Blood Res 2017; 52(3): 200-206  https://doi.org/10.5045/br.2017.52.3.200
Platelet to lymphocyte ratio (PLR) retains independent prognostic significance in advanced stage marginal zone lymphoma patients treated with rituximab, cyclophosphamide, vincristine, and prednisone combination chemotherapy (R-CVP): Consortium for Improving Survival of Lymphoma trial
Jeongkuk Seo1, Won Seog Kim2, Jin Seok Kim3, Seok Jin Kim2, Jae Hoon Lee4, Jun Shik Hong4, Gyeong-Won Lee5, Sung Yong Oh1, Ji-Hyun Lee1, Dok Hyun Yoon6, Won-Sik Lee7, Hyo Jung Kim8, Jae-Yong Kwak9, Hye Jin Kang10, Jae-Cheol Jo11, Yong Park12, Ho Sup Lee13, Hyo-Jin Kim1, Cheolwon Suh6
1Department of Internal Medicine, Dong-A University Hospital, Busan, 2Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, 3Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, 4Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, 5Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, 6Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 7Department of Hemato/Oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, 8Department of Internal Medicine, Hallym Medical Center, Hallym University College of Medicine, Anyang, 9Division of Hematology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, 10Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, 11Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, 12Department of Internal Medicine, Korea University College of Medicine, Seoul, 13Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
Correspondence to: Cheolwon Suh, M.D., Ph.D.Sung Yong Oh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea (C.S.)Department of Internal Medicine, Dong-A University College of Medicine, Daeshin Park road 26, Seo-gu, Busan 49201, Korea(S.Y.O.)E-mail: C.S., csuh@amc.seoul.krS.Y.O., drosy@dau.ac.kr
Received: April 29, 2017; Revised: May 28, 2017; Accepted: July 7, 2017; Published online: September 30, 2017.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background
Rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) is one of the effective chemotherapeutic regimens for patients with advanced stage marginal zone lymphoma (MZL). However, prognostic factors that affect the outcome of treatment for MZL are not well understood.
Methods 
Between August 2006 and June 2013, patients with newly diagnosed stage III and IV MZL treated with R-CVP as a first-line therapy from 15 institutions were retrospectively analyzed. Patients’ clinical and laboratory data at diagnosis were collected by review of medical records.
Results
A total of 80 patients were analyzed. Bone marrow involvement was observed in 30% cases. Twelve patients (15%) had nodal MZL, and 41.3% patients exhibited multiple mucosa- associated lymphoma tissue sites. Overall response rate was 91.3%, including 73.8% achieving complete response. Advanced MZL patients treated with R-CVP showed a 3-year progression-free survival (PFS) rate of 69.6%. Prognostic markers significantly affecting PFS in univariate analysis were platelet to lymphocyte ratio (PLR, <95 vs. ≥95, P=0.014), serum albumin (≤3.9 vs. >3.9 g/dL, P =0.008), and the International Prognostic Index (IPI) score (1 vs. 2‒4, P =0.032). In multivariate analysis, only PLR (<95 vs. ≥95, HR 0.367, 95% CI, 0.139‒0.971, P =0.043) was an independent risk factor for PFS.
Conclusion 
PLR ≥95 at diagnosis is an independent prognostic marker for PFS in advanced stage MZL patients treated with R-CVP. This marker may aid clinicians in predicting the response to R-CVP chemotherapy in stage III and IV MZL patients.
Keywords: Marginal zone lymphoma, R-CVP, Prognosis, PLR 


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