Original Article
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Blood Res 2023; 58(4):
Published online December 31, 2023
https://doi.org/10.5045/br.2023.2023156
© The Korean Society of Hematology
Correlation between red blood cell distribution width/platelet count and prognosis of newly diagnosed diffuse large B-cell lymphoma
Correspondence to : Kai Sun, Ph.D.
Department of Hematology, Henan University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou 450003, China
E-mail: sunkai@cellscience.org
#These authors contributed equally to this work.
*This study was partially supported by a grant from the National Natural Science Foundation of China (no. 81971508) and the Henan Province Science and Technology Tackling project (no. 222102310101).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Red blood cell distribution width/platelet count ratio (RPR) is a reliable prognostic assessment indicator for numerous diseases. However, no studies to date have examined the relationship between RPR and the prognosis of diffuse large B-cell lymphoma (DLBCL). Therefore, this study aimed to investigate the correlation between RPR and the clinical characteristics and prognosis of patients with diffuse large B-cell lymphoma.
Methods
We retrospectively studied 143 patients with newly diagnosed DLBCL and used the median value as the RPR threshold. We also investigated the correlation of pretreatment RPR level with clinical characteristics and its impact on DLBCL prognosis.
Results
Using the median value as the cut-off, patients with DLBCL were divided into a low RPR group (＜0.0549) and a high RPR group (≥0.0549). Patients in the high RPR group were older, had a later Ann Arbor stage, were prone to bone marrow invasion, and had a higher National Comprehensive Cancer Network International Prognostic Index score (P＜0.05). A survival analysis showed that progression-free survival (PFS) (P=0.003) and overall survival (OS) (P＜0.0001) were significantly shorter in the high versus low RPR group. A multifactorial Cox analysis showed that bone marrow invasion and elevated lactate dehydrogenase (LDH) were separate risk factors for PFS (P＜0.05), while an RPR ≥0.0549 and elevated LDH were separate risk factors for OS (P＜0.05).
Conclusion
A high RPR (≥0.0549) in patients with newly diagnosed DLBCL is an independent risk factor for a poor prognosis.
Graphical Abstract
Keywords: Red blood cell distribution width, Platelet count, Diffuse large B-cell lymphoma, Prognosis
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Original Article
Blood Res 2023; 58(4): 187-193
Published online December 31, 2023 https://doi.org/10.5045/br.2023.2023156
Copyright © The Korean Society of Hematology.
Correlation between red blood cell distribution width/platelet count and prognosis of newly diagnosed diffuse large B-cell lymphoma
Xiaobo Liu1,#, Yanliang Bai2,#, Ying Liu2, Weiya Li2, Yabin Cui1, Jinhui Xu2, Xingjun Xiao2, Xiaona Niu2, Kai Sun1
1Department of Hematology, Henan University People’s Hospital and Henan Provincial People’s Hospital, 2Department of Hematology, Zhengzhou University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou, China
Correspondence to:Kai Sun, Ph.D.
Department of Hematology, Henan University People’s Hospital and Henan Provincial People’s Hospital, Zhengzhou 450003, China
E-mail: sunkai@cellscience.org
#These authors contributed equally to this work.
*This study was partially supported by a grant from the National Natural Science Foundation of China (no. 81971508) and the Henan Province Science and Technology Tackling project (no. 222102310101).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background
Red blood cell distribution width/platelet count ratio (RPR) is a reliable prognostic assessment indicator for numerous diseases. However, no studies to date have examined the relationship between RPR and the prognosis of diffuse large B-cell lymphoma (DLBCL). Therefore, this study aimed to investigate the correlation between RPR and the clinical characteristics and prognosis of patients with diffuse large B-cell lymphoma.
Methods
We retrospectively studied 143 patients with newly diagnosed DLBCL and used the median value as the RPR threshold. We also investigated the correlation of pretreatment RPR level with clinical characteristics and its impact on DLBCL prognosis.
Results
Using the median value as the cut-off, patients with DLBCL were divided into a low RPR group (＜0.0549) and a high RPR group (≥0.0549). Patients in the high RPR group were older, had a later Ann Arbor stage, were prone to bone marrow invasion, and had a higher National Comprehensive Cancer Network International Prognostic Index score (P＜0.05). A survival analysis showed that progression-free survival (PFS) (P=0.003) and overall survival (OS) (P＜0.0001) were significantly shorter in the high versus low RPR group. A multifactorial Cox analysis showed that bone marrow invasion and elevated lactate dehydrogenase (LDH) were separate risk factors for PFS (P＜0.05), while an RPR ≥0.0549 and elevated LDH were separate risk factors for OS (P＜0.05).
Conclusion
A high RPR (≥0.0549) in patients with newly diagnosed DLBCL is an independent risk factor for a poor prognosis.
Keywords: Red blood cell distribution width, Platelet count, Diffuse large B-cell lymphoma, Prognosis
Fig 1.
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Table 1 . Relationship between RPR and clinical characteristics in newly diagnosed DLBCL patients..
Variable RPR <0.0549 (N=71) RPR ≥0.0549 (N=72) χ2 P Sex 0.338 0.561 Male 36 (50.7%) 40 (55.6%) Female 35 (49.3%) 32 (44.4%) Age, years 5.241 0.022 ≤60 47 (66.2%) 34 (47.2%) >60 24 (33.8%) 38 (52.8%) ECOG PS score 3.348 0.067 <2 61 (85.9%) 53 (73.6%) ≥2 10 (14.1%) 19 (26.4%) B symptoms 2.786 0.095 No 57 (80.3%) 49 (68.1%) Yes 14 (19.7%) 23 (31.9%) Ann Arbor stage 11.826 0.001 I–II 42 (59.2%) 22 (30.6%) III-IV 29 (40.8%) 50 (69.4%) LDH 0.362 0.547 Normal 42 (59.2%) 39 (54.2%) Elevated 29 (40.8%) 33 (45.8%) Extranodal sites, N 3.002 0.083 <2 53 (74.6%) 44 (61.1%) ≥2 18 (25.4%) 28 (38.9%) Bone marrow involvement 7.842 0.005 No 70 (98.6%) 62 (86.1%) Yes 1 (1.4%) 10 (13.9%) NCCN-IPI 6.220 0.013 0–3 50 (70.4%) 36 (50.0%) 4–8 21 (29.6%) 36 (50.0%) Hans type 2.556 0.110 GCB 34 (47.9%) 25 (34.7%) Non-GCB 37 (52.1%) 47 (65.3%) Abbreviations: ECOG PS, Eastern Cooperative Oncology Group Physical Status; GCB, germinal center B-cell; LDH, lactate dehydrogenase; NCCN-IPI, National Comprehensive Cancer Network International Prognostic Index; RPR, red blood cell distribution width/platelet count..
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Table 2 . Univariate analysis of predictors of overall survival (OS) and progression-free survival (PFS) time in patients with newly diagnosed DLBCL..
Factor PFS OS HR (95% CI) P HR (95% CI) P Sex, male 0.966 (0.515–1.810) 0.913 0.818 (0.347–1.928) 0.646 Age >60 years 0.983 (0.519–1.861) 0.959 2.338 (0.968–5.644) 0.059 Ann Arbor stage III–IV 3.093 (1.468–6.518) 0.003 8.135 (1.895–34.928) 0.005 B symptoms 2.720 (1.448–5.111) 0.002 2.827 (1.200–6.661) 0.017 ECOG PS score ≥2 1.735 (0.863–3.488) 0.122 2.048 (0.826–5.076) 0.122 LDH elevated 2.603 (1.352–5.012) 0.004 6.124 (2.060–18.203) 0.001 Extranodal sites ≥2 1.778 (0.943–3.353) 0.076 3.123 (1.315–7.417) 0.010 Bone marrow involvement 5.969 (2.816–12.653) 0.000 5.649 (2.188–14.585) 0.000 Hans type 1.281 (0.666–2.464) 0.459 1.775 (0.689–4.577) 0.235 NCCN-IPI >3 2.988 (1.563–5.712) 0.001 7.174 (2.412–21.342) 0.000 RPR ≥0.0549 2.644 (1.338–5.226) 0.005 10.349 (2.410–44.447) 0.002 Abbreviations: DLBCL, diffuse large B-cell lymphoma; ECOG PS, Eastern Cooperative Oncology Group Physical Status; LDH, lactate dehydrogenase; NCCN-IPI, National Comprehensive Cancer Network International Prognostic Index; RDW, red blood cell distribution width; PLT, platelet count; RPR, RDW to PLT ratio..
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Table 3 . Multifactorial analysis of predictors of overall survival (OS) and progression-free survival (PFS) time in patients with newly diagnosed DLBCL..
Factors PFS OS HR (95% CI) P HR (95% CI) P B symptoms 1.505 (0.736–3.077) 0.262 1.058 (0.408–2.741) 0.908 LDH elevated 2.196 (1.049–4.594) 0.037 5.271 (1.608–17.282) 0.006 Extranodal sites ≥2 0.898 (0.431–1.871) 0.773 1.193 (0.443–3.209) 0.727 Bone marrow involvement 3.644 (1.510–8.794) 0.004 2.585 (0.874–7.651) 0.086 RPR ≥0.0549 1.923 (0.925–3.998) 0.080 8.542 (1.945–37.521) 0.004 Abbreviations: LDH, lactate dehydrogenase; PLT, platelet count; RDW, red blood cell distribution width; RPR, RDW to PLT ratio..
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