Improving the international prognostic index score using peripheral blood counts: Results of a large multicenter study involving 520 patients with diffuse large B cell lymphoma

Abstract

The main purpose of this study was to assess whether it is possible to improve the prognostic impact of international prognostic index (IPI) score by combining it with peripheral blood counts. Thus, we evaluated the prognostic power of lymphocyte, neutrophil, and monocyte counts in 520 patients with diffuse large B cell lymphoma treated with R-CHOP, confirming that these parameters have a strong impact on overall survival (OS). Using revised IPI (R-IPI), 44% of patients were categorized as poor-risk and showed an OS at 5 years of 46%. As OS at 5 years of the 520 patients is 67%, it is clearly evident that R-IPI tends to overestimate the proportion of patients with poor prognosis. Accordingly, in an attempt to improve the discriminating power of R-IPI, we evaluated and compared three different scores by combining the neutrophil lymphocyte ratio (NLR) and absolute monocyte count (AMC) with the following values: (a) IPI score 3-5, (b) age > 60 years and performance status, (c) age ≥ 65 years and LDH > ULN. The three indexes studied, had a similar 5 years OS for the high-risk group (46%-52%), but the proportion of patients classified as poor-risk were 37%, Raffaella Marcheselli and Alessia Bari contributed equally to this study.

Clinical Study of the Role of Differential Blood Count as a Pretreatment Diagnosis for Patients With Diffuse Large B Cell Lymphoma (DLBCL)

“…The study showed that PLR≥150 in DLBCL cases at diagnosis correlates positively with increased LDH>230UI/L(AUC=0.638, P=0.026,95%CI).In agreement to prior findings (Chang et al, 2015) and ECOG-PS score 2-4(AUC =0.609 P = 0.075, 95% CI) Figure 3B. In agreement with the previous finding by (Marcheselli et al, 2020).…”

“…Approximately 50 to 60 percent of patients are affected by advanced-stage diffuse disease III and IV (Chang et al, 2015). The international prognosis index is subjected to the current standard prognostic system for lymphoma but it has been suggested that the international prognosis index (IPI) might not be perfect in risk classification, diagnosis, and early diagnosis in DLBCL patients (Marcheselli et al, 2020). Further evaluation in prior reports stated RBC and HB are internal signals that initiate an inflammatory response, tumor growth, and resistance to chemotherapy (Moses & Brandau, 2016).…”

Biological signatures of the International Prognostic Index in diffuse large B-cell lymphoma

“…In addition to the prognostic capability of IPI upon treatment with R-CHOP–based immunochemotherapy, 25 , 26 , 27 we found a correlation of IPI with genetic subtypes and LME categories based on a large cohort of patients with newly diagnosed DLBCL, demonstrating different genetic and tumor microenvironmental signatures of the IPI in DLBCL.…”