Consecutive Hypoalbuminemia Predicts Inferior Outcome in Patients with Diffuse Large B-Cell Lymphoma

Albumin at diagnosis can be used to predict survival in diffuse large B-cell lymphoma (DLBCL). But whether consecutive albuminemia, which seen in DLBCL patients from time to time, could be more accuracy to predict outcome remains unknown.

We retrospectively analyzed 574 de novo DLBCL patients treated with R-CHOP from our and other 2 centers. All the patients were divided into a training cohort (n=278) and a validation cohort (n=296) depending on the source of the patients. Overall survival (OS) and progression-free survival (PFS) were analyzed by the method of Kaplan-Meier and the differences between groups were compared by the log-rank test. Multivariable analysis was conducted by Cox proportional hazard regression model.

The cutoff value of albumin for survival analysis was 39.2g/L with an area under the curve value of 0.589±0.034 (p=0.009) by receiver operating characteristic curve. In the training cohort, 163(58.6%) patients had low serum albumin at diagnosis and 80 of them were present with consecutive hypoalbuminemia. Patients with consecutive hypoalbuminemia showed inferior OS and PFS (p=0.010 andp=0.079, respectively). Similar survival differences were also observed in the independent validation cohort (p=0.006 andp=0.030, respectively). Multivariate analysis revealed that consecutive hypoalbuminemia was an independent prognostic factor OS (relative ratio [RR], 0.499; 95% confidence interval [CI], 0.317-0.786,p=0.003) and PFS (RR, 0.576; 95% CI, 0.413-0.804,p=0.001) in all entire DLBCL patients independent of IPI.

In conclusion, our study suggests that consecutive hypoalbuminemia is a simple and effective prognostic factor in DLBCL patients, allowing the identification of an inferior outcome subgroup in DLBCL patients, which may need to closely follow up.