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Original Article

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Blood Res 2019; 54(4):

Published online December 31, 2019

https://doi.org/10.5045/br.2019.54.4.244

© The Korean Society of Hematology

Clinical impacts of inflammatory markers and clinical factors in patients with relapsed or refractory diffuse large B-cell lymphoma

Do-Young Kim1#, Moo-Kon Song2#, Joo-Seop Chung1, Ho-Jin Shin1, Deok Hwan Yang3, Sung-Nam Lim4, Sung-Yong Oh5

Author Info. +

Department of Hematology-Oncology, 1Pusan National University Hospital Medical Research Institute, Busan, 2Hanyang University Hanmaeum Changwon Hospital, Changwon, Department of Hematology, 3Chonnam National University Hwasun Hospital, Hwasun, 4Busan Haeundae Paik Hospital, 5Dong-A University Hospital, Busan, Korea

Correspondence to : Joo-Seop Chung, M.D., Ph.D.
Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea
E-mail: hemon@pusan.ac.kr

#These authors contributed equally to this work.

Received: May 29, 2019; Revised: August 9, 2019; Accepted: August 29, 2019

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

Systemic inflammatory response can be associated with the prognosis of diffuse large B cell lymphoma (DLBCL). We investigated the systemic factors significantly related to clinical outcome in relapsed/refractory DLBCL.

Methods

In 242 patients with DLBCL, several factors, including inflammatory markers were analyzed. We assessed for the correlation between the survivals [progression-free survival (PFS) and overall survival (OS)] and prognostic factors.

Results

In these patients, a high derived neutrophil/lymphocyte ratio (dNLR) (PFS, HR=2.452, P=0.002; OS, HR=2.542, P=0.005), high Glasgow Prognostic Score (GPS) (PFS, HR=2.435, P=0.002; OS, HR=2.621, P=0.002), and high NCCN-IPI (PFS, HR=2.836, P=0.003; OS, HR=2.928, P=0.003) were significantly associated with survival in multivariate analysis. Moreover, we proposed a risk stratification model based on dNLR, GPS, and NCCN-IPI, thereby distributing patients into 4 risk groups. There were significant differences in survival among the 4 risk groups (PFS, P<0.001; OS, P<0.001).

Conclusion

In conclusion, dNLR, GPS, and NCCN-IPI appear to be excellent prognostic parameters for survival in relapsed/refractory DLBCL.

Keywords Derived neutrophil/lymphocyte ratio, Glasgow prognostic score, DLBCL

Article

Original Article

Blood Res 2019; 54(4): 244-252

Published online December 31, 2019 https://doi.org/10.5045/br.2019.54.4.244

Copyright © The Korean Society of Hematology.

Clinical impacts of inflammatory markers and clinical factors in patients with relapsed or refractory diffuse large B-cell lymphoma

Do-Young Kim1#, Moo-Kon Song2#, Joo-Seop Chung1, Ho-Jin Shin1, Deok Hwan Yang3, Sung-Nam Lim4, Sung-Yong Oh5

Department of Hematology-Oncology, 1Pusan National University Hospital Medical Research Institute, Busan, 2Hanyang University Hanmaeum Changwon Hospital, Changwon, Department of Hematology, 3Chonnam National University Hwasun Hospital, Hwasun, 4Busan Haeundae Paik Hospital, 5Dong-A University Hospital, Busan, Korea

Correspondence to:Joo-Seop Chung, M.D., Ph.D.
Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea
E-mail: hemon@pusan.ac.kr

#These authors contributed equally to this work.

Received: May 29, 2019; Revised: August 9, 2019; Accepted: August 29, 2019

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

Systemic inflammatory response can be associated with the prognosis of diffuse large B cell lymphoma (DLBCL). We investigated the systemic factors significantly related to clinical outcome in relapsed/refractory DLBCL.

Methods

In 242 patients with DLBCL, several factors, including inflammatory markers were analyzed. We assessed for the correlation between the survivals [progression-free survival (PFS) and overall survival (OS)] and prognostic factors.

Results

In these patients, a high derived neutrophil/lymphocyte ratio (dNLR) (PFS, HR=2.452, P=0.002; OS, HR=2.542, P=0.005), high Glasgow Prognostic Score (GPS) (PFS, HR=2.435, P=0.002; OS, HR=2.621, P=0.002), and high NCCN-IPI (PFS, HR=2.836, P=0.003; OS, HR=2.928, P=0.003) were significantly associated with survival in multivariate analysis. Moreover, we proposed a risk stratification model based on dNLR, GPS, and NCCN-IPI, thereby distributing patients into 4 risk groups. There were significant differences in survival among the 4 risk groups (PFS, P<0.001; OS, P<0.001).

Conclusion

In conclusion, dNLR, GPS, and NCCN-IPI appear to be excellent prognostic parameters for survival in relapsed/refractory DLBCL.

Keywords: Derived neutrophil/lymphocyte ratio, Glasgow prognostic score, DLBCL

Fig 1.

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Figure 1.Comparisons of the response rates and survivals among the salvage therapies administered to patients with relapsed diffuse large B cell lymphoma.
Blood Research 2019; 54: 244-252https://doi.org/10.5045/br.2019.54.4.244

Fig 2.

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Figure 2.Comparisons of the survival rates according to NCCN-IPI, glasgow prognostic score, and derived neutrophil/lymphocyte ratio in patients with relapsed diffuse large B cell lymphoma.

Abbreviations: dNLR, derived neutrophil/lymphocyte ratio; GPS, glasgow prognostic score; NCCN-IPI, National Cancer Center Network-International Prognostic Index.

Blood Research 2019; 54: 244-252https://doi.org/10.5045/br.2019.54.4.244

Fig 3.

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Figure 3.Comparisons of survivals according to a combined scoring system based on NCCN-IPI, glasgow prognostic score, and derived neutrophil/lymphocyte ratio in patients with relapsed diffuse large B cell lymphoma.
Blood Research 2019; 54: 244-252https://doi.org/10.5045/br.2019.54.4.244
The baseline characteristics of the patients with relapsed/refractory diffuse large B cell lymphoma.

Abbreviations: ALC, absolute lymphocyte count; AMC, absolute monocyte count; ANC, absolute neutrophil count; ASCT, autologous stem cell transplantation; B2MG, beta-2-microglobulin; CRP, C-reactive protein; CT, computed tomography; ECOG, Eastern Cooperative Oncology Group; EN, extranodal; GPS, glasgow prognostic score; Hb, hemoglobin; IPI, International Prognostic Index; LDH, lactate dehydrogenase; NCCN, National Comprehensive Cancer Network; PET, positron emission tomography; PLT, platelet; SUVmax, maximum standard uptake value..


Receiver operating characteristic analysis of continuous variables as prognostic factors for predicting disease progression in patients with relapsed diffuse large B cell lymphoma.

Abbreviations: AUC, area under curve; CI, confidence interval; dNLR, derived neutrophil/lymphocyte ratio; LMR, lymphocyte/monocyte ratio; NLR, neutrophil/lymphocyte ratio; PLR, platelet/lymphocyte ratio; PNI, Prognostic Nutritional Index; SII, Systemic Inflammation-Immune Index; SUVmax, maximum standard uptake value..


Univariate analysis for prognostic factors in relapsed/refractory patients with diffuse large B cell lymphoma.

Abbreviations: ASCT, autologous stem cell transplantation; B2MG, beta-2-microglobulin; dNLR, derived neutrophil/lymphocyte count ratio; GPS, glasgow prognostic score; IPI, International Prognostic Index; LMR, lymphocyte/monocyte ratio; NCCN, National Comprehensive Cancer Network; NLR, neutrophil/lymphocyte count ratio; PLR, platelet/lymphocyte count ratio; PNI, Prognostic Nutritional Index; R, rituximab; SUVmax, maximum standardized uptake value..


Multivariate analysis for prognostic factors in relapsed/refractory patients with diffuse large B cell lymphoma.

Abbreviations: ASCT, autologous stem cell transplantation; B2MG, beta-2-microglobulin; dNLR, derived neutrophil/lymphocyte count ratio; GPS, glasgow prognostic score; IPI, International Prognostic Index; LMR, lymphocyte/monocyte ratio; NCCN, National Comprehensive Cancer Network; NLR, neutrophil/lymphocyte count ratio; PLR, platelet/lymphocyte count ratio; PNI, Prognostic Nutritional Index; R, rituximab; SUVmax, maximum standardized uptake value..


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