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Original Article

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Blood Res 2016; 51(2):

Published online June 23, 2016

https://doi.org/10.5045/br.2016.51.2.113

© The Korean Society of Hematology

Baseline renal function as a prognostic indicator in patients with newly diagnosed diffuse large B-cell lymphoma

Junshik Hong1,#, Sojung Lee1,#, Gayoung Chun1, Ji Yong Jung1, Jinny Park1, Jeong Yeal Ahn2, Eun Kyung Cho1, Dong Bok Shin1, and Jae Hoon Lee1*

Author Info. +

1Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.

2Department of Laboratory Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.

Correspondence to : Correspondence to Jae Hoon Lee, M.D., Ph.D. Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdongdae-ro 774-gil, Namdong-gu, Incheon 21565, Korea. jhlee@gilhospital.com

Received: March 21, 2016; Revised: April 16, 2016; Accepted: May 24, 2016

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

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Background

The association between baseline renal impairment (RI) and the prognosis of diffuse large B-cell lymphoma (DLBCL) was previously not defined. The aim of this study was to evaluate the prognostic value of RI in patients with DLBCL treated with three-weekly rituximab plus cyclophosphamide, Adriamycin, vincristine, and prednisolone immunochemotherapy (R-CHOP21).

Methods

Patients with newly diagnosed de novo DLBCLs treated with ≥1 cycle of R-CHOP21 were analyzed retrospectively. Pretreatment blood samples were collected and the glomerular filtration rate (GFR) was calculated. RI was defined by a GFR of <60 mL/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Results

Of the 185 patients enrolled in the present study, 19 patients (10.3%) had RI. The reasons for baseline RI were pre-existing CKD (N=5), acute kidney injury due to either obstruction (N=2) or electrolyte imbalance (N=2) related to DLBCL, and undefined causes (N=10). Patients with baseline RI showed inferior overall survival (OS) compared to those without RI (P<0.001). In multivariate analysis, RI was identified as an International Prognostic Index (IPI)-independent prognostic indicator. A baseline hemoglobin level of <10 g/dL and the presence of RI effectively discriminated a portion of the patients with far inferior event-free survival and OS among the patients having high or high-intermediate risk cancers according to either the standard- or the National Comprehensive Cancer Network-IPI.

Conclusion

Pretreatment RI was an independent prognostic marker for inferior OS in patients with DLBCL treated with R-CHOP21 immunochemotherapy.

Keywords Diffuse large B-cell lymphoma, Renal insufficiency, Prognosis, Rituximab

Article

Original Article

Blood Res 2016; 51(2): 113-121

Published online June 23, 2016 https://doi.org/10.5045/br.2016.51.2.113

Copyright © The Korean Society of Hematology.

Baseline renal function as a prognostic indicator in patients with newly diagnosed diffuse large B-cell lymphoma

Junshik Hong1,#, Sojung Lee1,#, Gayoung Chun1, Ji Yong Jung1, Jinny Park1, Jeong Yeal Ahn2, Eun Kyung Cho1, Dong Bok Shin1, and Jae Hoon Lee1*

1Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.

2Department of Laboratory Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.

Correspondence to: Correspondence to Jae Hoon Lee, M.D., Ph.D. Department of Internal Medicine, Gachon University Gil Medical Center, 21 Namdongdae-ro 774-gil, Namdong-gu, Incheon 21565, Korea. jhlee@gilhospital.com

Received: March 21, 2016; Revised: April 16, 2016; Accepted: May 24, 2016

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

The association between baseline renal impairment (RI) and the prognosis of diffuse large B-cell lymphoma (DLBCL) was previously not defined. The aim of this study was to evaluate the prognostic value of RI in patients with DLBCL treated with three-weekly rituximab plus cyclophosphamide, Adriamycin, vincristine, and prednisolone immunochemotherapy (R-CHOP21).

Methods

Patients with newly diagnosed de novo DLBCLs treated with ≥1 cycle of R-CHOP21 were analyzed retrospectively. Pretreatment blood samples were collected and the glomerular filtration rate (GFR) was calculated. RI was defined by a GFR of <60 mL/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Results

Of the 185 patients enrolled in the present study, 19 patients (10.3%) had RI. The reasons for baseline RI were pre-existing CKD (N=5), acute kidney injury due to either obstruction (N=2) or electrolyte imbalance (N=2) related to DLBCL, and undefined causes (N=10). Patients with baseline RI showed inferior overall survival (OS) compared to those without RI (P<0.001). In multivariate analysis, RI was identified as an International Prognostic Index (IPI)-independent prognostic indicator. A baseline hemoglobin level of <10 g/dL and the presence of RI effectively discriminated a portion of the patients with far inferior event-free survival and OS among the patients having high or high-intermediate risk cancers according to either the standard- or the National Comprehensive Cancer Network-IPI.

Conclusion

Pretreatment RI was an independent prognostic marker for inferior OS in patients with DLBCL treated with R-CHOP21 immunochemotherapy.

Keywords: Diffuse large B-cell lymphoma, Renal insufficiency, Prognosis, Rituximab

Fig 1.

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Figure 1.

Kaplan–Meier graphs for overall survival according to (A) the standard International Prognostic Index and (B) the National Comprehensive Cancer Network International Prognostic Index.

Blood Research 2016; 51: 113-121https://doi.org/10.5045/br.2016.51.2.113

Fig 2.

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Figure 2.

Kaplan–Meier graph of the patients analyzed according to renal function.

Blood Research 2016; 51: 113-121https://doi.org/10.5045/br.2016.51.2.113

Fig 3.

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Figure 3.

Kaplan–Meier curves according to subgroups defined by either the standard International Prognostic Index (IPI) (A–C) or the National Comprehensive Cancer Network-IPI (D–F).

Blood Research 2016; 51: 113-121https://doi.org/10.5045/br.2016.51.2.113
Patient characteristics.

Abbreviations: ECOG, Eastern Cooperative Oncology Group; NCCN, National Comprehensive Cancer Network; GCB, germinal center B-cell-like..
Baseline renal function estimated using several parameters in the analyzed patients.

Abbreviations: MDRD, Modification of Diet in Renal Disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration..
The relationship of renal impairment defined by the CKD-EPI formula to the baseline characteristics of the patients analyzed.

Abbreviations: ECOG, Eastern Cooperative Oncology Group; IPI, International Prognostic Index; NCCN, National Comprehensive Cancer Network; GCB, germinal center B-cell-like..
Univariate and multivariate analysis for event-free and overall survival.

Abbreviations: HR, Hazard Ratio; IPI, International Prognostic Index; ECOG, Eastern Cooperative Oncology Group; NCCN, National Comprehensive Cancer Network..
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