Low prognostic nutritional index predicts poor outcome in diffuse large B-cell lymphoma treated with R-CHOP

Abstract

Prognostic nutritional index (PNI), based on serum albumin concentration and the absolute peripheral lymphocyte count, has been used to predict survival in various tumors. Whether PNI can predict prognosis in patients with diffuse large B-cell lymphoma (DLBCL) remains unknown. We retrospectively analyzed 253 patients with newly diagnosed DLBCL in the present study. The PNI was calculated as: albumin (g/L) + 5 × total lymphocyte count × 10(9)/L. All patients were divided in low and high groups according to the analysis of receiver operating characteristic (ROC) curve. Low PNI was associated with more unfavorable clinical features (p < 0.05). Patients with low PNI tended to have worse event-free survival (EFS) and overall survival (OS) (EFS, p = 0.001; OS, p < 0.001). For patients treated with R-CHOP, PNI proved to be predictive for survival (EFS, p = 0.001; OS, p < 0.001), while no significant effect was found in DLBCL patients who received CHOP chemotherapy (EFS, p = 0.496; OS, p = 0.125). Multivariate analysis showed that low PNI is an independent adverse predictor of OS and EFS, especially in DLBCL patients treated with R-CHOP. In conclusion, this study suggests that PNI is an effective prognostic factor in DLBCL patients treated with R-CHOP.

Prognostic nutritional index and the prognosis of diffuse large b-cell lymphoma: a meta-analysis

“…Due to the type of lymphoma not being DLBCL, 4 full-text articles were further removed. As a result, a total of 7 relevant studies were included in the current meta-analysis [ 15−20 , 22 ] (Fig. 1 ).…”

“…Out of the 7 chosen studies that were published from 2016 to 2020, 4 were conducted in China [ 15−17 , 19 ], while the remaining 3 were each carried out in Korea [ 18 ], Japan [ 20 ] and Croatia [ 22 ], respectively. In terms of language, 6 studies were published in English [ 15 , 16 , 18 – 20 , 22 ] and 1 in Chinese [ 17 ]. The total sample size was 1311, and the cut-off values of PNI were between 40 and 45.…”

“…The total sample size was 1311, and the cut-off values of PNI were between 40 and 45. Whilst R-CHOP or R-CHOP like regimen was employed in 3 studies [ 18 , 19 , 22 ]; R-CHOP/CHOP or CHOP like regimen was used in another 3 studies [ 15 – 17 ]; whereas rituximab-containing chemotherapy regimens (R-CHOP /R-CVP/rituximab alone) and palliative therapy were used in the remaining study [ 20 ]. The prognostic values of PNI on OS [ 15−20 , 22 ] were reported in all 7 studies; while the association between PNI and PFS [ 15 , 16 , 18 , 22 ] was shown in 4 studies.…”

“…Recent studies have found that PNI, an indicator that reflects the nutritional and immune status of patients, can be used to predict the clinical outcomes of patients with various malignant tumors, regardless of the tumor location and origin [ 10 – 14 ]. Some studies have focused on exploring the prognostic value of PNI for DLBCL, however the results were inconsistent and contradictory [ 3 , 15 – 20 ], possibly due to small sample sizes and patient heterogeneity in individual studies. In order to achieve a comprehensive evaluation of PNI for DLBCL, we aggregated the data from related studies and performed a meta-analysis to investigate how PNI is used in predicting the OS and the progression-free survival (PFS) of patients.…”

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

“…The importance of incorporating information from a comprehensive geriatric assessment in initial treatment decisions for older/less fit patients has also been recognized [73][74][75][76][77][78][79][80][81][82]. Data on the impact of factors not captured in traditional performance status measures, as sarcopenia, body mass index, nutritional index, and cachexia on DLBCL outcome are now emerging, and are of special interest in older patients [83][84][85][86][87][88][89][90]. Analyses of DLBCL treatment costs have also been assessed [91].…”