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

Abstract

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. Disclosures No relevant conflicts of interest to declare.

Cachexia index as a potential biomarker for cancer cachexia and a prognostic indicator in diffuse large B‐cell lymphoma

“…Sarcopenia is associated with shorter survival, reduced response to treatment, increased treatment‐related toxicities, frequent dose reduction, and early termination of treatment 13,24–27 . Hypoalbuminaemia is a predictive factor for shorter survival, decreased relative dose intensity of anthracycline and cyclophosphamide, and increased risk of TRM 28–32 . High NLR is also correlated with shorter survival, lower CR rate, advanced stage, higher LDH level, and increased risk of depression 32–37 .…”

The correlation between paclitaxel chemotoxicity and the plasma albumin level in cancer patients

“…In addition, the physical status of the patient (poor performance status), tumour staging, etc. can also lead to hypoproteinemia 12 …”

“…can also lead to hypoproteinemia. 12 Hypoalbuminemia is a well-known finding related to cancer and is commonly regarded as a sign of malnutrition. Studies have shown that the incidence of hypoalbuminemia in cancer patients is about 20%-45.8%.…”

Malnutrition und Outcome bei älteren Patienten (≥ 65 Jahre) mit aggressiven Non-Hodgkin-Lymphomen

“…Im Zusammenhang mit Globulin wurde Albumin außerdem in Form der Albumin-Globulin-Ratio (AGR) eine prognostische Aussagekraft bezogen auf das präoperativ chemotherapeutisch behandelte Rektum-Karzinom(Toiyama et al 2018) und das DLBCL(Kim et al 2018) zugeschrieben.Die im Rahmen dieser Arbeit erzielten Ergebnisse zeigen, dass ein SA < 3,5 g/dl für ältere Patienten mit DLBCL prognostisch relevant für das PFS und das OS ist. Damit konnten bisherige Ergebnisse aus der Literatur bestätigt werden: In einer retrospektiven Studie mit 124 DLBCL-Patienten mit einem Durchschnittsalter von 58 (20-84) Jahren war ein SA-Cutoff-Wert von 3,7 g/dl ebenfalls signifikant für OS und PFS(Dalia et al 2014), ebenso in einer bisher nur als Abstract veröffentlichten chinesischen Studie mit einem SA-Cut-off-Wert von 3,9 g/dl(Wei et al 2017). Von mehreren untersuchten Blutwerten war in einer retrospektiven Studie mit 157 DLBCL-Patienten allein SA prognostisch signifikant für das Gesamtüberleben(Bairey et al 2016).…”