title: A new prognostic score for elderly patients with diffuse large B-cell lymphoma treated with R-CHOP: the prognostic role of blood monocyte and lymphocyte counts is absent.
abstract: BACKGROUND
  Absolute lymphocyte count (ALC) and absolute monocyte count (AMC) have been documented as independent predictors of survival in patients with newly diagnosed Diffuse Large B-cell Lymphoma (DLBCL). Analysis of the prognostic impact of ALC and AMC in the context of International Prognostic Index (IPI) and other significant variables in elderly population treated in the R-CHOP regime has not been carried out yet.
  
  
  RESULTS
  In this retrospective study, a cohort of 443 newly diagnosed DLBCL patients with age ≥ 60 was analyzed. All patients were treated with the R-CHOP therapy. An extensive statistical analysis was performed to identify risk factors of 3-year overall survival (OS). In multivariate analysis, only three predictors proved significant: Eastern Cooperative Oncology Group performance status (ECOG), age and bulky disease presence. These predictors were dichotomized (ECOG ≥ 1, age ≥ 70, bulk ≥ 7.5) to create a novel four-level score. This score predicted 3-year OS of 94.0%, 77.4%, 62.7% and 35.4% in the low-, low-intermediate, high-intermediate and high-risk groups, respectively (P<0.001). Further, a three-level score was tested which stratifies the population better (3-year OS: 91.9%, 67.2%, 36.2% in the low, intermediate and high-risk groups, respectively) but is more difficult to interpret. Both the 3- and 4-level scores were compared to standard scoring systems and, in our population, were shown to be superior in terms of patients risk stratification with respect to 3-year OS prediction. The results were successfully validated on an independent cohort of 162 patients of similar group characteristics.
  
  
  CONCLUSIONS
  The prognostic role of baseline ALC, AMC or their ratio (LMR) was not confirmed in the multivariate context in elderly population with DLBCL treated with R-CHOP. The newly proposed age-specific index stratifies the elderly population into risk groups more precisely than the conventional IPI and its existing variants.
authors: Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic.
authors: Vít
authors: V
authors: Procházka
authors: First Internal Department, Charles University General Hospital, Prague, Czech Republic.
authors: Robert
authors: R
authors: Pytlík
authors: Department of Internal Medicine-Hematooncology, University Hospital Brno, and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: Andrea
authors: A
authors: Janíková
authors: Second Department of Medicine, Department of Hematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic.
authors: David
authors: D
authors: Belada
authors: Department of Internal Medicine-Hematooncology, University Hospital Brno, and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
authors: David
authors: D
authors: Sálek
authors: Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic.
authors: Tomáš
authors: T
authors: Papajík
authors: Department of Pathology and Molecular Medicine, Charles University, and Second Medical School and Faculty Hospital in Motol, Prague, Czech Republic.
authors: Vít
authors: V
authors: Campr
authors: Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacký University, Olomouc, Czech Republic.
authors: Tomáš
authors: T
authors: Fürst
authors: Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacký University, Olomouc, Czech Republic.
authors: Jana
authors: J
authors: Furstova
authors: First Internal Department, Charles University General Hospital, Prague, Czech Republic.
authors: Marek
authors: M
authors: Trněný
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015415:Biomarkers / Q000032:analysis; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D012107:Research Design / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone