title: Baseline renal function as a prognostic indicator in patients with newly diagnosed diffuse large B-cell lymphoma.
abstract: BACKGROUND
  The association between baseline renal impairment (RI) and the prognosis of diffuse large B-cell lymphoma (DLBCL) was previously not defined. The aim of this study was to evaluate the prognostic value of RI in patients with DLBCL treated with three-weekly rituximab plus cyclophosphamide, Adriamycin, vincristine, and prednisolone immunochemotherapy (R-CHOP21).
  
  
  METHODS
  Patients with newly diagnosed de novo DLBCLs treated with ≥1 cycle of R-CHOP21 were analyzed retrospectively. Pretreatment blood samples were collected and the glomerular filtration rate (GFR) was calculated. RI was defined by a GFR of <60 mL/min/1.73 m(2) according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.
  
  
  RESULTS
  Of the 185 patients enrolled in the present study, 19 patients (10.3%) had RI. The reasons for baseline RI were pre-existing CKD (N=5), acute kidney injury due to either obstruction (N=2) or electrolyte imbalance (N=2) related to DLBCL, and undefined causes (N=10). Patients with baseline RI showed inferior overall survival (OS) compared to those without RI (P<0.001). In multivariate analysis, RI was identified as an International Prognostic Index (IPI)-independent prognostic indicator. A baseline hemoglobin level of <10 g/dL and the presence of RI effectively discriminated a portion of the patients with far inferior event-free survival and OS among the patients having high or high-intermediate risk cancers according to either the standard- or the National Comprehensive Cancer Network-IPI.
  
  
  CONCLUSIONS
  Pretreatment RI was an independent prognostic marker for inferior OS in patients with DLBCL treated with R-CHOP21 immunochemotherapy.
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Sojung
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Gayoung
authors.initials: G
authors.lastname: Chun
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Jinny
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Jeong Yeal
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Dong Bok
authors.initials: DB
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Gachon University Gil Medical Center Incheon Regional Cancer Center, Gachon University College of Medicine, Incheon, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
keywords: Diffuse large B-cell lymphoma; Prognosis; Renal insufficiency; Rituximab