1. New prognosis score including absolute lymphocyte/monocyte ratio, red blood cell distribution width and beta-2 microglobulin in patients with diffuse large B-cell lymphoma treated with R-CHOP: Spanish Lymphoma Group Experience (GELTAMO)
- Author
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Mario Gutiérrez Rodríguez, Jose Rodriguez, Sonia González de Villambrosia, Mariana Bastos, Hugo Luzardo, Leyre Bento, Marta García-Recio, Azueg Hong, Raul Cordoba, Raquel Del Campo, Pau Abrisqueta, Ana M. Martín-Moreno, Gilberto Barranco, Pilar Roca, Antonio Salar, Jordi Martinez-Serra, José María Sánchez-Pina, Mónica Baile, Olga García, Juan M. Sancho, Antonio Gutierrez, Alejandro Martín, Daniel García, Jorge Sastre-Serra, M José Rodríguez-Salazar, Antonio Díaz-López, and Silvana Novelli
- Subjects
Male ,Lymphocyte ,Gastroenterology ,Monocytes ,0302 clinical medicine ,International Prognostic Index ,Risk Factors ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,Lymphocytes ,Stage (cooking) ,Aged, 80 and over ,education.field_of_study ,Hematology ,Middle Aged ,Prognosis ,medicine.anatomical_structure ,Vincristine ,030220 oncology & carcinogenesis ,Female ,Lymphoma, Large B-Cell, Diffuse ,Rituximab ,complete blood cell counts ,index ,Adult ,medicine.medical_specialty ,Adolescent ,Population ,diffuse large B-cell lymphoma ,03 medical and health sciences ,Young Adult ,Internal medicine ,medicine ,Humans ,education ,Cyclophosphamide ,Aged ,Beta-2 microglobulin ,business.industry ,Red blood cell distribution width ,medicine.disease ,Lymphoma ,Blood Cell Count ,Doxorubicin ,Prednisone ,prognosis ,business ,beta 2-Microglobulin ,beta 2-microglobulin ,Diffuse large B-cell lymphoma ,030215 immunology - Abstract
The International Prognostic Index (IPI) is the most widely used score for non-Hodgkin lymphoma but lacks the ability to identify a high-risk population in diffuse large B-cell lymphoma (DLBCL). Low absolute lymphocyte count and high monocytes have proved to be unfavourable factors. Red-cell distribution width (RDW) has been associated with inflammation and beta-2 microglobulin (B2M) with tumour load. The retrospective study included 992 patients with DLBCL treated with R-CHOP. In the multivariate analysis, age, Eastern Cooperative Oncology Group performance status (ECOG-PS), stage, bulky mass, B2M, RDW, and lymphocyte/monocyte ratio (LMR) were independently related to progression-free survival (PFS). A new prognosis score was generated with these variables including age categorized into three groups (0, 1, 2 points); ECOG ≥ 3-4 with two; stage III/IV, bulky mass, high B2M, LMR 2·25 and RDW 0·96 with one each; for a maximum of 9. This score could improve the discrimination of a very high-risk subgroup with five-year PFS and overall survival (OS) of 19% and 24% versus 45% and 59% of R (revised)-IPI respectively. This score also showed greater predictive ability than IPI. A new score is presented including complete blood cell count variables and B2M, which are readily available in real-life practice without additional tests. Compared to R-IPI, it shows a more precise high-risk assessment and risk discrimination for both PFS and OS.
- Published
- 2019