title: Utility of a simple prognostic stratification based on platelet counts and serum albumin levels in elderly patients with diffuse large B cell lymphoma.
abstract: Few studies have examined the prognostic impact of blood markers [other than the five factors in the enhanced International Prognostic Index (NCCN-IPI)] in elderly patients with diffuse large B cell lymphoma (DLBCL). We retrospectively analyzed 391 DLBCL patients receiving rituximab plus anthracycline-containing chemotherapy to examine the prognostic impact of simple blood markers. The NCCN-IPI was more accurate for discriminating prognoses than the original IPI. Multivariate analysis identified platelet count (<100,000/μl) and albumin (<3.5 g/dl) levels as significantly associated with lower overall survival (OS), independently of the NCCN-IPI. These parameters stratified patients into three risk groups: platelet-albumin (PA) score low (platelet count ≥100,000/μl, albumin ≥3.5 g/dl, n = 243); intermediate (platelet count <100,000/μl, albumin ≥3.5 g/dl or platelet count ≥100,000/μl, albumin <3.5 g/dl, n = 125); and high (platelet count <100,000/μl, albumin <3.5 g/dl, n = 23). The 5-year OS rates were 81.5, 48.6, and 20.2 %, respectively (p < 0.001). Notably, most patients with a low platelet count (n = 30) were stratified into the high-risk subgroup, suggesting that platelet count was prognostic for high-risk patients with a dismal outcome. In elderly patients (n = 291), the prognostic value of the NCCN-IPI might be diminished because the low-risk category was excluded; however, the PA score was predictive of survival: the 5-year OS rates for PA score low (n = 171), intermediate (n = 101), and high (n = 19) groups were 77.6, 47.9, and 19.0 %, respectively (p < 0.001). Platelet count and albumin levels are useful prognostic factors, and their combined use can predict survival, even in elderly patients.
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan. ochi.yotaro.24v@kyoto-u.jp.|Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. ochi.yotaro.24v@kyoto-u.jp.
authors.forename: Yotaro
authors.identifier: http://orcid.org/0000-0001-8472-6164
authors.initials: Y
authors.lastname: Ochi
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.|Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kazuma
authors.affiliation: Department of Cell Therapy, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Hiramoto
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ono
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yoshioka
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Yonetani
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsushita
authors.affiliation: Department of Clinical Pathology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Department of Cell Therapy, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hashimoto
authors.affiliation: Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ishikawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D012709:Serum Albumin / Q000378:metabolism*; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D015415:Biomarkers; D012709:Serum Albumin; D000069283:Rituximab
keywords: Diffuse large B cell lymphoma; Platelet count; Prognosis; Serum albumin; Thrombocytopenia