title: Independent Prognostic Value of Serum Markers in Diffuse Large B-Cell Lymphoma in the Era of the NCCN-IPI.
abstract: BACKGROUND
  Several serum parameters have been evaluated for adding prognostic value to clinical scoring systems in diffuse large B-cell lymphoma (DLBCL), but none of the reports used multivariate testing of more than one parameter at a time. The goal of this study was to validate widely available serum parameters for their independent prognostic impact in the era of the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) score to determine which were the most useful.
  
  
  METHODS
  This retrospective bicenter analysis includes 515 unselected patients with DLBCL who were treated with rituximab and anthracycline-based chemoimmunotherapy between 2004 and January 2014.
  
  
  RESULTS
  Anemia, high C-reactive protein, and high bilirubin levels had an independent prognostic value for survival in multivariate analyses in addition to the NCCN-IPI, whereas neutrophil-to-lymphocyte ratio, high gamma-glutamyl transferase levels, and platelets-to-lymphocyte ratio did not.
  
  
  CONCLUSIONS
  In our cohort, we describe the most promising markers to improve the NCCN-IPI. Anemia and high C-reactive protein levels retain their power in multivariate testing even in the era of the NCCN-IPI. The negative role of high bilirubin levels may be associated as a marker of liver function. Further studies are warranted to incorporate these markers into prognostic models and define their role opposite novel molecular markers.
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Thomas
authors.initials: T
authors.lastname: Melchardt
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Katharina
authors.initials: K
authors.lastname: Troppan
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Lukas
authors.initials: L
authors.lastname: Weiss
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Clemens
authors.initials: C
authors.lastname: Hufnagl
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Daniel
authors.initials: D
authors.lastname: Neureiter
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Tränkenschuh
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Schlick
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Florian
authors.initials: F
authors.lastname: Huemer
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Alexander
authors.initials: A
authors.lastname: Deutsch
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Peter
authors.initials: P
authors.lastname: Neumeister
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Greil
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Martin
authors.initials: M
authors.lastname: Pichler
authors.affiliation: From the Department of Internal Medicine III, Cancer Research Institute, Paracelsus Medical University Salzburg, Salzburg, Austria; Division of Hematology, Medical University of Graz, Graz, Austria; Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria; and Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Duarte, Texas.
authors.forename: Alexander
authors.initials: A
authors.lastname: Egle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008099:Liver / Q000378:metabolism; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D015415:Biomarkers; D018836:Inflammation Mediators; D000069283:Rituximab