title: Prognostic impact of hepatitis C virus infection in patients with diffuse large B-cell lymphoma treated with immunochemotherapy in the context of a novel prognostic index.
abstract: OBJECTIVE
  Patients with hepatitis C virus (HCV) infection have been associated with development of diffuse large B-cell lymphoma (DLBCL), yet its impact on several clinical aspects, including phenotypic characteristics and treatment-related toxicities as well as survival outcome after rituximab-based immunochemotherapy, remains controversial.
  
  
  METHODS
  To elucidate the characteristics of HCV-positive DLBCL in the context of a new prognostic model, the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI), we retrospectively analyzed DLBCL patients diagnosed and treated with immunochemotherapy at our institute during the last decade.
  
  
  RESULTS
  In all, HCV infection was identified in 22 (17.7%) of 124 DLBCL patients. Except for being more likely to present with an advanced stage of disease, patients with HCV infection were phenotypically indistinguishable from HCV-negative cases. Multivariate analysis showed 3 factors independently predicted a dismal overall survival (OS) outcome: lower albumin level (<3 g/dL vs. ≥3 g/dL, p<0.001; HR=13.21, 95% CI=2.69-64.98, p=0.001), presence of HCV infection (vs. HCV-negative; HR=9.75, 95% CI=1.97-48.34, p=0.005), and poor NCCN-IPI risk (high-intermediate or high vs. low-intermediate or low; HR=5.56, 95% CI=1.17-26.55, p=0.031).
  
  
  CONCLUSIONS
  Our study has demonstrated that HCV infection status and low serum albumin level add important prognostic values to the newly proposed NCCN-IPI model for patients with DLBCL.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Yi-Yang
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Cih-En
authors.initials: CE
authors.lastname: Huang
authors.affiliation: Department of Public Health, College of Medicine National Cheng Kung University, Tainan, Taiwan.
authors.forename: Fu-Wen
authors.initials: FW
authors.lastname: Liang
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Pin-Tsung
authors.initials: PT
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Kuan-Der
authors.initials: KD
authors.lastname: Lee
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan. Electronic address: ccchen1968@gmail.com.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D012709:Serum Albumin
keywords: Albumin; Diffuse large B-cell lymphoma; Hepatitis C; NCCN-IPI; Prognosis; Rituximab