Abstract
Introduction: Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare hematologic malignancy with a poor prognosis when treated with current therapies. Clinical factors have been developed to prognosticate survival in EBV-positive DLBCL patients; however, more refined, easy to use and reliable prognostic tools are needed. The neutrophil to lymphocyte ratio (NLR) has been reported prognostic in patients with DLBCL (Troppan et al. BJC 2014). We have investigated the prognostic value of the NLR in the overall survival (OS) of patients with untreated EBV-positive DLBCL.
Methods: We included patients with a pathological diagnosis of EBV-positive DLBCL who were diagnosed and treated at our institution between 2001-2014. We excluded cases with primary cutaneous CNS involvement, and patients with >50% incomplete data. IRB approval was obtained prior to research. Pathological samples were reviewed by hematopathologists to confirm the diagnosis. Pertinent clinicopathological data such as age, sex, performance status, LDH levels, stage, extranodal sites of disease, absolute neutrophil and lymphocyte counts were collected through chart review, and are presented using descriptive statistics. The NLR was calculated by dividing the absolute neutrophil by the lymphocyte count, and dichotomized in NLR>=5 and NLR<5. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. Univariate Cox models were fitted to evaluate hazard ratios (HR) for OS.
Results: A total of 46 patients were included in our analysis. The median age was 73 years (range 25-95 years) with male predominance (70%). Poor performance status (ECOG >1) was seen in 25 (58%), elevated LDH levels in 19 (46%), 1+ extranodal site in 24 (57%), and advanced stage (stage 3 and 4) in 23 (53%) of patients. Based on the NLR, 13 patients (39%) had NLR>=5. Patients with NLR >=5 were more likely to present with poor performance (ECOG >1; 85% vs. 15%; p=0.04), elevated LDH levels (69% vs. 31%; p=0.04), advanced stage (III and IV, 69% vs. 31%, p=0.05), and IPI score 3-5 (77% vs.23%; p=0.02). There were no differences in age, sex and number of extranodal sites. NLR>=5 was associated with a worse OS (HR 2.67, 95% CI 1.01-7.01; p=0.047).
Conclusion: The NLR appears as a novel and easy to use prognostic factor for OS in patients with untreated EBV-positive DLBCL. Our findings support the need for validation of the NLR in larger retrospective or prospective studies in patients with EBV-positive DLBCL.
No relevant conflicts of interest to declare.
