title: Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patients' survival benefit from rituximab.
abstract: OBJECTIVE
  To evaluate the prognostic value of absolute lymphocyte count (ALC) at diagnosis in patients with diffuse large B-cell lymphoma (DLBCL).
  
  
  METHODS
  In a large cohort of patients with DLBCL treated with CHOP (n = 119) or RCHOP (n = 102) in our institution, we evaluated the prognostic value of ALC at diagnosis with regards to treatment response, overall (OS) and progression-free survival (PFS). Use of rituximab, all International Prognostic Index (IPI) determinants, beta2microglobulin level, presence of B symptoms or bulky disease, and ALC were evaluated.
  
  
  RESULTS
  Low ALC (<1.0 x 10(9)/L) was associated with advanced stage, performance status >or=2, elevated lactate dehydrogenase, number of extranodal involvement >or=2, B symptoms, elevated beta2microglobulin and higher IPI risk group. Low ALC was associated with lower CR rate by univariate analysis (odds ratio = 3.29, P = 0.024) but not by multivariate analysis. By univariate analysis using Cox proportional hazard model, low ALC was associated with shorter OS [hazard ratio (HR) = 2.89, P < 0.001] and PFS (HR = 2.91, P < 0.001). Multivariate analysis revealed that low ALC was associated with shorter OS (HR = 2.51, P = 0.003) and PFS (HR = 2.72, P < 0.001), independent of above-mentioned parameters. Subclass analyses revealed that the use of rituximab improves OS in patients with low ALC (HR = 0.42, P = 0.05) but not in those with high ALC (HR = 0.83, P = 0.71). This observation was most obvious in patients with higher IPI score.
  
  
  CONCLUSIONS
  Low ALC is a poor prognostic marker in patients with DLBCL and suggests patients' survival benefit from rituximab.
authors.affiliation: Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan. yooki-tky@umin.ac.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oki
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Harumi
authors.initials: H
authors.lastname: Kato
authors.forename: Yachiyo
authors.initials: Y
authors.lastname: Kuwatsuka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Taji
authors.forename: Yoshitoyo
authors.initials: Y
authors.lastname: Kagami
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone