Prognostic Value of the Pretreatment Advanced Lung Cancer Inflammation Index (ALI) in Diffuse Large B Cell Lymphoma Patients Treated with R-CHOP Chemotherapy

Abstract

Background: The Advanced Lung Cancer Inflammation Index (ALI, body mass index × albumin/neutrophil-to-lymphocyte ratio) has been demonstrated to be a prognostic factor of survival in some solid cancers. We retrospectively investigated the usefulness of the ALI to predict chemotherapy response and survival in 212 patients with diffuse large B cell lymphoma (DLBCL) treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Methods: Patients were allocated to a low ALI group (n = 82, 38.7%) or a high ALI group (n = 130, 61.3%) according to an optimal pretreatment ALI cut-off value of 15.5 as determined by receiver operating curve analysis. Results: The low ALI group displayed more adverse clinical characteristics, lower rates of complete remission (54.9 vs. 75.4%, p = 0.008), and poorer 5-year progression-free (PFS, 58.1 vs. 77.3%, p = 0.006) and overall (OS, 64.2 vs. 80.2%, p = 0.008) survival. Multivariate analysis showed that low ALI was found to independently predict shorter PFS and OS. Interestingly, a low ALI reverted to a high ALI during treatment in 58 patients (27.4%), and the 5-year OS of these patients was better than that of patients whose ALI remained low (n = 24, 72.5 vs. 24%, p < 0.001). Conclusions: ALI might be an easily available marker for predicting clinical outcomes in DLBCL patients treated with R-CHOP chemotherapy.

Inflammatory Biomarkers in Diffuse Large B-Cell Lymphoma: Time for Extending the Established Prognosis Scores?

“…In theory, these easily measureable, cheap, and broadly available blood-borne surrogates are useful for predicting the clinical outcome in many if not all types of cancer patients. In this issue of Acta Haematologica , Park et al [2] report clinical evidence for the prognostic use of the Advanced Lung Cancer Inflammation Index (ALI) in diffuse large B-cell lymphoma (DLBCL) patients. Within the limitations of a retrospective observational cohort study, these investigators demonstrated a consistent association between a low ALI and poor outcomes in 212 patients with DLBCL undergoing standard R-CHOP immune chemotherapy.…”

“…In their study on DLBCL, Park et al [2] defined a cut-off value for low ALI, thereby dichotomizing their patient population into a “low ALI” subgroup comprising roughly a third of their population and a subpopulation above this cut-off. Importantly, the probabilities of complete remission after R-CHOP, 5-year progression-free survival, and 5-year overall survival were around 20% lower in this “low ALI” group as compared to the patients above the ALI cut-off, respectively.…”

“…Similarly, patients assigned to lower-risk groups according to the ALI may benefit from receiving less intensive treatment. However, Park et al [2] have unfortunately not shown whether a “high” ALI identifies an additional low-risk group of DLBCL patients. Second, ALI may allow for personalizing of the treatment intensity based on intermediate assessments during therapy [8].…”

“…Second, ALI may allow for personalizing of the treatment intensity based on intermediate assessments during therapy [8]. Notably, Park et al [2] demonstrate that patients can change the ALI group during R-CHOP therapy, and that this change harbors prognostic information on future outcomes. This dynamic ALI result is in our opinion the most intriguing and important finding of their study, and sets their work apart from the numerous previous studies that have only looked at pretreatment inflammatory biomarkers and overall survival.…”

“…In conclusion, inflammatory biomarkers such as the ALI are not yet ready for the clinic, but the current study by Park et al [2] provides important guidance for future research on how the ALI or other such inflammatory indices may improve the treatment of patients with DLBCL in the future.…”