Abstract
BackgroundDespite the use of modern immunochemotherapy regimens, a significant proportion of diffuse large B-cell lymphoma (DLBCL) patients will relapse. We proposed absolute lymphocyte count/absolute monocyte count ratio (ALC/AMC ratio) as a new prognostic factor in relapsed or primary refractory DLBCL.MethodsWe retrospectively analyzed 163 patients who have been diagnosed with relapsed or primary refractory DLBCL. The overall survival (OS) and progression-free survival (PFS) were measured from the time of first relapse. The Cox proportional hazards model was used to evaluate ALC/AMC ratio as prognostic factors for OS and PFS.ResultsOn univariate and multivariate analysis performed with factors included in the saaIPI, early relapse, prior exposure to rituximab and autologous stem-cell transplantation (ASCT), the ALC/AMC ratio at the time of first relapse remained an independent predictor of PFS and OS (PFS: P < 0.001; OS: P < 0.001). Patients with lower ALC/AMC ratio (<2.0) had lower overall response rate, 1-year PFS and 2-year OS rate compared with those with higher ALC/AMC ratio (≥2.0). Moreover, the ALC/AMC ratio can provide additional prognostic information when superimposed on the saaIPI.ConclusionsLower ALC/AMC ratio at the time of first relapse is a adverse prognostic factor for OS and PFS in relapsed or primary refractory DLBCL, and leads to the identification of high-risk patients otherwise classified as low/intermediate risk by the saaIPI alone.
Highlights
Despite the use of modern immunochemotherapy regimens, a significant proportion of diffuse large B-cell lymphoma (DLBCL) patients will relapse
We showed that in primary refractory and relapsed patients with a low-intermediate/high-intermediate, respectively, the absolute lymphocyte count (ALC)/AMC ratio was a useful way to distinguish those with favorable outcomes from those with adverse outcomes (OS: P < 0.001, progression-free survival (PFS): P < 0.001, Additional file 4: Figure S1C and D; overall survival (OS): P < 0.001, PFS: P < 0.001, Additional file 5: Figure S2C and D; respectively)
The ALC/AMC ratio at diagnosis, as a simple biomarker combining an estimate of host immune homeostasis and tumor microenvironment, was recently shown to be an independent prognostic indicator in Hodgkin’s Lymphoma (HL) [16,17] and DLBCL [10], and combining the dichotomized ALC and AMC to generate the ALC/AMC prognostic score was provided prognostic information independently of that included in the International Prognostic Index (IPI) [8,9]
Summary
Despite the use of modern immunochemotherapy regimens, a significant proportion of diffuse large B-cell lymphoma (DLBCL) patients will relapse. We proposed absolute lymphocyte count/absolute monocyte count ratio (ALC/AMC ratio) as a new prognostic factor in relapsed or primary refractory DLBCL. Diffuse large B-cell lymphoma (DLBCL) is the most common, accounts for 25%-30% of all newly diagnosed cases of adult Non-Hodgkin lymphoma (NHL). It is an aggressive lymphoma, but is potentially curable [1]. Absolute lymphocyte count/absolute monocyte count ratio (ALC/AMC ratio) at diagnosis, as a simple biomarker combining an estimate of host immune homeostasis and tumor microenvironment, was recently shown to be an independent prognostic indicator in HL [16,17] and DLBCL [10,11]. We assessed the prognostic significance of ALC/AMC ratio at the time of first relapse
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