Serum albumin retains independent prognostic significance in diffuse large B-cell lymphoma in the post-rituximab era

Abstract

Serum albumin (SA) has been shown to be a prognostic marker in many hematological malignancies and in diffuse large B-cell lymphoma (DLBCL) prior to chemo-immunotherapy. SA may be a surrogate for age, comorbid status, and disease severity. Here, we aimed to assess whether SA can be an independent prognostic marker in patients with newly diagnosed DLBCL treated with rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone (R-CHOP). Patients who presented at the Moffitt Cancer Center from 2007 to 2010 for DLBCL diagnosis or treatment were identified using our institutional database. Clinical and treatment data were recorded, including SA levels at diagnosis. Survival time was estimated using the Kaplan-Meier method, with Cox proportional hazard model used to identify potential risk factors for time-to-event data. From 295 identified patients, 171 were excluded for not having primary treatment at our institution or not having R-CHOP treatment. In 124 included patients (mean age at diagnosis of 58 years, 91 % Caucasian), 25 % were categorized as poor by the revised International Prognostic Index. Overall and progression-free survival at 4 years were 65 % (95 % CI 57-75) and 58 % (95 % CI 0.49-0.69), respectively. Using multivariate analysis, we found that the hazard index of death of patients with SA ≥3.7 g/dL was 26 % (95 % CI 13-53) of the hazard for those patients who had SA <3.7 g/dL when controlling for the revised International Prognostic Index risk and initial lymphocyte count. Our study shows that SA ≥3.7 g/dL is an independent prognostic marker in DLBCL patients treated with R-CHOP.

Serum albumin level at diagnosis of diffuse large B‐cell lymphoma: an important simple prognostic factor

“…A recently published paper found that an albumin level of <3.7 g/dl is an independent prognostic indicator in DLBCL patients treated with R‐CHOP . They found that serum albumin <3.7 g/dl significantly reduced OS and PFS in the good and poor prognostic category . Although, surprisingly, in our study pretreatment hypoalbuminemia was associated with decreased OS, it was not associated with response rate.…”

“…Studies of non‐Hodgkin's lymphoma reported that albumin <3.0 g/dl was one of the factors predicting early death from aggressive disease treated with ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) . A recently published paper found that an albumin level of <3.7 g/dl is an independent prognostic indicator in DLBCL patients treated with R‐CHOP . They found that serum albumin <3.7 g/dl significantly reduced OS and PFS in the good and poor prognostic category .…”

Prognostic Value of the Pretreatment Advanced Lung Cancer Inflammation Index (ALI) in Diffuse Large B Cell Lymphoma Patients Treated with R-CHOP Chemotherapy

“…Furthermore, a variety of systemic inflammatory biomarkers has been identified and studied in patients with DLBCL, and might provide useful prognostic information (Table 4). These biomarkers include NLR [30,31], serum LDH [32], serum CRP [33,34], GPS [35,36], serum albumin [37,38], and the peripheral blood absolute lymphocyte and monocyte counts [39]. Troppan et al [30 ]reported that DLBCL patients with an NLR score <4 at diagnosis experienced better OS and disease-free survival than patients with a score of ≥4.…”

Prognostic model based on the Geriatric Nutritional Risk Index and sarcopenia in patients with diffuse large B-cell lymphoma

“…However, other studies found that the prognostic value of sarcopenia was limited in elderly and male patients [28,29]. There are also contradictory reports regarding the prognostic role of hypoalbuminemia with various cut-off points [13,16,30].…”

“…Given the high tumor burden of DLBCL and the favorable response rate with substantial treatment-related toxicities of R-CHOP treatment, the prognostic role of cancer cachexia is also likely to be observed in DLBCL patients. Several markers for malnutrition and cachexia such as body mass index (BMI), sarcopenia, adipopenia, and serum albumin level have been studied and suggested to be prognostic factors in DLBCL [13][14][15][16]. Additionally, the clinical value of the Geriatric Nutritional Risk Index (GNRI), which was originally developed to predict nutrition-related morbidity and mortality in non-cancer patients [17], was evaluated in two previous DLBCL studies with conflicting results [18,19].…”