Abstract
The prognostic value of serum beta-2 microglobulin for diffuse large B-cell lymphoma (DLBCL) is not well known in the rituximab era. A retrospective registry data analysis of 833 patients with de novo DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was conducted to establish the prognostic significance of serum beta-2 microglobulin at a ≥2.5 mg/L cutoff. Five-year progression-free survival (PFS, 76.1% vs. 41.0%; p < 0.001) and overall survival (OS, 83.8% vs. 49.2%; p < 0.001) were significantly worse in patients with elevated serum beta-2 microglobulin (n = 290, 34.8%). Furthermore, the five parameters of the International Prognostic Index, accompanying B symptoms, bone marrow involvement and impaired renal function were associated with worse PFS and OS. In multivariate analysis, elevated beta-2 microglobulin was a significant poor prognostic factor for PFS (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.29–2.24; p < 0.001) and OS (HR, 2.0; 95% CI, 1.47–2.75; p < 0.001). In an independent validation cohort of 258 R-CHOP treated patients with de novo DLBCL, elevated beta-2 microglobulin levels remained a significant poor prognostic factor for PFS (HR, 2.03; 95% CI, 1.23–3.32; p = 0.005) and exhibited a strong trend of association with worse OS (HR, 1.64; 95% CI, 0.98–2.75; p = 0.062). The significance of serum beta-2 microglobulin levels as an independent prognostic factor for patients with DLBCL receiving R-CHOP is confirmed.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, a heterogeneous disease with a variety of molecular aberrations and diverse clinical outcomes [1, 2]
In this retrospective cohort study, the elevated baseline serum beta-2 microglobulin was associated with distinct adverse clinical features and higher International Prognostic Index (IPI), R-IPI and National Comprehensive Cancer Network (NCCN)-IPI risk groups in patients with diffuse large B-cell lymphoma (DLBCL) treated with R-CHOP
As well-established prognostic factor, high serum beta-2 microglobulin is a component of the International Staging System (ISS) and Revised-ISS for multiple myeloma [12, 13, 22, 23] and one of the parameters of the follicular lymphoma international prognostic index 2, a proven prognostic model of follicular lymphoma in the rituximab era [14]
Summary
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, a heterogeneous disease with a variety of molecular aberrations and diverse clinical outcomes [1, 2]. The International Prognostic Index (IPI) utilized for over the past 20 years to determine the prognosis of patients with DLBCL, remains a valid predictor of clinical outcomes even in the rituximab-CHOP (R-CHOP) era [5, 6]. Previous studies showed elevated serum beta-2 microglobulin was an independent poor prognostic factor in patients with DLBCL treated with CHOP or CHOP-like regimens [15, 16]. The prognostic value of beta-2 microglobulin in patients with DLBCL treated with rituximab containing regimens has not yet been fully investigated
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