Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patients' survival benefit from rituximab
Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patients' survival benefit from rituximab
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DOI：
10.1111/j.1600-0609.2008.01129.x
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发表时间：
2008-12-01
影响因子：
3.1
通讯作者：
Morishima, Yasuo
中科院分区：
文献类型：
--
作者：
Oki, Yasuhiro;Yamamoto, Kazuhito;Morishima, Yasuo
为了评价淋巴细胞绝对计数(ALC)在弥漫性大B细胞淋巴瘤(DLBCL)诊断中的预后价值，我们在本机构用CHOP(n=119)或RCHOP(n=102)治疗的大量DLBCL患者中，从治疗反应、总体(OS)和无进展生存期(PFS)方面评价ALC的预后价值。使用利妥昔单抗、所有国际预后指数决定因素、β2微球蛋白水平、B症状或大病的存在以及ALC进行评估。低ALC(1.0×10(9)/L)与晚期、表现状态>；=2、乳酸脱氢酶升高、结外受累数目>；=2、B症状、β2微球蛋白升高和IPI风险较高组相关。单因素分析显示低ALC与低CR率相关(优势比=3.29，P=0.024)，而多因素分析则不相关。通过COX比例风险模型的单因素分析，低ALC与较短的OS[风险比(HR)=2.89，P<0.001]和PFS(HR=2.91，P<0.001)相关。多因素分析显示，低ALC与较短的OS(HR=2.51，P=0.003)和较短的PFS(HR=2.72，P<；0.001)相关，与上述参数无关。亚类分析显示，利妥昔单抗可改善低ALC患者的OS(HR=0.42，P=0.05)，但对高ALC患者(HR=0.83，P=0.71)无影响。这一观察结果在IPI评分较高的患者中最为明显。低ALC是DLBCL患者预后较差的标志物，提示利妥昔单抗对患者的生存有利。
To evaluate the prognostic value of absolute lymphocyte count (ALC) at diagnosis in patients with diffuse large B-cell lymphoma (DLBCL).In a large cohort of patients with DLBCL treated with CHOP (n = 119) or RCHOP (n = 102) in our institution, we evaluated the prognostic value of ALC at diagnosis with regards to treatment response, overall (OS) and progression-free survival (PFS). Use of rituximab, all International Prognostic Index (IPI) determinants, beta 2microglobulin level, presence of B symptoms or bulky disease, and ALC were evaluated.Low ALC (< 1.0 x 10(9)/L) was associated with advanced stage, performance status >= 2, elevated lactate dehydrogenase, number of extranodal involvement >= 2, B symptoms, elevated beta 2microglobulin and higher IPI risk group. Low ALC was associated with lower CR rate by univariate analysis (odds ratio = 3.29, P = 0.024) but not by multivariate analysis. By univariate analysis using Cox proportional hazard model, low ALC was associated with shorter OS [hazard ratio (HR) = 2.89, P < 0.001] and PFS (HR = 2.91, P < 0.001). Multivariate analysis revealed that low ALC was associated with shorter OS (HR = 2.51, P = 0.003) and PFS (HR = 2.72, P < 0.001), independent of above-mentioned parameters. Subclass analyses revealed that the use of rituximab improves OS in patients with low ALC (HR = 0.42, P = 0.05) but not in those with high ALC (HR = 0.83, P = 0.71). This observation was most obvious in patients with higher IPI score.Low ALC is a poor prognostic marker in patients with DLBCL and suggests patients' survival benefit from rituximab.