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Prognostic significance of absolute lymphocyte count at diagnosis of diffuse large B-cell lymphoma: a meta-analysis

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Abstract

The prognostic value of absolute lymphocytic count (ALC) has been a recent matter of debate in the study of non-Hodgkin-lymphoma. To evaluate the prognostic value of ALC at diagnosis in patients with diffuse large B-cell lymphoma (DLBCL), we performed a meta-analysis of published studies that provided survival information with reference to ALC at diagnosis. Six studies covering a total of 1,206 subjects were included in this analysis. The summary hazard ratios of low ALC for overall survival were 2.72 (95% confidence interval (CI) 2.15–3.45, P < 0.001) in the entire population, 2.96 (95% CI 2.04–4.29, P < 0.001) in the population that received CHOP, and 2.78 (95% CI 1.87–4.13, P < 0.001) in the population that received R-CHOP. The corresponding ratios for progression-free survival were 2.79 (95% CI 1.90–4.11, P < 0.001) in the entire population, and 2.56 (95% CI 1.66–3.96, P < 0.001) in the population that received R-CHOP. In conclusion, our systematic analysis suggests that low ALC has an adverse effect on outcome in DLBCL. Although it should be borne in mind that this meta-analysis was mainly based on data abstracted from observational studies, these results may justify risk-adapted therapeutic strategies for DLBCL to account for ALC at diagnosis.

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References

  1. Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol. 1999;17:3835–49.

    PubMed  CAS  Google Scholar 

  2. Coiffier B. State-of-the-art therapeutics: diffuse large B-cell lymphoma. J Clin Oncol. 2005;23:6387–93.

    Article  PubMed  CAS  Google Scholar 

  3. Hawkins CA, Collignon P, Adams DN, Bowden FJ, Cook MC. Profound lymphopenia and bacteraemia. Intern Med J. 2006;36:385–8.

    Article  PubMed  CAS  Google Scholar 

  4. Heimann TM, Bolnick K, Aufses A H Jr. Prognostic significance of severe preoperative lymphopenia in patients with Crohn’s disease. Ann Surg. 1986;203:132–5.

    Article  PubMed  CAS  Google Scholar 

  5. Rudiger A, Burckhardt OA, Harpes P, Muller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long-term mortality in patients with acute heart failure. Am J Emerg Med. 2006;24:451–4.

    Article  PubMed  Google Scholar 

  6. Porrata LF, Ristow KM, Markovic SN, Persky D, Habermann TM. Lymphocyte count persistence and early recovery predicts superior survival and is independent of the international prognostic index in patients treated with CHOP chemotherapy for diffuse large B cell lymphoma. Blood. 2004;104:3252.

    Google Scholar 

  7. Porrata LF, Ristow KM, Geyer SM, Markovic SN, Persky DO, Colgan JP, et al. Absolute lymphocyte count recovery predicts superior survival and is independent of the international prognostic index in patients treated with CHOP or R-CHOP chemotherapy for diffuse large B cell lymphoma. Blood. 2005;106:931.

    Google Scholar 

  8. Siddiqui M, Ristow K, Markovic SN, Witzig TE, Habermann TM, Colgan JP, et al. Absolute lymphocyte count predicts overall survival in follicular lymphomas. Br J Haematol. 2006;134:596–601.

    Article  PubMed  Google Scholar 

  9. Behl D, Ristow K, Markovic SN, Witzig TE, Habermann TM, Colgan JP, et al. Absolute lymphocyte count predicts therapeutic efficacy of rituximab therapy in follicular lymphomas. Br J Haematol. 2007;137:409–15.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. Plonquet A, Haioun C, Jais JP, Debard AL, Salles G, Bene MC, et al. Peripheral blood natural killer cell count is associated with clinical outcome in patients with aaIPI 2–3 diffuse large B-cell lymphoma. Ann Oncol. 2007;18:1209–15.

    Article  PubMed  CAS  Google Scholar 

  12. Bari A, Marcheselli L, Sacchi S, Marcheselli R, Pozzi S, Ferri P, et al. Prognostic models for diffuse large B-cell lymphoma in the rituximab era: a never-ending story. Ann Oncol. 2010;21:1486–91.

    Article  PubMed  CAS  Google Scholar 

  13. Porrata LF, Inwards DJ, Ansell SM, Micallef IN, Johnston PB, Hogan WJ, et al. New-onset lymphopenia assessed during routine follow-up is a risk factor for relapse postautologous peripheral blood hematopoietic stem cell transplantation in patients with diffuse large B-cell lymphoma. Biol Blood Marrow Transplant. 2010;16:376–83.

    Article  PubMed  Google Scholar 

  14. Porrata LF, Ristow K, Habermann TM, Witzig TE, Inwards DJ, Markovic SN. Absolute lymphocyte count at the time of first relapse predicts survival in patients with diffuse large B-cell lymphoma. Am J Hematol. 2009;84:93–7.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Talaulikar D, Choudhury A, Shadbolt B, Brown M. Lymphocytopenia as a prognostic marker for diffuse large B cell lymphomas. Leuk Lymphoma. 2008;49:959–64.

    Article  PubMed  CAS  Google Scholar 

  17. Oki Y, Yamamoto K, Kato H, Kuwatsuka Y, Taji H, Kagami Y, et al. Low absolute lymphocyte count is a poor prognostic marker in patients with diffuse large B-cell lymphoma and suggests patients’ survival benefit from rituximab. Eur J Haematol. 2008;81:448–53.

    Article  PubMed  Google Scholar 

  18. Cox MC, Nofroni I, Ruco L, Amodeo R, Ferrari A, La Verde G, et al. Low absolute lymphocyte count is a poor prognostic factor in diffuse-large-B-cell-lymphoma. Leuk Lymphoma. 2008;49:1745–51.

    Article  PubMed  Google Scholar 

  19. Song MK, Chung JS, Seol YM, Kim SG, Shin HJ, Choi YJ, et al. Influence of low absolute lymphocyte count of patients with nongerminal center type diffuse large B-cell lymphoma with R-CHOP therapy. Ann Oncol. 2010;21:140–4.

    Article  PubMed  Google Scholar 

  20. Wilcox RA, Ristow K, Habermann TM, Inwards DJ, Micallef IN, Johnston PB, et al. The absolute monocyte and lymphocyte prognostic score predicts survival and identifies high-risk patients in diffuse large-B-cell lymphoma. Leukemia. 2011;25:1502–9.

    Article  PubMed  CAS  Google Scholar 

  21. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med. 1998;17:2815–34.

    Article  PubMed  CAS  Google Scholar 

  22. Hotta K, Matsuo K, Ueoka H, Kiura K, Tabata M, Tanimoto M. Meta-analysis of randomized clinical trials comparing Cisplatin to Carboplatin in patients with advanced non-small-cell lung cancer. J Clin Oncol. 2004;22:3852–9.

    Article  PubMed  CAS  Google Scholar 

  23. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  PubMed  CAS  Google Scholar 

  24. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

    Article  PubMed  CAS  Google Scholar 

  25. Egger M, Davey SG, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  PubMed  CAS  Google Scholar 

  26. Franklin J, Paulus U, Lieberz D, Breuer K, Tesch H, Diehl V. Is the international prognostic score for advanced stage Hodgkin’s disease applicable to early stage patients? German Hodgkin Lymphoma Study Group. Ann Oncol. 2000;11:617–23.

    Article  PubMed  CAS  Google Scholar 

  27. Porrata LF, Ristow K, Witzig TE, Tuinistra N, Habermann TM, Inwards DJ, et al. Absolute lymphocyte count predicts therapeutic efficacy and survival at the time of radioimmunotherapy in patients with relapsed follicular lymphomas. Leukemia. 2007;21:2554–6.

    Article  PubMed  CAS  Google Scholar 

  28. Prochazka V, Trneny M, Salek D, Kozak T, Papajik T, Pytlik R, et al. Median absolute lymphocyte count independently predicts survival of elderly patients with diffuse large B-cell lymphoma treated with R-chemotherapy: analysis of 651 patients included In the Czech lymphoma project. Blood. 2010;116:1187–8.

    Google Scholar 

  29. Anderson TC, Jones SE, Soehnlen BJ, Moon TE, Griffith K, Stanley P. Immunocompetence and malignant lymphoma: immunologic status before therapy. Cancer. 1981;48:2702–9.

    Article  PubMed  CAS  Google Scholar 

  30. Shohat B, Joshua H, Ben-Bassat M. Investigation of the cellular immunocompetence in chronic lymphatic leukemia and malignant lymphoma patients as assessed by the local graft versus host reaction in rats. J Reticuloendothel Soc. 1974;16:276–81.

    PubMed  CAS  Google Scholar 

  31. Hunter CP, Tannenbaum H, Churchill WH, Moloney WC, Schur PH. Immunologic abnormalities in patients with malignant lymphoproliferative diseases. J Natl Cancer Inst. 1977;58:1185–90.

    PubMed  CAS  Google Scholar 

  32. Gergely L, Vancsa A, Miltenyi Z, Simon Z, Barath S, Illes A. Pretreatment T lymphocyte numbers are contributing to the prognostic significance of absolute lymphocyte numbers in B-cell non-Hodgkins lymphomas. Pathol Oncol Res. 2011;17:249–55.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the library of Zhejiang University for entering database and acquiring full texts. This study was supported in part by grants from the National Natural Science Foundation of China (No. 30170391, No. 30971283, No. 81170502), the Natural Science Foundation of Zhejiang Province (No. Z205166) and the Zhejiang Provincial Fund of Science and Technology Bureau (No. 2007C23007).

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Hematology-Oncology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China

    Jianhua Feng, Zhujun Wang, Xiaoping Guo, Yuanyuan Chen, Yuping Cheng & Yongmin Tang

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  1. Jianhua Feng
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  2. Zhujun Wang
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  3. Xiaoping Guo
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  6. Yongmin Tang
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Correspondence to Yongmin Tang.

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Feng, J., Wang, Z., Guo, X. et al. Prognostic significance of absolute lymphocyte count at diagnosis of diffuse large B-cell lymphoma: a meta-analysis. Int J Hematol 95, 143–148 (2012). https://doi.org/10.1007/s12185-011-0993-6

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  • DOI: https://doi.org/10.1007/s12185-011-0993-6

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