Pretreatment Nutritional Status and Cardiovascular Risk Factors Affect Survival of Diffuse Large B-Cell Lymphoma Patients Treated with Immunochemotherapy

Background

Pretreatment nutritional status assessed by body mass index (BMI), total cholesterol (TC), albumin, total lymphocyte count (TLC) have been noted to have prognostic significance in diffuse large B-cell lymphoma (DLBCL) patients. Along with malnutrition, higher comorbidity score was observed to affect poor treatment outcome and treatment-related toxicity in the rituximab era. These factors have mostly been assessed in a small cohort of single center.

Method

Five hundred and twenty-five patients with newly diagnosed DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in 6 centers of South Korea from January, 2007 to March, 2016 were analyzed. Pretreatment nutritional status was assessed by controlling nutritional status (CONUT) score, which has been suggested to have strong prognostic impact in resectable solid cancer patients. The CONUT score was calculated by adding scores of the serum albumin concentration (score 0: ≥ 3.5 g/dL, score 2: 3.00-3.49 g/dL, score 4: 2.50-2.99 g/dL, score 6: < 2.50 g/dL), the TLC (score 0: ≥ 1600/mm³, score 1: 1200-1599/mm³, score 2: 800-1199/mm³, score 3: < 800/mm³), and the TC concentration (score 0: ≥ 180 mg/dL, score 1: 140-179 mg/dL, score 2: 100-139 mg/dL, score 3: < 100 mg/dL). Cardiovascular risk factors screened for the analysis were: diabetes mellitus (DM), hypertension, previous history of myocardial infarction and cerebrovascular infarction.

Result

The median follow-up duration was 29.47 months (range: 0.60 - 139.03 months) and the median age was 62 years (range: 20-89 years). By univariate analysis, BMI ≤ 20 kg/m² (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.32-3.66, p= 0.003), TC < 140 mg/dL (HR, 1.76; 95% CI, 1.11-2.79, p= 0.017), albumin < 3.0 g/dL (HR, 4.86; 95% CI, 2.80-8.46, p= 0.000), TLC < 1200/mm³(HR, 1.69; 95% CI, 1.09-2.62, p= 0.019), CONUT score ≥ 4 (HR, 3.22; 95% CI, 2.03-5.10, p= 0.000), and cardiovascular risk factors ≥ 1 (HR, 2.53; 95% CI, 1.63-3.91, p= 0.000) significantly affected overall survival (OS). In multivariate analysis, BMI ≤ 20 kg/m² (HR, 1.93; 95% CI, 1.12-3.33, p= 0.019), albumin < 3.0 g/dL (HR, 2.50; 95% CI, 1.27-4.94, p= 0.008), CONUT score ≥ 4 (HR, 2.32; 95% CI, 1.15-4.66, p= 0.019), and cardiovascular risk factors ≥ 1 (HR, 2.15; 95% CI, 1.34-3.45, p= 0.001) were significantly associated with OS. In terms of factors affecting progression-free survival (PFS), there were significant association with albumin < 3.0 g/dL (HR, 1.99; 95% CI, 1.04-3.82, p= 0.038), TLC < 1200/mm³ (HR, 1.47; 95% CI, 1.00-2.15, p= 0.048) and CONUT score ≥ 4 (HR, 1.76; 95% CI, 1.16-2.69, p= 0.008) but none of these factors had prognostic impact on PFS in multivariate analysis.

Conclusion

Malnourishment status indicated by BMI ≤ 20 kg/m² and CONUT score ≥ 4 and at least one or more cardiovascular risk factors at diagnosis poorly affect survival in DLBCL patients treated with Rituximab-based regimen.