The Absolute Monocyte and Lymphocyte Prognostic Index for Patients With Diffuse Large B-Cell Lymphoma Who Receive R-CHOP

Abstract

An index based on the initial absolute lymphocyte and monocyte counts may provide prognostic information regarding outcome beyond that of the International Prognostic Factors Index in management of patients with untreated diffuse large cell lymphoma who are receiving R-CHOP chemotherapy. Background The baseline absolute monocyte count and absolute lymphocyte count were used to generate a prognostic index (the AMLPI) for survival in diffuse large B-cell lymphoma (DLBCL). Methods Data from 245 patients with DLBCL who were treated with standard R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, prednisone) were reviewed. By using the values previously reported for the AMLPI, its prognostic value was examined in our population. Results After a median follow-up of 22 months for censored observations, the 3-year progression-free survival (PFS) rates for the international prognostic index (IPI) 0–2 and 3–5 risk groups were 73% and 58%, respectively (P = .0004); comparable overall survival (OS) rates were 88% and 68%, respectively (P < .0001). For patients with IPI scores of 0–2, 1-year PFS rates for AMLPI low-, intermediate-, and high-risk groups were 92%, 89%, and 80%, respectively (P = .022); comparable 1-year OS rates were 96%, 95%, and 80%, respectively (P = .049). By multivariate analysis, with the adjustment of IPI in the model, AMLPI effects (low- vs. high-risk groups) on PFS and OS rates were significant, with P = .046 (hazard ratio [HR] 0.402 [95% CI, 0.164–0.986] and P = .052 (HR 0.325 [95% CI, 0.104–1.011]), respectively. Conclusions The absolute monocyte and lymphocyte counts prognostic index (the AMLPI) may add prognostic value beyond that of the IPI for patients with DLBCL who receive R-CHOP.

Prognostic Implication of the Absolute Lymphocyte to Absolute Monocyte Count Ratio in Patients With Classical Hodgkin Lymphoma Treated With Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine or Equivalent Regimens

“…Similar data have been also produced for diffuse large B-cell lymphomas (DLBCL) [20][21][22][23][24][25][26][27][28] and follicular lymphomas [28,29], associating lower ALC/AMC with inferior outcomes.…”

Prognostic impact of absolute lymphocyte count/absolute monocyte count ratio and prognostic score in patients with nasal-type, extranodal natural killer/T-cell lymphoma

“…Subsequent evidence also investigated the prognostic value of ALC/AMC prognostic score in diffuse large-Bcell lymphoma. [24][25][26] Significant difference in clinical outcome was noticed in the patients with different ALC/AMC prognostic scores and high score was related to poor survival. We stratified patients into three risk categories with significantly different survival outcomes according to AMC/ALC prognostic score.…”

“…Moreover, the value of the incorporation of ALC and AMC has been explored and several studies revealed that ALC/AMC ratio [21][22][23][24] and ALC/AMC prognostic score (low risk and normal ALC and AMC; intermediate risk, low ALC, or high AMC; high risk, low ALC, and high AMC) 19,25,26 were related to survival in certain types of lymphomas. Although there are definite results in these cancers, the role of ALC/ AMC ratio and ALC/AMC prognostic score 20 in ENKTL is still unclear and requires validation in other patient cohorts.…”

Monocyte count at diagnosis is a prognostic parameter in diffuse large B-cell lymphoma: results from a large multicenter study involving 1191 patients in the pre- and post-rituximab era

“…Although cut-off values in the various studies were slightly different, similar conclusions were drawn by each group separately, indicating that an elevated monocyte count or lymphopenia at diagnosis has an adverse impact on survival in Hodgkin's lymphoma 17,18,25 and nonHodgkin's lymphoma. [8][9][10][11][12][13][23][24] Lymphopenia is a well-established prognostic marker in advanced Hodgkin's lymphoma and is included in the International Prognostic Score. 25 In non-Hodgkin's lymphoma, lymphocyte counts have mostly been evaluated in T-cell lymphomas and low levels are associated with infe-haematologica | 2014; 99(1) 25 while in T-cell lymphoma studies the value generally used was ≤1000/mm 3 .…”

“…8,9 However, there is no current consensus regarding the best AMC cut-off value to be applied in common practice. [8][9][10][11][12][13] The main aim of this collaborative multicenter study was to verify the prognostic significance of AMC in a very large cohort of newly diagnosed patients with DLBCL and evaluate different cut-off levels (610, 620, 630, 800 and to 1000 cells/mm 3 ), reported to be significant in other recent reports. We also examined whether AMC could be utilized as a simple independent prognostic factor for survival, comparing it to the IPI.…”