Clinical characteristics and prognosis of patients with diffuse large B-cell lymphoma

doi:10.3969/j.issn.1674-8115.2023.10.009

Abstract

Abstract:

Objective ·To analyze the clinical characteristics and prognostic risk factors of patients with diffuse large B-cell lymphoma (DLBCL), and evaluate the prognostic effects of autologous stem cell transplantation (ASCT) and rituximab maintenance therapy on DLBCL patients. Methods ·The clinical data of 160 patients with DLBCL who were first diagnosed by pathology and immunotyping were collected from the Department of Hematology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020, and the risk factors affecting the efficacy and prognosis of patients were analyzed. Moreover, the clinical characteristics of patients with relapsed/refractory DLBCL and the effect of salvage ASCT on overall survival (OS) were assessed. For those high-risk patients who achieved complete remission (CR) in the interim assessment, the impact of ASCT and rituximab maintenance therapy on survival outcomes was further assessed. Results ·Patients with initial age of treatment >60 years (P=0.005), International Prognostic Index (IPI) 3?5 scores (P=0.032), low albumin level (P=0.001) and anemia (P=0.007) had poor efficacy. Multivariate analysis showed that the initial age of treatment >60 years (HR=2.788, 95%CI 1.575?4.936, P=0.000), non-GCB subtype (HR=2.230, 95%CI 1.150?4.324, P=0.018), elevated lactate dehydrogenase level (HR=2.064, 95%CI 1.006?4.234, P=0.048) and low albumin level (HR=2.052, 95% CI 1.169?3.602, P=0.012) were the independent risk factors for progression-free survival (PFS). The initial age of treatment >60 years (HR=2.269, 95% CI 1.060?4.860, P=0.035) and IPI scores of 3 to 5 (HR=2.557, 95%CI 1.132?5.778, P=0.024) were independent factors affecting OS. For patients with relapsed/refractory DLBCL, salvage ASCT was found to significantly improve the prognosis of these patients and was a protective factor for the death event of patients (P=0.030). For patients in the high-risk group who achieved CR in the interim evaluation after chemotherapy, there were no deaths in patients on maintenance therapy with consolidation ASCT and rituximab to the end point of follow-up; however, it did not prolong the OS of the patients (P>0.05). Conclusion ·In patients with relapsed/refractory DLBCL, salvage ASCT can significantly prolong the OS, whereas in the high-risk patients of DLBCL, consolidation ASCT and rituximab maintenance therapy can't prolong the OS.

Key words: diffuse large B-cell lymphoma (DLBCL), autologous stem cell transplantation (ASCT), clinical feature, prognostic factor

CLC Number:

R557

ZHAO Jie, JIANG Yan, HAO Siguo. Clinical characteristics and prognosis of patients with diffuse large B-cell lymphoma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(10): 1282-1288.

Figures/Tables 6

TrendMD

References 21

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Variable	Patients/n(%)
Gender
Male	88 (55.0)
Female	72 (45.0)
Age
≤60 years	73 (45.6)
>60 years	87 (54.4)
Group B symptoms
No	87 (54.4)
Yes	73 (45.6)
Hans classification
GCB	56 (35.0)
Non-GCB	104 (65.0)
ECOG score
<2 scores	117 (73.1)
≥2 scores	43 (26.9)
Ann Arbor stage
Ⅰ‒Ⅱ	63 (39.4)
Ⅲ‒Ⅳ	97 (60.6)
IPI score
0‒2 scores	70 (43.8)
3‒5 scores	90 (56.2)
LDH level
≤211 U·L^-1	51 (31.9)
>211 U·L^-1	109 (68.1)
Albumin level
≥35 g·L^-1	123 (76.9)
<35 g·L^-1	37 (23.1)
Absolute lymphocyte level
>1.1×10⁹·L^-1	104 (65.0)
≤1.1×10⁹·L^-1	56 (35.0)
Anemia
No	106 (66.2)
Yes	54 (33.8)
Chemotherapy regimen
R-CHOP	147 (91.9)
CHOP	13 (8.1)

Variable	Patients/n(%)
Gender
Male	88 (55.0)
Female	72 (45.0)
Age
≤60 years	73 (45.6)
>60 years	87 (54.4)
Group B symptoms
No	87 (54.4)
Yes	73 (45.6)
Hans classification
GCB	56 (35.0)
Non-GCB	104 (65.0)
ECOG score
<2 scores	117 (73.1)
≥2 scores	43 (26.9)
Ann Arbor stage
Ⅰ‒Ⅱ	63 (39.4)
Ⅲ‒Ⅳ	97 (60.6)
IPI score
0‒2 scores	70 (43.8)
3‒5 scores	90 (56.2)
LDH level
≤211 U·L^-1	51 (31.9)
>211 U·L^-1	109 (68.1)
Albumin level
≥35 g·L^-1	123 (76.9)
<35 g·L^-1	37 (23.1)
Absolute lymphocyte level
>1.1×10⁹·L^-1	104 (65.0)
≤1.1×10⁹·L^-1	56 (35.0)
Anemia
No	106 (66.2)
Yes	54 (33.8)
Chemotherapy regimen
R-CHOP	147 (91.9)
CHOP	13 (8.1)

Variable	Overall response rate (CR+PR)
Variable	Patients/n(%)	P value
Gender
Male	74/88 (84.1)	0.381
Female	64/72 (88.9)
Age
≤60 years	69/73 (94.5)	0.005
>60 years	69/87 (79.3)
Group B symptoms
No	79/87 (90.8)	0.068
Yes	59/73 (80.8)
Hans classification
GCB	51/56 (91.1)	0.194
Non-GCB	87/104 (89.7)
ECOG score
<2 scores	104/117 (88.9)	0.110
≥2 scores	34/43 (79.1)
Ann Arbor stage
Ⅰ‒Ⅱ	57/63 (90.5)	0.211
Ⅲ‒Ⅳ	81/97 (83.5)
IPI score
0‒2 scores	65/70 (92.9)	0.032
3‒5 scores	73/90 (81.1)
LDH level
≤211 U·L^-1	47/51 (92.2)	0.138
>211 U·L^-1	91/109 (83.5)
Albumin level
≥35 g·L^-1	112/123 (91.1)	0.001
<35 g·L^-1	26/37 (70.3)
Absolute lymphocyte level
>1.1×10⁹·L^-1	93/104 (89.4)	0.112
≤1.1×10⁹·L^-1	45/56 (80.4)
Anemia
No	97/106 (91.5)	0.007
Yes	41/54 (75.9)
Chemotherapy regimen
R-CHOP	126/147 (85.7)	0.508
CHOP	12/13 (92.3)

Variable	Overall response rate (CR+PR)
Variable	Patients/n(%)	P value
Gender
Male	74/88 (84.1)	0.381
Female	64/72 (88.9)
Age
≤60 years	69/73 (94.5)	0.005
>60 years	69/87 (79.3)
Group B symptoms
No	79/87 (90.8)	0.068
Yes	59/73 (80.8)
Hans classification
GCB	51/56 (91.1)	0.194
Non-GCB	87/104 (89.7)
ECOG score
<2 scores	104/117 (88.9)	0.110
≥2 scores	34/43 (79.1)
Ann Arbor stage
Ⅰ‒Ⅱ	57/63 (90.5)	0.211
Ⅲ‒Ⅳ	81/97 (83.5)
IPI score
0‒2 scores	65/70 (92.9)	0.032
3‒5 scores	73/90 (81.1)
LDH level
≤211 U·L^-1	47/51 (92.2)	0.138
>211 U·L^-1	91/109 (83.5)
Albumin level
≥35 g·L^-1	112/123 (91.1)	0.001
<35 g·L^-1	26/37 (70.3)
Absolute lymphocyte level
>1.1×10⁹·L^-1	93/104 (89.4)	0.112
≤1.1×10⁹·L^-1	45/56 (80.4)
Anemia
No	97/106 (91.5)	0.007
Yes	41/54 (75.9)
Chemotherapy regimen
R-CHOP	126/147 (85.7)	0.508
CHOP	12/13 (92.3)

Variable	Univariate analysis		Multivariate analysis
Variable	HR (95%CI)	P value	HR (95%CI)	P value
Female	0.668 (0.394‒1.132)	0.134
Age>60 years	2.744 (1.553‒4.848)	0.001	2.788 (1.575‒4.936)	0.000
Group B symptoms	1.424 (0.850‒2.386)	0.179
Non-GCB	2.398 (1.243‒4.624)	0.009	2.230 (1.150‒4.324)	0.018
ECOG score ≥2	2.330 (1.379‒3.937)	0.002
Ann Arbor stage Ⅲ‒Ⅳ	2.496 (1.366‒4.561)	0.003
IPI score 3‒5	3.149 (1.722‒5.759)	0.000
Increased LDH [>211 U·L^-1]	2.796 (1.413‒5.535)	0.003	2.064 (1.006‒4.234)	0.048
Low albumin [<35 g·L^-1]	2.824 (1.657‒4.811)	0.000	2.052 (1.169‒3.602)	0.012
Lymphocytopenia (≤1.1×10⁹·L^-1)	2.142 (1.277‒3.592)	0.004
Anemia	1.894 (1.128‒3.179)	0.016
Chemotherapy (R-CHOP)	0.937 (0.400‒2.195)	0.881