Prognostic model for relapsed/refractory transplant-ineligible diffuse large B-cell lymphoma utilizing the lymphocyte-to-monocyte ratio.

Abstract

We conducted a multi-institutional retrospective study in 100 transplant-ineligible (TI) patients with diffuse large B-cell lymphoma (DLBCL) that relapsed or progressed after first-line R-CHOP (or -like) therapy to develop a robust predictive model for TI relapsed/refractory (r/r) DLBCL, which has a heterogeneous but poor prognosis by currently available treatment modalities other than chimeric antigen receptor T-cell (CAR-T) therapy or bispecific antibodies. The median age at relapse or progression was 76 years. The median progression-free survival (PFS) and overall survival (OS) from the first progression were 11.5 months and 21.9 months, respectively. Multivariate analysis identified low lymphocyte-to-monocyte ratio (LMR), elevated high lactate dehydrogenase, and elevated C-reactive protein at progression as independent predictors of OS. A predictive model based on these three factors, here designated as the Kyoto Prognostic Index for r/r DLBCL (KPI-R), successfully stratified their OS and PFS with statistical significance. In addition, event-free survival less than 24 months for R-CHOP and low LMR were identified as significant predictive factors for non-response in any sequence of salvage therapy. We concluded that LMR is a bonafide predictor of treatment response and prognosis in patients with TI r/r DLBCL, and may be helpful in treatment decision-making.

• Authors: Daisuke Ide, Takahiro Fujino, Tsutomu Kobayashi, Aya Egashira, Akihiro Miyashita, Kentaro Mizuhara, Reiko Isa, Taku Tsukamoto, Shinsuke Mizutani, Hitoji Uchiyama, Hiroto Kaneko, Nobuhiko Uoshima, Eri Kawata, Masafumi Taniwaki, Yuji Shimura, Junya Kuroda
• Journal: International journal of hematology (Int J Hematol) (Mar 16 2024) ISSN: 1865-3774 [Electronic] Japan
• PMID: 38492199 (Publication Type: Journal Article)
• Copyright: © 2024. Japanese Society of Hematology.