Background

Systemic inflammatory factors such as C-reactive protein (CRP), ¥â2-microglobulin (B2MG), and ferritin were documented an prognostic factor in patients with hematologic malignancies including lymphoma. The purpose of this study was to find the significance of systemic inflammatory factors for predicting survival outcome in patients with diffuse large B cell lymphoma (DLBCL).

Methods

A total of 188 patients who newly diagnosed DLBCL and received an rituximab combined chemotherapy at the South Korea between September 2004 and April 2012 were enrolled retrospectively in the current study. Pretreatment serum CRP, B2MG, and ferritin were measured within 4 weeks before the beginning of first line chemotherapy.

Results

The median age of patients was 58 years (range, 14-84 years) and the mean level of serum CRP, B2MG, and ferritin at pre-treatment were 2.37 mg/dL (range: 0.01 – 29.80), 2.64 mg/L (range: 0.71 – 24.01), and 285.01 ng/ml (range: 5.34-4872.40). Systemic inflammatory factors score were given 1 point if serum levels were more than normal range (CRP; 0.8 mg/dL, B2MG; 2.5 mg/L and ferritin; 220 ng/ml). Systemic inflammatory risk were divided into three groups according to systemic inflammatory factors scores ; low risk was 0 score, intermediate risk was 1 or 2 score, and high risk was 3 score respectively. 5-year progression free survival rates (PFS) were 66.9%, 65.0% and 10.6% in risk groups respectively (p < 0.001). 5-year overall survival rates (OS) were 74.4%, 48.8% and 19.8% in risk groups respectively (p < 0.001).

Conclusions

Systemic inflammatory factor (CRP, B2MG and ferritin) score were associated with survival outcomes in patients with DLBCL treated by R-CHOP. However, further studies are needed to confirm prognostic value of systemic factors such as CRP, B2MG and ferritin.

Table 1

Patient characteristics

Value (%)N = 188
Age, years
Median (range) 		58 (16 – 84) 
Gender (%)
Male
Female 		109 (58.0)
79 (42.0) 
IPI (%)
Low
Low-intermediate
High-intermediateHigh 		64 (34.0)
49 (26.1)
30 (16.0)
45 (23.9) 
LDH
Normal
elevated 		80 (42.6)
108 (57.4) 
ECOG (%)
0 – 1
¡Ã 2 		80 (42.6)
108 (57.4) 
Stage (%)
< III
¡Ã III 		87 (46.3)
101 (53.7) 
Extranodal involvement (%)
< 2
¡Ã 2 		156 (83.0)
32 (17.0) 
Bulky mass (%)
< 10 cm
¡Ã10 cm 		164 (87.2)
24 (12.8) 
CRP, mg/dL
Mean (range) 		2.37 (0.01 – 29.80) 
¥â2-microglobulin, mg/L
Mean (range) 		2.64 (0.71 – 24.01) 
BM involvement (%)
Present
Absent 		27 (14.4)
161 (85.6) 
ALC, x 103/mL
Mean (range) 		1706 (40 – 22365) 
Ferritin, ng/mL
Mean (range) 		285.01 (5.34 – 4872.40) 
Value (%)N = 188
Age, years
Median (range) 		58 (16 – 84) 
Gender (%)
Male
Female 		109 (58.0)
79 (42.0) 
IPI (%)
Low
Low-intermediate
High-intermediateHigh 		64 (34.0)
49 (26.1)
30 (16.0)
45 (23.9) 
LDH
Normal
elevated 		80 (42.6)
108 (57.4) 
ECOG (%)
0 – 1
¡Ã 2 		80 (42.6)
108 (57.4) 
Stage (%)
< III
¡Ã III 		87 (46.3)
101 (53.7) 
Extranodal involvement (%)
< 2
¡Ã 2 		156 (83.0)
32 (17.0) 
Bulky mass (%)
< 10 cm
¡Ã10 cm 		164 (87.2)
24 (12.8) 
CRP, mg/dL
Mean (range) 		2.37 (0.01 – 29.80) 
¥â2-microglobulin, mg/L
Mean (range) 		2.64 (0.71 – 24.01) 
BM involvement (%)
Present
Absent 		27 (14.4)
161 (85.6) 
ALC, x 103/mL
Mean (range) 		1706 (40 – 22365) 
Ferritin, ng/mL
Mean (range) 		285.01 (5.34 – 4872.40) 
View Large

IPI, international prognostic index; LDH, lactate dehydrogenase; ECOG, Eastern Cooperative Oncology Group (ECOG) performance status; CRP, C-reactive protein; BM, bone marrow; ALC, absolute lymphocyte counts; CHOP-like (cyclophosphamide, adriamycin, vincristine, prednisolone); RCHOP (rituximab plus CHOP)

Table 2.

Survival outcome according to systemic inflammatory factor score in patients with DLBCL

Risk5yrs PFS (%)P-value5yrs OS (%)P-value
Low
Intermediate
High 		66.9
65.0
10.6 		< 0.001 74.4
48.8 1
9.8 		< 0.001 
Risk5yrs PFS (%)P-value5yrs OS (%)P-value
Low
Intermediate
High 		66.9
65.0
10.6 		< 0.001 74.4
48.8 1
9.8 		< 0.001 
View Large

Systemic inflammatory factor (normal range); ¥â2-microglobulin (2.5mg/L), CRP (0.8mg/dL), ferritin (220 ng/mL)

Systemic inflammatory factor score : given 1 point if more than normal range

Low risk ; 0, Intermediate risk ; 1 or 2, High risk ; 3

Figure 1.
Figure 1. 5 years progression free survival curves according to Systemic inflammatory factor score in patients with DLBCL
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5 years progression free survival curves according to Systemic inflammatory factor score in patients with DLBCL

Figure 1.
Figure 1. 5 years progression free survival curves according to Systemic inflammatory factor score in patients with DLBCL
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5 years progression free survival curves according to Systemic inflammatory factor score in patients with DLBCL

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Figure 2.
Figure 2. 5 years overall survival curves according to Systemic inflammatory factor score in patients with DLBCL
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5 years overall survival curves according to Systemic inflammatory factor score in patients with DLBCL

Figure 2.
Figure 2. 5 years overall survival curves according to Systemic inflammatory factor score in patients with DLBCL
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5 years overall survival curves according to Systemic inflammatory factor score in patients with DLBCL

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
diffuse large b-cell lymphoma, r-chop, c-reactive protein, ferritin, chemotherapy regimen, cyclophosphamide, doxorubicin, prednisone, and vincristine, rituximab, cyclophosphamide, doxorubicin, extranodal disease

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2013 by The American Society of Hematology
2013
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