Abstract
BackgroundSystemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large B-cell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive.MethodsWe retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index.ResultsSurvival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82–92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p < 0.001) and overall survival (OS) (not reached vs. 12.9 months, p < 0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI).ConclusionsA combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.
Highlights
Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large Bcell lymphoma (DLBCL)
Patient characteristics According to the Geriatric Nutritional Risk Index (GNRI) score, 94, 49, 55, and, 30 patients were classified as no, low, moderate, and major risk groups, respectively
These findings suggest that the combined use of GNRI and sarcopenia may improve the predictability of each factor in DLBCL patients
Summary
Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large Bcell lymphoma (DLBCL). Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult non-Hodgkin lymphoma. Five robust DLBCL subsets were detected using whole-exome sequencing. These subsets were shown to be a better predictor of disease prognosis relative to IPI scores [8]. Comprehensive geriatric assessment could identify non-fit patients in whom curative intent treatment did not improve the prognosis [9]. Development of such novel prognosticators for disease outcomes remains a significant unmet need, allowing doctors to individualize treatment strategies for DLBCL patients
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