title: Low absolute lymphocyte count is a poor prognostic factor in diffuse-large-B-cell-lymphoma.
abstract: The prognostic value of absolute lymphocytic count (ALC), has been a recent matter of debate in non-Hodgkin-lymphoma (NHL). We assessed prospectively the value of ALC at diagnosis and also after the completion of immuno-chemotherapy in 101 diffuse-large-B-cell-lymphoma (DLBCL). Analysis of prognostic factors with respect to overall survival (OS), event free survival (EFS) and progression free survival (PFS) was done by two-tailed log-rank test. The ALC cut-off value was calculated as <0.84 x 10(9)/L at diagnosis: this was a strong negative prognostic factor for OS (p = 0.0004), EFS (p < 0.00001) and PFS (p < 0.00001) and in multivariate analysis was independent from the revised-international-prognostic-index (R-IPI). ALC after chemo-immunotherapy was not of prognostic value. As R-IPI and ALC < 0.84 x 10(9)/L, were the factors better discriminating poor prognosis, a new trichotomous score (ALC/R-IPI) was built up: (1) low risk: R-IPI = very good or good and ALC < 0.84 x 10(9)/L; (2) intermediate risk: patients with at least one risk factor (R-IPI = poor or ALC < 0.84 x 10(9)/L). (3) high risk: patients with both risk factors. This new prognostic score was highly significant in univariate analysis for OS (p = 0.0002), EFS (p < 0.00001) and PFS (p < 0.00001). In multivariate analysis ALC/R-IPI was the most predictive factor for OS (OR = 2.954; p = 0.002) and EFS (OR = 2.381; p < 0.00001) and the only predictive factor for PFS (OR = 4.018; p < 0.00001). Our data, show that ALC at diagnosis has a strong prognostic relevance and is independent from the R-IPI. The new score including both values proved the most powerful predictor at multivariate analysis.
authors.affiliation: Department of Hematology, AO Sant'Andrea, La Sapienza University,Rome, Italy. mccox@libero.it
authors.forename: Maria Christina
authors.initials: MC
authors.lastname: Cox
authors.forename: Italo
authors.initials: I
authors.lastname: Nofroni
authors.forename: Luigi
authors.initials: L
authors.lastname: Ruco
authors.forename: Rachele
authors.initials: R
authors.lastname: Amodeo
authors.forename: Antonella
authors.initials: A
authors.lastname: Ferrari
authors.forename: Giacinto
authors.initials: G
authors.lastname: La Verde
authors.forename: Patrizia
authors.initials: P
authors.lastname: Cardelli
authors.forename: Enrico
authors.initials: E
authors.lastname: Montefusco
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Conte
authors.forename: Bruno
authors.initials: B
authors.lastname: Monarca
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Aloe-Spiriti
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006801:Humans; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis