Prognostic Role of Blood Markers in Primary Central Nervous System Lymphoma Patients Treated With High-Dose Methotrexate-Based Therapy

Abstract

Purpose: Primary central nervous system lymphoma (PCNSL) is a rare type of extra-nodal non-Hodgkin lymphoma, but the prognostic value of blood parameters indicating systemic inflammation and nutritional status remains unknown. We aim to explore the prognostic role of blood parameters in PCNSL.Methods: All PCNSL patients diagnosed at West China Hospital between February 2011 and February 2020 were retrospectively screened. For patients who were initially treated with high-dose methotrexate (HD-MTX)-based therapy, clinical data were collected. Survival analyses were performed using the Kaplan–Meier method and multivariable Cox proportional regression. The accuracies of different multivariate models were assessed by Harrell's C statistical analysis (C-index).Results: Sixty patients were included. Median overall survival (OS) was 4.8 ± 3.7 years, and median progression-free survival (PFS) was 1.9 ± 1.3 years. In the multivariate analysis, hemoglobin (Hb) (HR 3.940, p = 0.013), neutrophil–lymphocyte ratio (NLR) (HR 10.548, p = 0.034), and total bilirubin (TBIL) (HR 3.429, p = 0.004) had independent prognostic values for PFS, while lymphocyte–monocyte ratio (LMR) (HR 6.195, p = 0.039), systemic immune-inflammation index (SII) (HR 5.144, p = 0.012), and TBIL (HR 3.892, p = 0.009) were independently related to OS. The C-index of the Memorial Sloan-Kettering Cancer Center (MSKCC) score increased from 0.57 to 0.72 when SII and TBIL were combined.Conclusions: Our study indicated that pretreatment Hb, NLR, SII, LMR, and TBIL were convenient prognostic factors in PCNSL. Adding SII and TBIL to the MSKCC score can better predict the survival of PCNSL based on HD-MTX regimens.

A Prognostic Model Using Post-Steroid Neutrophil-Lymphocyte Ratio Predicts Overall Survival in Primary Central Nervous System Lymphoma

“…Here, we demonstrated the same trend in a pure PCNSL cohort. This was in keeping with several studies by other author groups [ 1 , 2 , 21 ]. In the Jung et al study [ 1 ], NLR greater or equal to 2.0 was associated with worse survival; of note, we also arrived at the same cut-off value of 2.0 for our baseline NLR, with effect estimates in the same direction.…”

“…In the Jung et al study [ 1 ], NLR greater or equal to 2.0 was associated with worse survival; of note, we also arrived at the same cut-off value of 2.0 for our baseline NLR, with effect estimates in the same direction. Similarly, in a more recent Luo et al study [ 21 ], the group found that NLR > 1.79 correlated with worse PFS.…”

“…Given these differences in patient characteristics, MSKCC score was only weakly applicable in our population. The poor calibration of MSKCC to modern patient cohorts was also noted by Luo et al in a Chinese cohort from the rituximab era, associated with a poor concordance index of 0.57 [ 21 ]. Our new proposed NCCS-NNI score was more discriminative and better calibrated in our internal validation, and could be more in line with modern trends in healthcare and treatment options.…”

Relapsed and refractory primary CNS lymphoma: treatment approaches in routine practice

“…However, there are very limited data about the validity of these scoring systems in the context of rrPCNSL. Notably, all existing prognostic models are based on clinical parameters measured at baseline; no robust data are yet available on dynamic factors measured during therapy and/or based on clinical, pathobiological or imaging characteristics of PCNSL ( 33 – 36 ). Identifying those most at risk of being refractory or relapse in PCNSL is further complicated by different first line regimens being employed in routine clinical practice ( 33 ).…”

A novel scoring model (SII-MSKCC) to better predict the clinical outcomes of primary central nervous system lymphoma

“…Lymphocytes play crucial roles in tumor defense by inducing cytotoxic cell death 14 . Therefore, SII has been reported to predict the outcomes in patients with PCNSL 15,16 and DLBCL [17][18][19] . However, the sample size is quite limited due to the relatively low incidence and stern discipline of diagnosis.…”