Useful prognostic tools based on complete blood cell counts in diffuse large B‐cell lymphoma

Abstract

Introduction Diffuse large B‐cell lymphoma (DLBCL) is the most frequent lymphoma. Three prognostic factors are widely used in DLBCL: International Prognostic Index (IPI), Revised‐IPI (R‐IPI), and National Comprehensive Cancer Network‐IPI (NCCN‐IPI). Method We established a prognostic model using peripheral blood absolute lymphocyte/absolute monocyte counts ratio (LMR), hemoglobin, and platelet counts obtained from complete blood cell counts (CBC) data at diagnosis based on 214 cases of DLBCL who received more than one course of R‐CHOP therapy at a single institution. Results The cutoff values for using the receiver operating characteristics (ROC) curve for LMR, hemoglobin, and platelet counts were 1.6, 100 g/L, and 150 × 109/L, respectively. Stratification was performed using the three factors (LMR < 1.6, hemoglobin < 100 g/L, and platelet counts < 150 × 109/L). CBC Group 1 (none of the 3 factors) included 92 cases, CBC Group 2 (1 or 2 of these factors) included 108 cases, and CBC Group 3 (all 3 factors) included 11 cases. The 5‐year OS rates were 78.2%, 60.9%, and 10.1%, respectively. In multivariate analysis, CBC Group 3 (hazard ratio, 2.9760; 95% confidence interval, 1.2670‐6.991; P = .01) were prognostic factors for OS. CBC Group 3 had factors based on which the further stratification of the poor prognosis group into IPI high‐risk and R‐IPI poor‐risk groups (P = .01, <.0001, respectively) was possible. Conclusions In DLBCL, combination of three CBC parameters has the potential to be a useful prognostic tool.

Low lymphocyte‐to‐monocyte ratio predicts poor outcome in high‐risk aggressive large B‐cell lymphoma

“…The observation that low LMR is associated with inferior survival validates the previous findings [18-25, 27, 29]. However, the cutoff level in our high-risk cohort was lower than in previous studies being mostly around 2.6, suggesting that the cutoff may be dependent on the clinical risk group [18][19][20][21][22][23][24][25][26][27]29]. The treatment in our trial was also more intensive than the R-CHOP regimen mostly used in the previous studies possibly affecting the outcome and thus interfering with the prognostic impact of LMR.…”

“…In our cohort, a cutoff level of 1.72 discriminated best the low and high LMR subgroups with different outcomes. The observation that low LMR is associated with inferior survival validates the previous findings [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 29 ]. However, the cutoff level in our high‐risk cohort was lower than in previous studies being mostly around 2.6, suggesting that the cutoff may be dependent on the clinical risk group [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 ].…”

“…The lymphocyte/monocyte ratio (LMR), calculated by the ratio of absolute lymphocyte count (ALC) to absolute monocyte count (AMC), is an inflammatory biomarker indicating the balance between the host immune system and TME. Low ALC, high AMC, and low LMR have been shown to translate to poor survival in patients with DLBCL [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. To our knowledge, however, the prognostic impact of LMR has been demonstrated only in heterogeneous patient populations treated mostly with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or R‐CHOP.…”

Peripheral blood cell ratios as prognostic factors in canine diffuse large B‐cell lymphoma treated withCHOPprotocol

“…In humans with DLBCL, the presence of thrombocytopenia is associated with poor outcome and is related to the systemic inflammatory status, with upregulation of inflammatory markers, bone marrow invasion and autoimmune destruction 60,61 . In dogs, the mechanisms underlying lymphoma associated thrombocytopenia have not been elucidated, but possibly could be similar to those described for humans.…”

The Clinical Significance of Circulating Lymphocytes Morphology in Diffuse Large B-Cell Lymphoma As Determined by a Novel, Highly Sensitive Microscopy

“…Moreover, these modalities do not provide information about the cells' functionality. In DLBCL, prognostic models based on CBC-derived lymphocyte counts have been suggested [16], including the use of lymphocyte counts kinetics to predict the outcome following CAR T treatment [17]. However, so far, no such models employing peripheral blood smear (PBS) analysis have been proposed.…”