Baseline Serum Cholinesterase Levels Predict the Outcome of HIV-Related Diffuse Large B-Cell Lymphoma

Abstract

Background Serum cholinesterase (CHE) has been utilized as a surrogate marker in the context of solid cancers. Nevertheless, its potential association with the prognosis of hematologic malignancies remains unclear. Methods Sixty-five patients with new-onset HIV-related diffuse large B-cell lymphoma (DLBCL) were enrolled in this retrospective study. The patients were categorized into a high CHE group (> 5500 U/L) and a low CHE group (≤ 5500 U/L). The demographic details, laboratory test results and clinical outcomes were compared between the high CHE group and the low CHE group. The overall response rate (ORR) at the end of chemotherapy was assessed by logistic regression analysis, and the 1-year overall survival rate (OS) was assessed by a multivariate Cox proportional hazards model. Results Compared with patients with high CHE, HIV-related DLBCL patients with low CHE exhibited lower levels of hemoglobin [g/L; 101.0 (81.0-115.0) vs. 123.5 (108.2–141.0), P < 0.001] and serum albumin [g/L; 31.2 ± 5.6 vs. 40.4 ± 4.5, P < 0.001] but higher levels of lactate dehydrogenase (LDH) [U/L; 404.0 (253.0-849.0) vs. 248.0 (178.3–372.0), P = 0.014] and C-reactive protein (CRP) [mg/L; 36.1 (5.8–66.6) vs. 5.1 (0.8–5.1), P < 0.001]. Moreover, HIV-related DLBCL patients with low CHE demonstrated a higher prevalence of Ann Arbor stage III/IV (92.6% vs. 56.8%, P < 0.001) and International Prognostic Index (IPI) ≥ 3 (85.2% vs. 35.1%, P = 0.002) at the time of diagnosis of DLBCL. The 1-year OS of patients was 84.2% in the high CHE group and 40.7% in the low CHE group (log-rank P < 0.001). At the end of chemotherapy, the ORR was 80.0% in the high CHE group and 31.8% in the low CHE group (P < 0.001). In multivariate analysis, CHE > 5500 U/L was independently associated with a higher ORR [adjusted odds ratio (AOR): 4.74 (1.02–22.06), P = 0.047] and lower 1-year mortality [hazard ratio (HR): 0.11 (0.03–0.52), P = 0.005]. Conclusion Based on our robust data, baseline serum CHE levels show great potential as a surrogate marker for risk stratification and for guiding treatment decisions in HIV-related DLBCL patients.