Abstract
BackgroundThe composition of the tumor microenvironment (TME) is conditioned by immunity and the inflammatory response. Nutritional and inflammation-based risk scores have emerged as relevant predictors of survival outcome across a variety of hematological malignancies.MethodsIn this retrospective multicenter trial, we ascertained the prognostic impact of established nutritional and inflammation-based risk scores [Glasgow Prognostic Score (GPS), C-reactive–protein/albumin ratio (CAR), neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), and prognostic index (PI)] in 209 eligible patients with histologically confirmed CD20+ follicular lymphoma (FL) of WHO grade 1 (37.3%), 1–2 (16.3%), 2 (26.8%) or 3A (19.8%) admitted to the participating centers between January 2000 and December 2019. Characteristics significantly associated with overall or progression-free survival (OS, PFS) upon univariate analysis were subsequently included in a Cox proportional hazard model.ResultsIn the study cohort, the median age was 63 (range 22–90 years). The median follow-up period covered 99 months. The GPS and the CAR were identified to predict survival in FL patients. The GPS was the only independent predictor of OS (p < 0.0001; HR 2.773; 95% CI 1.630–4.719) and PFS (p = 0.001; HR 1.995; 95% CI 1.352–2.944) upon multivariate analysis. Additionally, there was frequent occurrence of progression of disease within 24 months (POD24) in FL patients with a calculated GPS of 2.ConclusionThe current results indicate that the GPS predicts especially OS in FL patients. Moreover, GPS was found to display disease-specific effects in regard to FL progression. These findings and potential combinations with additional established prognosticators should be further validated within prospective clinical trials.
Highlights
The composition of the tumor microenvironment (TME) is conditioned by immunity and the inflammatory response
follicular lymphoma (FL) grade 3B is associated with the absence of centrocytes and is biologically more closely related to diffuse large B-cell lymphoma (DLBCL) than indolent FLs classified as grade 1–3A (Horn et al 2011; Katzenberger et al 2004)
FL patients who experienced lymphoma progression after an initial watch and wait period would have been considered for the current study, if a cytoreductive treatment had been administered within the course of the disease
Summary
The composition of the tumor microenvironment (TME) is conditioned by immunity and the inflammatory response. Methods In this retrospective multicenter trial, we ascertained the prognostic impact of established nutritional and inflammation-based risk scores [Glasgow Prognostic Score (GPS), C-reactive–protein/albumin ratio (CAR), neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), and prognostic index (PI)] in 209 eligible patients with histologically confirmed CD20+ follicular lymphoma (FL) of WHO grade 1 (37.3%), 1–2 (16.3%), 2 (26.8%) or 3A (19.8%) admitted to the participating centers between January 2000 and December 2019. There was frequent occurrence of progression of disease within 24 months (POD24) in FL patients with a calculated GPS of 2. GPS was found to display disease-specific effects in regard to FL progression. These findings and potential combinations with additional established prognosticators should be further validated within prospective clinical trials. FL grade 3B is associated with the absence of centrocytes and is biologically more closely related to diffuse large B-cell lymphoma (DLBCL) than indolent FLs classified as grade 1–3A (Horn et al 2011; Katzenberger et al 2004)
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