Absolute lymphocyte count (ALC), absolute monocyte count (AMC), and ALC/AMC ratio to predict outcome in aggressive non-Hodgkin lymphoma (aNHL).

Abstract

e18547 Background: Prognostic factors in NHL have been well studied in the pre-rituximab era. More recently, tumor infiltrating macrophages were found to confer an adverse prognosis. Porrata et al. at Mayo Clinic have described the ALC, AMC, and ALC/AMC ratio as important prognostic factors. We have evaluated pts with aNHL treated in the rituximab era to identify prognostic factors Methods: From January 2006 and April 2011, 89 pts with aNHL treated at our center were accrued. Initial treatment was R-CHOP based. 59 were entered on R-CHOP + GM-CSF protocol and the remainder were identified from our database. Results: Median age was 59 (25-89), 44% were male; histologies included DLBCL (n=75), high grade follicular lymphoma (n=11), and other (n=5). Median follow up = 27 mo. 3 year FFS and OS for the entire group: 78% and 83% respectively. On univariate analysis, FFS was superior for low IPI (0-2, p=0.01), normal B2 microglobulin (p=0.008), females (p=0.04), ALC > 865 (p=0.001), ALC/AMC ratio of >1.43 (p=0.02) but contrary to Porrata’s findings, there was no difference by AMC. In pts with low IPI, there was a significant difference in FFS and OS for those with an ALC >865 (93% vs 56%, p=0.0008;96% vs 60%, p=0.0004). In females ALC had no prognostic value, but males with low ALC had a significantly worse FFS and OS (85 vs 34%, p=0.007; 91% vs 53%, p=0.006). Females with high AMC had superior FFS (p=.02) but the opposite trend was seen in males. On multivariate analysis, gender, B2-microglobulin, and combined IPI with ALC/AMC ratio >1.43 remained as independent prognostic factors with gender being the most significant factor in the model. Conclusions: Prior to Rituximab, gender was not prognostic. Our findings suggest that: 1- favorable impact of Rituximab occurs mostly in females; this could be related to their immune system. 2- Both ALC and ALC/AMC ratio have prognostic significance, and can identify patients with favorable IPI who have poor outcome. This effect is particularly striking for males. To the best of our knowledge this is the first study to find an interaction between gender and ALC, and ALC/AMC as well as a divergent effect of gender and AMC on prognosis