Low Immunoglobulin G and Low Lymphocyte-Monocyte Ratio at the End of Treatment Predict Early Progression in Diffuse Large B-Cell Lymphoma

• Published in: Blood 2024-11, Vol.144, p.4459-4459
• Main Authors: Uryu, Hideki, Kawashima, Masaharu, Suzuki, Kazuhito, Fukushima, Ryoko, Gunji, Tadahiro, Ishii, Hiroto, Hirano, Kei, Nagao, Riku, Yokoyama, Hiroki, Katsube, Atsushi, Tanoue, Susumu, Sakayori, Yo, Mochizuki, Yasutaka, Ishii, Keita, Ohba, Rie, Tsukamoto, Kurumi, Hattori, Daiki, Katori, Mitsuji, Saito, Takeshi, Nishiwaki, Kaichi, Dobashi, Nobuaki, Yano, Shingo
• Format: Article
• Language: English
• ISSN: 0006-4971
• DOI: 10.1182/blood-2024-201850

Introduction The outcome of diffuse large B-cell lymphoma (DLBCL) has improved with rituximab-containing immunochemotherapy. However, some patients with DLBCL experience relapse or disease progression. Particularly, early progressive disease (EPD) influences dismal prognosis. Immunoglobulin G (IgG), absolute lymphocyte (ALC) and lymphocyte-monocyte ratio (LMR) are candidates for host immune biomarkers and reportedly influence the prognosis of DLBCL. We performed a retrospective analysis to identify the key factors affecting EPD in DLBCL patients. Patients and Methods Patients newly diagnosed with DLBCL at our institution between January 2015 and December 2021 were evaluated. All patients were treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) immunochemotherapy. In this study, EPD was defined as progression within 12 months from the date of initial treatment. We surveyed the correlation between EPD and characteristics (age >60 years, performance status [PS] ≥2, international prognostic index [IPI] ≥3, serum albumin [Alb] ≤3.5 g/dl, and lactate dehydrogenase [LDH] >upper limit normal [ULN]) and immune biomarkers (IgG, ALC, and LMR) at the time of diagnosis and at the end of treatment (EOT). We analyzed I) comparison of immune biomarkers between groups; Group1: EPD, Group2: late PD, Group3: no PD, II) factors related to EPD, and III) progression-free survival (PFS) and overall survival (OS) between patients with EPD factors. Statistical analyses of patient characteristics were performed using Fisher's exact test, Student's t-test, or Mann-Whitney U test. Comparison of immune biomarkers between the Group1-3 was conducted using the Kruskal-Wallis test. The optimal cutoff of immune biomarkers for EPD was calculated using receiver operating characteristic (ROC) analysis. Factors affecting EPD were evaluated using Gray's test and the Fine-Gray proportional hazard model. Survival was calculated using the Kaplan-Meier method, and statistical analyses were performed using the log-rank test. Results Among 263 patients, 104 experienced relapse/progression (including 66 with EPD), with a median follow-up of 41 months (range 3-106 months). The median age of the EPD group was 71.5 years (range: 43-85 years). Twenty-five (37.9%) patients had PS ≥2, 39 (59.1%) had Alb ≤3.5 g/dl, 56 (84.8%) had LDH >ULN, and 45 (68.2%) had IPI ≥3. The median IgG, EOT-IgG, ALC, EOT-ALC, LMR, and EOT-LMR in the EPD group were 1145 mg/dl, 685 mg/dl, 110