Prognostic model based on the geriatric nutritional risk index and sarcopenia in patients with diffuse large B-cell lymphoma

Abstract

Background: Systemic inflammation and cachexia are associated with adverse clinical outcomes in diffuse large Bcell lymphoma (DLBCL). The Geriatric Nutritional Risk Index (GNRI) is one of the main parameters used to assess these conditions, but its efficacy in DLBCL is inconclusive. Methods: We retrospectively reviewed 228 DLBCL patients who were treated with R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The patients were stratified according to GNRI score (> 98, 92 to 98, 82 to < 92, and < 82) as defined in previous studies. Additionally, the extent of sarcopenia was categorized as sarcopenia-both, sarcopenia-L3/PM alone, and non-sarcopenia-both according to skeletal muscle index. Results: Survival curves plotted against a combination of GNRI and sarcopenia scores revealed two clear groups as follows: high cachexia risk (HCR) group (GNRI < 82, sarcopenia-both, or GNRI 82-92 with sarcopenia-L3/PM alone) and low cachexia risk (LCR) group (others). The HCR group had a lower complete response rate (46.5% vs. 86.6%) and higher frequency of treatment-related mortality (19.7% vs. 3.8%) and early treatment discontinuation (43.7% vs. 8.3%) compared with the LCR group. The median progression-free survival (PFS) (not reached vs. 10.3 months, p < 0.001) and overall survival (OS) (not reached vs. 12.9 months, p < 0.001) were much shorter in the HCR group than in the LCR group. On multivariable analyses, the HCR group was shown to be an independent negative prognostic factor for PFS and OS after adjusting the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI). Conclusions: A combined model of GNRI and sarcopenia may provide prognostic information independently of the NCCN-IPI in DLBCL.

Consecutive Hypoalbuminemia Predicts Inferior Outcome in Patients With Diffuse Large B-Cell Lymphoma

“…The major limitation of this study is its retrospective nature ( 22 ), which may introduce inherent selection bias by recruiting DLBCL patients who were diagnosed and followed at tertiary medical centers. To minimize the inherent biases of the retrospective study and ensure the homogeneity of treatment, we included only patients with de novo DLBCL treated with R-CHOP and excluded patients with primary central nervous system and mediastinal lymphoma, immunodeficiency-associated tumors, transformed non-Hodgkin lymphoma and posttransplant lymphoproliferative disorder, which might result in a selection bias.…”

Clinical Outcomes, Treatment Toxicity, and Health Care Utilization in Older Adults with Aggressive Non-Hodgkin Lymphoma

“…Although patients' comorbidities have been shown to increase the risk of morbidity and mortality in patients receiving cancer therapy [33], the mechanisms by which hypoalbuminemia affects clinical outcomes remains unclear. Hypoalbuminemia may relate to nutritional status or disease biology as albumin is a prognostic factor for survival in DLBCL and is affected by proinflammatory mediators including interleukein-6, interleukin-1, and tumor necrosis factor [20,22,31,[34][35][36]. Future work should investigate the potential mechanisms underlying this relationship to identify novel biomarkers to identify those at the highest risk for treatment toxicity.…”

Low Geriatric Nutritional Risk Index Is Associated with Poorer Prognosis in Elderly Diffuse Large B-Cell Lymphoma Patients Unfit for Intensive Anthracycline-Containing Therapy: A Real-World Study

“…For example, previous studies showed that the Charlson Comorbidity Index (CCI), a standardized scoring system to predict mortality with respect to the weight of comorbidities, can predict the clinical outcome in lymphoma patients [ 14 , 15 ]. Parameters of the nutritional status, including the serum albumin level, body weight, and body mass index (BMI), were also explored as predictors [ 11 , 12 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Previous studies revealed that skeletal muscle and fat mass wasting identified by computed tomography (CT) are valuable for predicting the clinical outcomes in DLBCL patients [ 23 , 24 ].…”

“…Several studies have demonstrated the GNRI to be a better prognostic factor than the serum albumin level, body weight, or BMI alone in hematologic malignancies [ 29 , 30 , 31 ]. Regarding lymphoma, the GNRI was associated with long-term survival in DLBCL patients [ 13 , 16 , 17 , 18 ]. However, the impact of the GNRI on different treatment strategies has not been elucidated.…”