Yaygın Büyük B Hücreli Lenfomalı Hastalarda Lenfosit Monosit Oranının Prognozla İlişkisi: Retrospektif Çalışma

Amaç: Yaygın büyük B hücreli lenfomada (YBBHL) rituksimab ile birlikte tam yanıt ve sağkalım oranlarının artmasına rağmen hastaların yaklaşık %30’u nüks veya dirençli hastalık ile karşı karşıyadır. Nüks ve dirençli hastalığın belirlenebilmesi için uluslararası prognostik indeks (UPİ) en yaygın kullanılan metottur. Son zamanlarda UPİ yerine veya birlikte kullanılabilecek lenfosit monosit oranı (LMO) YBBHL hastalarında klinik sağkalımı tahmin etmek için etkili bir prognostik faktör olarak önerilmiştir. Gereç ve Yöntem: 2012-2020 yılları arasında merkezimizde YBBHL tanısı konulan 223 hasta çalışmaya dahil edildi. Hastaların dosyalarından yaşı, cinsiyeti, mutlak lenfosit sayısı (MLS), mutlak monosit sayısı (MMS), takip süresi kaydedildi. Hastalar ölüm ve yaşam grubu olarak ikiye ayrıldı. MLS MMS’ye bölünerek LMO hesaplandı. Bulgular: Tanı anındaki medyan yaş 58 idi. MLS medyan 1,5x103/uL, MMS medyan 0,6x103/uL, LMO medyan 2,6 olarak saptandı. Medyan takip süresi 53 ay oldu. Beş yıllık genel sağkalım ve ilerlemesiz sağkalım sırasıyla %78 ve %69 olarak gerçekleşti. Ölüm grubunda hastaların yaşı yaşam grubundan anlamlı olarak daha yüksekti (p0,05) farklılık görülmedi. Sonuç: LMO’nun tek başına prognostik belirleyiciliği düşüktür. Bu nedenle diğer prognostik belirteçlerle birlikte değerlendirilmelidir.

Relationship of Lymphocyte to Monocyte Ratio at Diagnosis with Prognosis in Patients with Diffuse Large B-cell Lymphoma: A Retrospective Study

Aim: Although there is a complete response and increase in survival rates with rituximab in diffuse large-B-cell lymphoma (DLBCL), approximately30% of the patients face with relapse or refractory disease. International prognostic index (IPI) is the most widely used method used for identifyingrelapse and refractory disease. Recently, the lymphocyte monocyte ratio (LMR) that can be used in place of or in combination with IPI has beenproposed as an effective prognostic factor to predict clinical survival in DLBCL patients.Materials and Methods: Two hundred twenty three patients diagnosed with DLBCL at our center between 2012 and 2020 were included in thestudy. The age, gender, absolute lymphocyte count (ALC), absolute monocyte count (AMC), and follow-up time were recorded from the files of thepatients. Patients were divided into two groups as: exitus group and alive group. LMR was calculated.Results: The median age at diagnosis was 58 years. The median ALC was 1.5x103/uL, the median AMC was 0.6x103/uL, and the median LMR was 2.6.The median follow-up time was 53 months. Five-year overall survival and progression-free survival were 78% and 69%, respectively. The age wassignificantly higher in the exitus group than in the alive group (p0.05).Conclusion: LMR alone has low prognostic determinacy. Therefore, it should be evaluated with other prognostic determinants.

PDF

___

1. Flowers CR, Sinha R, Vose JM. Improving outcomes for patients with diffuse large B-cell lymphoma. CA Cancer J Clin. 2010;60:393-408.
2. Nastoupil LJ, Rose AC, Flowers CR. Diffuse large B-cell lymphoma: current treatment approaches. Oncology (Williston Park). 2012;26:488-95.
3. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:235- 42.
4. Pfreundschuh M, Trümper L, Osterborg A, Pettengell R, Trneny M, Imrie K, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol. 2006;7:379-91.
5. Sehn LH, Donaldson J, Chhanabhai M, Fitzgerald C, Gill K, Klasa R, et al. Introduction of combined CHOP plus rituximab therapy dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol. 2005;23:5027-33.
6. International Non-Hodgkin’s Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma. N Engl J Med. 1993;329:987-94.
7. Mikhaeel NG. Interim fluorodeoxyglucose positron emission tomography for early response assessment in diffuse large B cell lymphoma: where are we now? Leuk Lymphoma. 2009;50:1931-6.
8. Rosenwald A, Wright G, Chan WC, Connors JM, Campo E, Fisher RI, et al. The use of molecular profiling to predict survival after chemotherapy for diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:1937-47.
9. Broyde A, Boycov O, Strenov Y, Okon E, Shpilberg O, Bairey O. Role and prognostic significance of the Ki-67 index in non-Hodgkin’s lymphoma. Am J Hematol. 2009;84:338-43.
10. Markovic O, Popovic L, Marisavljevic D, Jovanovic D, Filipovic B, Stanisavljevic D, et al. Comparison of prognostic impact of absolute lymphocyte count, absolute monocyte count, absolute lymphocyte count/ absolute monocyte count prognostic score and ratio in patients with diffuse large B cell lymphoma. Eur J Intern Med. 2014;25:296-302.
11. Li YL, Gu KS, Pan YY, Jiao Y, Zhai ZM. Peripheral blood lymphocyte/ monocyte ratio at the time of first relapse predicts outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. BMC Cancer. 2014;14:341.
12. Hamlin PA, Zelenetz AD, Kewalramani T, Qin J, Satagopan JM, Verbel D, et al. Age-adjusted International Prognostic Index predicts autologous stem cell transplantation outcome for patients with relapsed or primary refractory diffuse large B-cell lymphoma. Blood. 2003;102:1989-96.
13. Gisselbrecht C, Glass B, Mounier N, Singh Gill D, Linch DC, Trneny M, et al. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol. 2010;28:4184-90.
14. Ngo L, Hee SW, Lim LC, Tao M, Quek R, Yap SP, et al. Prognostic factors in patients with diffuse large B cell lymphoma: Before and after the introduction of rituximab. Leuk Lymphoma. 2008;49:462-9.
15. Kim DH, Baek JH, Chae YS, Kim YK, Kim HJ, Park YH, et al. Absolute lymphocyte counts predicts response to chemotherapy and survival in diffuse large B-cell lymphoma. Leukemia. 2007;21:2227-30.
16. Cox MC, Nofroni I, Laverde G, Ferrari A, Amodeo R, Tatarelli C, et al. Absolute lymphocyte count is a prognostic factor in diffuse large B-cell lymphoma. Br J Haematol. 2008;141:265-8.
17. Feng J, Wang Z, Guo X, Chen Y, Cheng Y, Tang Y. Prognostic significance of absolute lymphocyte count at diagnosis of diffuse large B-cell lymphoma: a meta-analysis. Int J Hematol. 2012;95:143-8.
18. Tadmor T, Bari A, Sacchi S, Marcheselli L, Liardo EV, Avivi I, et al. Monocyte count at diagnosis is a prognostic parameter in diffuse large B-cell lymphoma: results from a large multicenter study involving 1191 patients in the pre- and post-rituximab era. Haematologica. 2014;99:125-30.
19. Porrata LF, Ristow KM, Habermann TM, Witzig TE, Colgan JP, Inwards DJ, et al. Peripheral blood absolute lymphocyte/monocyte ratio during rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone treatment cycles predicts clinical outcomes in diffuse large B-cell lymphoma. Leuk Lymphoma. 2014;55:2728-38.
20. Bento L, Díaz-López A, Barranco G, Martín-Moreno AM, Baile M, Martín A, et al. New prognosis score including absolute lymphocyte/monocyte ratio, red blood cell distribution width and beta-2 microglobulin in patients with diffuse large B-cell lymphoma treated with R-CHOP: Spanish Lymphoma Group Experience (GELTAMO). Br J Haematol. 2020;188:888-97.
21. Katoh D, Ochi Y, Yabushita T, Ono Y, Hiramoto N, Yoshioka S, et al. Peripheral Blood Lymphocyte-to-Monocyte Ratio at Relapse Predicts Outcome for Patients With Relapsed or Refractory Diffuse Large B-cell Lymphoma in the Rituximab Era. Clin Lymphoma Myeloma Leuk. 2017;17:91-7.
22. Reddy A, Zhang J, Davis NS, Moffitt AB, Love CL, Waldrop A, et al. Genetic and Functional Drivers of Diffuse Large B Cell Lymphoma. Cell. 2017;171:481-94.
23. Leivonen SK, Taskinen M, Cervera A, Karjalainen-Lindsberg ML, Delabie J, Holte H, et al. Alternative splicing discriminates molecular subtypes and has prognostic impact in diffuse large B-cell lymphoma. Blood Cancer J. 2017;7:e596.
24. Zhou S, Xu L, Ma Y, Tang L, Zhang Y, Shi Y, et al. Peripheral blood lymphocyte to monocyte ratio recovery from low levels at diagnosis after completion of first line therapy predicts good clinical outcomes in patients with diffuse large B-cell lymphoma. Oncotarget. 2017;8:19556-65
25. Porrata LF, Ristow KM, Habermann TM, Macon WR, Witzig TE, Colgan JP, et al. Peripheral blood absolute lymphocyte/monocyte ratio recovery during ABVD treatment cycles predicts clinical outcomes in classical Hodgkin lymphoma. Blood Cancer J. 2013;3:e110.
26. Lin GN, Liu PP, Liu DY, Peng JW, Xiao JJ, Xia ZJ. Prognostic significance of the pre-chemotherapy lymphocyte-to-monocyte ratio in patients with previously untreated metastatic colorectal cancer receiving FOLFOX chemotherapy. Chin J Cancer. 2016;35:5.
27. Su S, Liu Q, Chen J, Chen J, Chen F, He C, et al. A positive feedback loop between mesenchymal-like cancer cells and macrophages is essential to breast cancer metastasis. Cancer Cell. 2014;25:605-20.
28. Demircioglu S, Dogan A, Ekinci O, Demir C. The Association of NLR and MPV with Treatment Responses, Disease Stages and International Prognostic Index Scores in DLBCL. East J Med. 2019;24:325-9.