title: Peripheral blood absolute lymphocyte/monocyte ratio during rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone treatment cycles predicts clinical outcomes in diffuse large B-cell lymphoma.
abstract: A limitation of the prognostic factor peripheral blood absolute lymphocyte/monocyte ratio (ALC/AMC) at diagnosis in diffuse large B-cell lymphoma (DLBCL) is its inability to sequentially assess the host/tumor microenvironment interaction and clinical outcomes during treatment. Therefore, we studied the ALC/AMC ratio at each rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) cycle as a predictor for survival. We studied 107 consecutive patients with DLBCL diagnosed, treated only with R-CHOP and followed at the Mayo Clinic. Unsupervised hierarchical clustering identified four clusters based on the patterns of ALC/AMC ratio recovery during cycles. The most inferior survival was seen in the cluster with ALC/AMC ratio < 1.1 in all cycles. By multivariate analysis, ALC/AMC ratio < 1.1 during all cycles was an independent predictor for inferior overall survival and progression-free survival. The ALC/AMC ratio during R-CHOP cycles predicts survival and provides a platform to develop therapeutic modalities to manipulate the ALC/AMC ratio during R-CHOP cycles to improve DLBCL clinical outcomes.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic , Rochester, MN , USA.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Porrata
authors.forename: Kay M
authors.initials: KM
authors.lastname: Ristow
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Colgan
authors.forename: David J
authors.initials: DJ
authors.lastname: Inwards
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ansell
authors.forename: Ivana N
authors.initials: IN
authors.lastname: Micallef
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Nowakowski
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Svetomir N
authors.initials: SN
authors.lastname: Markovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016000:Cluster Analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Lymphocytes; lymphoma and Hodgkin disease; monocytes