Pre-treatment red blood cell distribution width provides prognostic information in multiple myeloma

Zhou, Di; Xu, Peipei; Peng, Miaoxin; Shao, Xiaoyan; Wang, Miao; Ouyang, Jian; Chen, Bing

doi:10.1016/j.cca.2018.02.009

“…However, in our study, elevated RDW was associated with poorer ECOG-PS, more extranodal sites of disease, B symptoms, higher Ann Arbor stage, higher LDH, higher IPI, higher NLR, lower ALB and lower Hb. In consideration of previous studies and our findings, it is rational to conclude that RDW is associated with tumor burden, chronic inflammation and malnutrition in DLBCL [32]. In our study, patients with high RDW and anemia had high bone marrow involvement rate (RDW:P=0.007, anemia: P=0.192), which may be due to the influence of bone marrow microenvironment on hematopoiesis.…”

Section: Discussionsupporting

confidence: 67%

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

Li

¹

,

Xia

²

,

Zheng

³

et al. 2019

Preprint

0

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Background: Elevated red blood cell distribution width (RDW) and decreased platelet count (PLT) can be clinically relevant to the prognosis in cancer patients . However, their prognostic values in patients with diffuse large B-cell lymphoma (DLBCL) need to be further explored. Methods: Healthy donors (n=130) and patients with DLBCL (n=349) were included and evaluated retrospectively in this study. The prognostic influence of clinical and pathological factors including RDW and PLT on overall survival (OS) and progression-free survival (PFS) were studied by Kaplan-Meier curves . To evaluate the independent prognostic relevance of RDW and PLT, univariate and multivariate Cox proportional hazards regression models were applied. The adjusted IPI model was established based on the results of multivariate analysis, and verified by Harrell's C statistical analysis. Results: Kaplan-Meier curves indicated that an elevated RDW value and thrombocytopenia are poor factors for OS (P<0.001, P=0.006) and PFS (P=0.003, P<0.001) in DLBCL patients. Multivariate analysis confirmed that elevated RDW value (HR=2.026, 95%CI= 1.263-3.250, P=0.003) and decreased PLT count (HR =1.749, 95%CI=1.010-3.028, P=0.046) were both independent prognostic factors. The c-index of IPI and NCCN-IPI were increased when RDW level and PLT were supplemented in our cohort. Conclusions: Our study shows that elevated RDW level and decreased PLT are independent poor prognostic factors in newly diagnosed DLBCL patients. Adding RDW and PLT to the IPI score may improve its predictive ability, and the adjusted IPI may be more powerful in predicting the survival of DLBCL patients in the rituximab era. Keywords : prognosis, diffuse large B-cell lymphoma ( DLBCL ), red blood cell distribution width (RDW), platelet count (PLT)

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“…Inflammation and malnutrition might damage erythropoiesis, thus resulting in an increased RDW. In 2018, Zhou et al analyzed the relationship between RDW and normal erythropoiesis/megakaryocytopoiesis in multiple myeloma patients at diagnosis and their study demonstrated the usefulness of RDW as an indicator for bone marrow hematopoiesis [32]. In our study, patients with high RDW and anemia had high bone marrow involvement rate (RDW:P=0.007, anemia: P=0.192), which may be due to the influence of bone marrow microenvironment on hematopoiesis.…”

Section: Discussionsupporting

confidence: 49%

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

Li

¹

,

Xia

²

,

Zheng

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: Elevated red blood cell distribution width (RDW) and decreased platelet count (PLT) can be clinically relevant to the prognosis in cancer patients . However, their prognostic values in patients with diffuse large B-cell lymphoma (DLBCL) need to be further explored. Methods: Healthy donors (n=130) and patients with DLBCL (n=349) were included and evaluated retrospectively in this study.The prognostic influence of clinical and pathological factors including RDW and PLT on overall survival (OS) and progression-free survival (PFS) were studied by Kaplan-Meier curves . To evaluate the independent prognostic relevance of RDW and PLT, univariate and multivariate Cox proportional hazards regression models were applied. The adjusted IPI model was established based on the results of multivariate analysis, and verified by Harrell's C statistical analysis. Results: Kaplan-Meier curves indicated that an elevated RDW value and thrombocytopenia are poor factors for OS (P<0.001, P=0.006) and PFS (P=0.003, P<0.001) in DLBCL patients. Multivariate analysis confirmed that elevated RDW value (HR=2.026, 95%CI= 1.263-3.250, P=0.003) and decreased PLT count (HR =1.749, 95%CI=1.010-3.028, P=0.046) were both independent prognostic factors. The c-index of IPI and NCCN-IPI were increased when RDW level and PLT were supplemented in our cohort. Conclusions:Our study shows that elevated RDW level and decreased PLT are independent poor prognostic factors in newly diagnosed DLBCL patients. Adding RDW and PLT to the IPI score may improve its predictive ability, and the adjusted IPI may be more powerful in predicting the survival of DLBCL patients in the rituximab era. Keywords : prognosis, diffuse large B-cell lymphoma ( DLBCL ), red blood cell distribution width (RDW), platelet count (PLT) Background Diffuse large B-cell lymphoma (DLBCL) is the most common type of aggressive lymphomas in hematological malignancies. In the newly diagnosed cases of non-Hodgkin's lymphomas (NHL), about 30% to 40% are DLBCL [1]. Although the survival of DLBCL patients has been greatly improved with the administration of CHOP chemotherapies (cyclophosphamide, doxorubicin, vincristine and prednisolone) with rituximab, there are still about 10-15% of patients suffered from primary refractory disease, and about 20-30% relapsed [2]. addition, age and sex-matched 130 healthy donors (HDs) from the Second Affiliated Hospital of Anhui Medical University were recruited as normal control group. Of the 349 DLBCL patients, we randomly selected 200 patients as the training set, while the remaining patients were assigned to the testing set (n=149) [11]. The demographic characteristics, clinical features and laboratory parameters were obtained from the patient's medical records from both institutions. Retrieved clinical-pathological parameters included gender, age, lactate dehydrogenase (LDH) level, Ann Arbor stage, number of extra nodal sites involvement, Eastern Cooperative Oncology Group performance status (ECOG PS), B symptoms, physical examinations, computed tomog...

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“…In total, forty-nine studies consisting of 19,790 patients were finally included in our analysis according to the inclusion and exclusion criteria (Fig. 1) 42-47,23,48,11,49,27,28,19,50-52,12,53,24,54,25,55,29,13,26,14,15,20,10,21,56,16,57-62,30,63-66,22,67,17,68,18,69.…”

Section: Resultsmentioning

confidence: 99%

Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies

Wang

¹

,

Song

²

,

Guo

³

et al. 2019

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Red blood cell distribution width (RDW) has been recently demonstrated to be a predictor of inflammation. High pretreatment RDW level is associated with poor survival outcomes in various malignancies, although the results are controversial. We aimed to investigate the prognostic role of RDW. A systematic literature search was performed in MEDLINE and EMBASE till April 2018. Pooled hazard ratios (HRs) were estimated for overall survival (OS) and combined disease-free survival, progression-free survival, and recurrence-free survival (DFS/PFS/RFS). 49 studies with 19,790 individuals were included in the final analysis. High RDW level adversely affected both OS and DFS/PFS/RFS. For solid cancers, colorectal cancer (CRC) had the strongest relationship with poor OS, followed by hepatic cancer (HCC). Negative OS outcomes were also observed in hematological malignancies. Furthermore, patients at either early or advanced stage had inverse relationship between high pretreatment RDW and poor OS. Studies with cut-off values between 13% and 14% had worse HRs for OS and DFS/PFS/RFS than others. Furthermore, region under the curve (ROC) analysis was used widely to define cut-off values and had relatively closer relationship with poorer HRs. In conclusion, our results suggested that elevated pretreatment RDW level could be a negative predictor for cancer prognosis.

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Pre-treatment red blood cell distribution width provides prognostic information in multiple myeloma

Cited by 24 publications

References 33 publications

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

Red blood cell distribution width and platelet counts are independent prognostic factors and improve the predictive ability of IPI score in diffuse large B-cell lymphoma patients

Prognostic role of pretreatment red blood cell distribution width in patients with cancer: A meta-analysis of 49 studies

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