Enhancement of the International prognostic index with β2-microglobulin, platelet count and red blood cell distribution width: a new prognostic model for diffuse large B-cell lymphoma in the rituximab era

Abstract

Background This study aimed to propose a new user-friendly, cost effective and robust risk model to facilitate risk stratification for diffuse large B-cell lymphoma (DLBCL) treated with frontline R-CHOP regimens. Methods Data on 998 patients with de novo DLBCL diagnosed between Jan 1st, 2005 and Dec 31st, 2018 at our center, who received frontline R-CHOP or R-CHOP-like regimens, were retrospectively collected. Patients were randomly divided into the training cohort (n = 701) and the validation cohort (n = 297). A new prognostic model for overall survival (OS) was built based on the training cohort. The performance of the new model was compared with International prognostic index (IPI), revised IPI (R-IPI) and National Comprehensive Cancer Network (NCCN)-IPI (NCCN-IPI). The new model was validated in the validation cohort. Results The multivariate analysis of the training cohort showed that the IPI, β2-microglobulin, platelet count and red blood cell distribution width were independent factors for OS, which were incorporated into the new prognostic model. Patients were stratified into low risk, low-intermediate risk, high-intermediate risk, high risk and very high risk groups, with distinct survival outcomes. The new model achieved good C-indexes for 5-year OS prediction of 0.750 (95%CI 0.719–0.781) and 0.733 (95%CI 0.682–0.784) in the training and validation cohorts, respectively, and displayed well-fitted calibration curves. The C-index and the time-dependent ROC analysis demonstrated better performance of the new model than the IPI, R-IPI and NCCN-IPI in both training and validation cohorts. The integrated Brier score for predicting 5-year OS of the new model was lower than that of the IPI, R-IPI and NCCN-IPI in both cohorts, and decision curve analysis also showed a higher net benefit, indicating the superiority of the new model over the conventional models. Conclusion The new prognostic model might be a useful predictive tool for DLBCL treated with R-CHOP regimens. Further external validation is warranted.

Prognostic value of red blood cell distribution width and D‐Dimer in diffuse large B‐cell lymphoma: Systematic review and meta‐analysis

“…A total of 13 studies 1 , 6 , 7 , 16 , 19 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 were included in our study (PRISMA flow diagram) based on the searched databases. Overall, eight studies 1 , 6 , 7 , 37 , 39 , 40 , 41 , 43 focused on the role of RDW and the remaining five studies 16 , 19 , 36 , 38 , 42 focused on D‐Dimer levels in DLBCL patients.…”

“…All included articles were retrospective cohorts. Eight studies were conducted in China 7 , 16 , 19 , 36 , 38 , 39 , 40 , 43 and others were conducted in Croatia, 41 Iraq, 37 Japan, 42 Peru, 1 and Spain. 6 The total sample size of the meta‐analysis was 3972 people (1252 and 2720 patients in the studies were related to prognostic roles of D‐Dimer and RDW in DLBCL patients, respectively) varying from 81 to 992 people in the included studies.…”

“…4,5 In the recent years, several prognostic factors such as Hemoglobin, Lymphocyte/Monocyte Ratio, Beta-2 microglobulin, and Neutrophil/Lymphocyte Ratio have been proposed to project the survival rate of DLBCL patients which can be easily performed in a common laboratory. [6][7][8][9] Nevertheless, easier and more available factors with high sensitivity are required for prediction of prognosis of DLBCL patients. Red blood cell distribution width (RDW) is considered a systemic inflammatory response marker that can be easily evaluated through the Complete Blood Count (CBC) test and has acceptable sensitivity in many diseases such as cardiovascular and autoimmune diseases and sepsis.…”

“…In the recent years, several prognostic factors such as Hemoglobin, Lymphocyte/Monocyte Ratio, Beta‐2 microglobulin, and Neutrophil/Lymphocyte Ratio have been proposed to project the survival rate of DLBCL patients which can be easily performed in a common laboratory 6–9 . Nevertheless, easier and more available factors with high sensitivity are required for prediction of prognosis of DLBCL patients.…”

Cost-effective prognostic evaluation of breast cancer: using a STAR nomogram model based on routine blood tests

“…Red blood cell distribution width reflects the degree of heterogeneity of red blood cell volume ( 50 ). As a laboratory hematological parameter, it can also be used as an independent prognostic marker to predict the survival of cancer patients ( 51 – 54 ). There are few studies on P-LCR in cancer ( 55 ).…”