Association Between the Neutrophil-to-Lymphocyte Ratio and Infection and Survival in Diffuse Large B Cell Lymphoma

Abstract

Background/Aim: Infection is a common cause of morbidity and mortality in patients treated for diffuse large Bcell lymphoma (DLBCL). However, there is limited information on the impact and risk factors for infection among patients receiving rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisolone (R-CHOP). Patients and Methods: A retrospective study evaluating patients with DLBCL receiving R-CHOP and R-COP between 2004 and 2021 was conducted at a medical center. Hospital patients' records for the five-item modified frailty index (mFI-5), sarcopenia, blood-based inflammatory markers, and clinical outcomes were statistically analyzed. Results: Patients with frailty, sarcopenia, and high neutrophil-to-lymphocyte ratio (NLR) were associated with a higher risk of infections. The revised International Prognostic Index poor-risk group, high NLR, infections, and treatment modality were risk factors for shorter progression-free and overall survival. Conclusion: Pre-treatment high NLR was a predictor of infection and survival outcome in DLBCL patients.Diffuse large B cell lymphoma (DLBCL) is the most common type of lymphoma (1). Chemoimmunotherapy (CIT) with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), the standard of care for DLBCL, is effective in 60%-70% of patients (2, 3).Bone marrow suppression induced febrile neutropenia (FN), and infections were crucial in the pathogenesis of lymphoma treatment-related mortality (4). During treatment with the R-CHOP regimen in DLBCL, up to 24% (5) and 63% (6) of patients present with FN and infection, respectively. Advanced disease, older age, poor performance status, comorbidities, poor nutritional status, and the absence of granulocyte colonystimulating factor (G-CSF) prophylaxis were independent risk factors for FN in patients treated with the R-CHOP regimen (7-9).Infection is a typical cause of morbidity and mortality in patients treated for lymphoma. However, there is limited information on infection risk factors and their impact on patients treated for DLBCL. Extensive research has previously revealed that sarcopenia, frailty status, and bloodbased biomarkers including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index (SII) are significant prognostic markers of DLBCL (10-12). Up to now, there has been no comprehensive analysis of the associated infection and survival outcome in patients with DLBCL.Thus, the current study aimed to retrospectively analyze the predictive effect of frailty, sarcopenia, and blood-based inflammatory markers on infections and survival outcomes in patients with DLBCL treated with the R-CHOP or R-COP regimen. Patients and MethodsPatient selection criteria. This retrospective study was approved by the Research Ethics Committee of the Hualien Tzu Chi General 948

Systemic inflammation response index as a prognostic factor for patients with sepsis-associated acute kidney injury: a retrospective observational study

“…Numerous studies have proposed that inflammatory indices, such as the neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio, can serve as prognostic markers for infectious diseases. [6][7][8] Additionally, the systemic inflammation response index (SIRI) has garnered increasing attention in recent years. Cai et al 9 reported that higher SIRI levels independently predicted adverse outcomes in patients with infective endocarditis.…”

A Novel Inflammatory-Nutritional Prognostic Scoring System for Patients with Diffuse Large B Cell Lymphoma

“…Accordingly, studies have reported that pretreatment platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR) are prognostic predictors in DLBCL. [6][7][8][9] In addition, tumor mediated-inflammatory cells could release inflammatory cytokines, leading to the activation of the coagulation cascade and thrombosis formation. As a degradation product of fibrin, elevated D-dimer could reflect high activation of coagulation and fibrinolysis, which was supposed to be related with poor OS of DLBCL.…”