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The lymphocyte to monocyte ratio improves the IPI‐risk definition of diffuse large B‐cell lymphoma when rituximab is added to chemotherapy
Author(s) -
Rambaldi Alessandro,
Boschini Cristina,
Gritti Giuseppe,
Delaini Federica,
Oldani Elena,
Rossi Andrea,
Barbui Anna Maria,
Caracciolo Daniele,
Ladetto Marco,
Gueli Angela,
Crescenzo Alberto,
Passera Roberto,
Devizzi Liliana,
Patti Caterina,
Gianni Alessandro Massimo,
Tarella Corrado
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23566
Subject(s) - rituximab , medicine , international prognostic index , diffuse large b cell lymphoma , chemotherapy , lymphoma , oncology , receiver operating characteristic , multivariate analysis , gastroenterology
The peripheral blood lymphocyte to monocyte ratio (LMR) at diagnosis can be clinically relevant in patients with diffuse large B‐cell lymphoma (DLBCL). We reviewed the outcome of 1,057 DLBCL patients followed from 1984 to 2012 at four centers. LMR was analyzed as a clinical biomarker by receiver‐operating characteristic (ROC) analysis and Harrell's C ‐statistics. Patients were characterized by a median age of 61 years, International Prognostic Index (IPI) score of >2 in 39%, and were treated with a rituximab‐containing chemotherapy in 66%. LMR proved strongly predictive for survival in patients treated with rituximab‐based programs, but not in those receiving chemotherapy alone. Additionally, an LMR value of ≤2.6 (as determined by ROC analysis) was associated with a worst performance status, a higher lactate dehydrogenase (LDH) level, an advanced clinical stage, and a higher IPI score ( P = 0.000). In patients treated with rituximab‐supplemented chemotherapy programs, an LMR value of <2.6 was found in most of the primary refractory patients (75%) which proved as the best cutoff to predict both response and survival ( P = 0.018). Finally, multivariate analysis and Harrell's C ‐statistics confirmed the IPI‐independent role of LMR on survival ( P = 0.0000). In conclusion, LMR is a potent predictor of clinical response and survival in DLBCL treated with rituximab‐containing chemotherapy. Am. J. Hematol. 88:1062–1067, 2013. © 2013 Wiley Periodicals, Inc.