Absolute lymphocyte count at the time of first relapse predicts survival in patients with diffuse large B‐cell lymphoma

Abstract

Peripheral blood absolute lymphocyte count (ALC) is a survival prognostic factor in hematological malignancies. No reports have addressed whether ALC at the time of first relapse (ALC-R) predicts survival. Thus, we assessed the prognostic significance of ALC-R in diffuse large B-cell lymphoma (DLBCL). Patients were required to have been diagnosed with first relapsed DLBCL, have ALC-R values, and to be followed at Mayo Clinic, Rochester. From Feb 1987 until March 2006, 97 first relapsed DLBCL patients qualified for the study. The overall survival (OS) and progression-free survival (PFS) were measured from the time of first relapse. The value of ALC-R 1.0 3 10 9 /L was used for the analysis. Both groups (ALC-R 1 or < 1 3 10 9 / L) were balanced for the international prognostic index at relapse (IPI-R) (P 5 0.3), and for autologous stem cell transplantation (P 5 0.4). Superior OS and PFS were observed with an ALC-R 1.0 3 10 9 /L (N 5 60) versus ALC-R < 1.0 3 10 9 /L (N 5 37) [median OS: 28.7 months, 5 years OS rates of 39% versus median OS: 10.2 months, 5 years OS rates of 14%, P < 0.002; and median PFS: 14.8 months, 5 years PFS rates of 21% versus median PFS: 6.5 months, 5 years PFS rates of 8%, P < 0.004, respectively]. ALC-R was an independent prognostic factor for OS [RR 5 0.4, P < 0.01] and PFS [RR 5 0.5, P < 0.005]. ALC-R predicts survival suggesting that host immunity is an important variable predicting survival in first relapsed DLBCL. Am. J. IntroductionRecent reports have shown that peripheral blood absolute lymphocyte count (ALC) at diagnosis to be an independent predictor of survival for patients with diffuse large B-cell lymphoma (DLBCL) [1][2][3]. The international prognostic index at relapse (IPI-R) [4][5][6][7][8] and time to relapse (TTR) [9] are predictors of clinical outcomes in first relapsed DLBCL patients. However, no reports have addressed whether ALC at the time of first relapse (ALC-R) predicts survival in non-Hodgkin lymphoma (NHL). Thus, we assessed the prognostic significance of ALC-R in first relapsed DLBCL.

Comparison of the Prognostic Impact of Neutrophil/Lymphocyte Ratio, Platelet/Lymphocyte Ratio, and Glasgow Prognostic Score in Diffuse Large B-Cell Lymphoma

“…It was found that the systemic inflammatory response was associated with poor outcomes in various diseases. For various solid tumors, as well as for lymphomas, inflammation parameters such as WBC, ANC, ALC, and CRP have been associated with higher mortality rates (41)(42)(43)(44)(45)(46). Our results are in accordance with findings on the important roles of inflammation and malnutrition in tumor progression.…”

Cutaneous T‐cell lymphoma: 2011 update on diagnosis, risk‐stratification, and management

“…Whether this observation may be explained by tumor-mediated suppression of nonmalignant T cells, diminished thymic output of naïve T cells and compensatory homeostatic expansion of oligoclonal peripheral T cells, or some other mechanism, is unknown [47]. As lymphopenia is an adverse prognostic factor in many hematologic malignancies [59][60][61][62][63][64], and undoubtedly contributes to the infectious complications observed in CTCL, improved understanding of the causative mechanism(s) leading to this dramatic loss of T-cell diversity may have significant therapeutic implications.…”

Combination immunotherapy using adoptive T-cell transfer and tumor antigen vaccination on the basis of hTERT and survivin after ASCT for myeloma

“…[15][16][17][18] Furthermore, the absolute lymphocyte count at the time of first relapse from large cell lymphoma predicted subsequent progression-free and OS. 19 Our objective has been to develop a strategy for inducing an effective antitumor immune response during the posttransplantation period to control or eliminate residual disease. In theory, the posttransplantation phase should be highly amenable to the application of immunotherapy because of a lower tumor burden.…”