The lower peripheral blood lymphocyte/monocyte ratio assessed during routine follow-up after standard first-line chemotherapy is a risk factor for predicting relapse in patients with diffuse large B-cell lymphoma
Introduction
Despite recent major advances in treating diffuse large B-cell lymphoma (DLBCL) with dose-intense regimens and the addition of the anti-CD20 monoclonal antibody rituximab, a significant proportion of patients will experience disease relapse, mainly during the first two years after completing therapy [1]. A primary aim of follow-up is to detect early relapse, with the hope of improving outcome following salvage chemotherapy. The current recommendation for long-term follow-up in patients with DLBCL, who are not participating in clinical trials, by the National Comprehensive Cancer Network is a follow-up every 3–6 months or as clinically indicated [2]. The European Society of Medical Oncology's recommendations for follow-up in NHL include follow-up every 3 months for 1 years, every 6 months for 2 years and then once a year [3].
Risk factors used to assess clinical outcomes in DLBCL patients treated with standard therapy are identified before treatment implementation, such as the international prognostic index (IPI) [4], gene expression profiling [5] or immunohistochemistry-based detection of prognostic biomarkers [6], [7]. Even though these risk factors are useful to guide physicians in the identification of patients who would benefit from standard therapy, a limitation of these is that they are tested at one point in time [8]. An inexpensive factor that could be monitored during follow-up after standard therapy and predicts relapse would be needed to help to identify patients who might require further evaluation for relapse. In DLBCL, LDH has been reported to have a sensitivity of 42% and a specificity of 85% to predict relapse during follow-up [9]. Recently, absolute lymphocyte count/absolute monocyte count ratio (ALC/AMC ratio) at diagnosis, as a simple biomarker combining an estimate of host immune homeostasis and tumor microenvironment, was recently shown to be an independent prognostic indicator in DLBCL [10] and HL [11], [12], [13]. However, to our best knowledge, there is no data available on whether ALC/AMC ratio can help in detecting relapse. Thus, we set out to evaluate the prognostic value of peripheral ALC/AMC ratio at follow-up as a marker to assess relapse during follow-up.
Section snippets
Patient
To participate in this study, consecutive 220 patients with DLBCL who were evaluated and treated with CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone) or R-CHOP (rituximab-cyclophosphamide, hydroxydaunorubicin, vincristine, prednisone) were followed up at the first affiliated hospital and the second hospital of Anhui Medical University between the years 2001 and 2011. Patients with primary DLBCL central nervous system lymphoma, transformed NHL, positive human
Patient characteristics
A total of 220 patients in this study, median follow-up following diagnosis was 36 months, had full information of the relapse (n = 163) or at last follow-up (n = 57). The median age for this cohort was 54 years (range: 13–84 years). The distribution of additional baseline characteristics for these patients is presented in Table 1. At diagnosis, the median AMC was 440/μl (interquartile range: 310–600) and the median ALC was 1320/μl (interquartile range: 1100–1792); at the time of confirmed relapse (
Discussion
The current risk factors used to assess prognosis in DLBCL patients are identified before treatment [4], [5], [6], [7]. An ideal risk factor is a risk factor that has the ability to predict not only future clinical outcomes but also clinical outcome at any given time point after therapy. So, recently, lymphopenia assessed during routine follow-up was found to be a risk factor for predicting early relapse in patients with DLBCL [8], [18]. Moreover, recent work, based on gene expression profiling
Conflict of interest statement
The authors declare no conflict of interest.
Acknowledgments
This research was supported by the key technology projects of Anhui Province of China (no. 11010402168) and the project of National Natural Scientific Research Fund of China (no. 81141104).
Contributions: YLL designed the study, collected the clinical data, performed the statistical analysis, and drafted the manuscript. KSG, YYP and YJ participated in the collection of the clinical data. ZMZ conceived of the study, and participated in its design and coordination and helped to draft the
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2015, EBioMedicineCitation Excerpt :We, and others, made similar observations for malaria (Warimwe et al., 2013a) and extended these to demonstrate that the ML ratio stratifies efficacy of the candidate anti-malaria RTS,S vaccine (Warimwe et al., 2013b). Other investigators have shown that an elevated ratio is associated with poor outcomes of nasopharyngeal carcinoma (Lin et al., 2014a; Li et al., 2013), diffuse large B-cell (Li et al., 2012, 2014a, 2014b; Rambaldi et al., 2013; Koh et al., 2014; Markovic et al., 2014; Porrata et al., 2014a, 2014b; Watanabe et al., 2014; Wei et al., 2014; Yan-Li et al., 2014) and Hodgkin's (Koh et al., 2012; Porrata et al., 2012, 2013a, 2013b; Romano et al., 2012) lymphomas, multiple myeloma (Shin et al., 2013), clear-cell renal carcinoma (Hutterer et al., 2014), non-small cell lung cancer (Lin et al., 2014b), soft tissue sarcoma (Szkandera et al., 2014) and colon cancer (Stotz et al., 2014). The neutrophil:lymphocyte (NL) ratio, another measure of the myeloid:lymphoid cell proportion, has also been reported to be associated with cardiovascular and cancer outcomes (Guthrie et al., 2013; Templeton et al., 2014; X. Wang et al., 2014).
Profile of Predictive Factors of Response to Therapy in Patients with Diffuse Large B-cell Lymphoma in dr Soetomo General Teaching Hospital Surabaya
2020, Journal of International Dental and Medical Research