The prognostic impact of serum albumin and absolute neutrophil count in patients with newly diagnosed diffuse large B-cell lymphoma

Background: Patients (pts) with diffuse large B cell lymphoma (DLBCL) are treated with immunochemotherapy and are generally stratified by the NCCN International prognostic index (NCCN-IPI). It has been reported that some host-related factors such as nutritional status (NS) and systemic inflammation (SI) were associated with the outcome of pts with solid tumors. However, data regarding their prognostic contribution in DLBCL are limited. Therefore, we decided to access the possible prognostic significance of some laboratory markers associated with NS/SI in DLBCL pts. Methods: We retrospectively reviewed the clinical outcome of 251 R-CHOP treated DLBCL pts. A receiver operating characteristic (ROC) curve analysis was used to illustrate the best cut off values of the serum albumin (SA), beta-2-microglobulin, absolute neutrophil (ANC), lymphocyte, monocyte and platelet counts, and hemoglobin level to predict overall survival (OS) by Kaplan-Meier method in our data set. Results: The estimated 5-year OS of the whole group was 61%. The multivariate analysis showed that only SA and ANC remained independent predictors of OS by applying the best cut off values determined by ROC - 39.4 g/L and 5.33 x 109/L, respectively. Furthermore, the combination of dichotomized SA and ANC generated a prognostic index (SA/ANC PI) that stratified patients into 3 different risk groups: low risk [LR] (SA > 39.4 g/L and ANC ≤5.53 x 109/L), intermediate risk [IR] (SA > 39.4 g/L or ANC ≤5.53 x 109/L), and high risk [HR] (SA ≤ 39.4 g/L and ANC >5.53 x 109/L). The 5-year OS for LR, IR and HR pts was 86%, 65.7% and 22.5% (P < 0.001), respectively, and our PI was independent of the NCCN-IPI. Conclusions: Our data showed that SA/ANC PI could predict OS in DLBCL pts and may present a reliable, convenient and sensitive predictor to identify pts with poor prognosis in addition to NCCN-IPI. Legal entity responsible for the study: Specialized Hospital for Active Therapy of Hematological Diseases Funding: None Disclosure: All authors have declared no conflicts of interest.