic value of albumin changes between diagnosis and end-of-treatment (EoT) in DLBCL remains unknown. We performed this study to evaluate the prognostic significance of albumin change after R-CHOP treatment in patients with DLBCL. Gender, height, weight, serum lactate dehydrogenase (LDH), performance status defined by Eastern Cooperative Oncology Group, number of extranodal sites, disease stage according to the Ann Arbor staging system, IPI score, serum albumin at diagnosis and EoT, and complete blood cell count. Albumin and overall survival were used as test and state variates in the receiver operating characteristic (ROC) curve, and Youden
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