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Original Article

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Blood Res 2017; 52(3):

Published online September 25, 2017

https://doi.org/10.5045/br.2017.52.3.200

© The Korean Society of Hematology

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, and Cheolwon Suh6*

Author Info. +

1Department of Internal Medicine, Dong-A University Hospital, Busan, Korea.

2Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.

3Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

4Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea.

5Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

6Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

7Department of Hemato/Oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.

8Department of Internal Medicine, Hallym Medical Center, Hallym University College of Medicine, Anyang, Korea.

9Division of Hematology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

10Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

11Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

12Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

13Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

Correspondence to : Cheolwon Suh, 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. csuh@amc.seoul.kr

Received: April 29, 2017; Revised: May 28, 2017; Accepted: July 7, 2017

Abstract

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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

Article

Original Article

Blood Res 2017; 52(3): 200-206

Published online September 25, 2017 https://doi.org/10.5045/br.2017.52.3.200

Copyright © The Korean Society of Hematology.

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, and Cheolwon Suh6*

1Department of Internal Medicine, Dong-A University Hospital, Busan, Korea.

2Department of Medicine, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.

3Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

4Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea.

5Division of Hematology-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea.

6Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

7Department of Hemato/Oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.

8Department of Internal Medicine, Hallym Medical Center, Hallym University College of Medicine, Anyang, Korea.

9Division of Hematology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

10Division of Hematology/Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

11Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

12Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

13Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

Correspondence to:Cheolwon Suh, 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. csuh@amc.seoul.kr

Received: April 29, 2017; Revised: May 28, 2017; Accepted: July 7, 2017

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

Fig 1.

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Figure 1.

Kaplan-Meier graph depicting progression-free survival (PFS) of patients with advanced stage marginal zone lymphoma (MZL) treated with R-CVP chemotherapy (PFS at 3 years was 69.6%).

Blood Research 2017; 52: 200-206https://doi.org/10.5045/br.2017.52.3.200

Fig 2.

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Figure 2.

Kaplan-Meier survival plots; (A) Serum albumin level ≥3.9 g/dL was shown to be a significant predictor of progression free survival (PFS) (HR=0.243, 95% CI 0.086–0.691, P=0.004); (B) PLR was also significantly prognostic for PFS when evaluated for values of <95 (HR=0.298, 95% CI 0.114–0.779, P=0.009); (C) IPI, when categorized by a score of 1 versus 2–4, had prognostic significance for PFS (HR=0.444, 95% CI 0.211–0.933, P=0.017).

Blood Research 2017; 52: 200-206https://doi.org/10.5045/br.2017.52.3.200

Table 1 . Demographic and clinical characteristics..

a)Bone, bronchus, esophagus, nasopharynx, paranasal sinus, peritoneum, soft tissue, thymus, thyroid (1 case of each)..

Abbreviations: BM, bone marrow; ECOG, Eastern Cooperative Oncology Group; IPI, international prognostic index; LDH, lactate dehydrogenase; MALT, mucosa associated lymphoid tissue; MZL, marginal zone lymphoma..

Table 2 . Area under the curve values of prognostic marker candidates..

a)Under the nonparametric assumption. b)Null hypothesis: true area=0.5..

Abbreviations: ALC, absolute lymphocyte count; AMC, absolute monocyte count; ANC, absolute neutrophil count; CI, confidence interval; NLR, neutrophil to lymphocyte count; PLR, platelet to lymphocyte count..

Table 3 . Univariate analysis of prognostic factors for time-to-progression..

a)P-value by log rank test. b)Number of patients initially evaluated with LDH were 71..

Abbreviations: CI, confidence interval; HR, hazard ratio; IPI, international prognostic index; LDH, lactate dehydrogenase; MZL, marginal zone lymphoma; PFS, progression free survival; PLR, platelet to lymphocyte ratio; SA, serum albumin..

Table 4 . Multivariate analysis of prognostic factors for progression free survival..

a)P-value by Cox regression..

Abbreviations: CI, confidence interval; HR, hazard ratio; IPI, international prognostic index; PFS, progression free survival; PLR, platelet to lymphocyte ratio; SA, serum albumin..
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