Absolute lymphocyte count at day + 21 predicts survival in patients with early-stage diffuse large B-cell lymphoma treated with rituximab, cyclophosphamide, adriamycin, vincristine and prednisone

Abstract

As lymphocytes play an active role in tumor control and as targets for immunochemotherapy, the prognostic significance of the absolute lymphocyte count (ALC) and its changes after rituximab, cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP) were investigated in patients with early-stage diffuse large B-cell lymphoma (DLBCL). The ALC was measured just before and on day + 21 after R-CHOP in 230 consecutive patients with stage I and II DLBCL. During the median follow-up of 31.8 (range, 1.8–70.0) months, 200 patients (89.7%) achieved a complete response (CR) and 20 achieved a partial response (PR) (9.0%), representing an overall response rate of 98.7% among 223 evaluable patients. Analyzed according to various ALCs, only an ALC ≥ 1.3 × 10⁹/L at day + 21 predicted longer progression-free (PFS) and overall survival (OS) in a univariate analysis (p < 0.001 and p = 0.001, respectively) as well as a higher CR rate adjusted to the revised International Prognostic Index (R-IPI) (odds ratio = 2.824; p = 0.031). Moreover, a multivariate analysis revealed that a high ALC at day + 21 predicted a better time to progression (TTP) (HR = 0.335; p = 0.006), PFS (HR = 0.332; p < 0.001) and OS (HR = 0.309; p = 0.002), independent of the R-IPI. In conclusion, the ALC after R-CHOP can be regarded as a prognostic marker in patients with early-stage DLBCL.

Keywords::

• Diffuse large B-cell lymphoma
• rituximab
• absolute lymphocyte count
• prognostic marker

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