Lymphopenia during routine follow-up may predict relapse in patients with extranodal NK/T cell lymphoma
Recently, absolute lymphocyte count (ALC) at diagnosis, as a surrogate marker of host immunity, has been reported to be a prognostic factor for clinical outcomes in extranodal NK/T cell lymphoma (ENKTL). In this retrospective study, we set out to investigate whether ALC at the time of confirmed relapse or at last follow-up is a marker for relapse after chemoradiotherapy in 84 patients with stage I/II ENKTL. Receiver operating characteristics (ROC) curve and area under the curve (AUC) analysis showed that ALC at follow-up was a significant marker for relapse (AUC = 0.883, P < 0.001). Using 1.215 × 109/L as the optimal cutoff value of ALC, 44 patients (52.4 %) were in lower ALC group and 40 patients (47.6 %) were in higher ALC group. The sensitivity and specificity for ALC at the time of confirmed relapse or at last follow-up was 94.1 and 76.0 %, respectively. The relative risk of relapse with an ALC < 1.215 × 109/L was 14.5. The positive predictive value with an ALC < 1.215 × 109/L was 72.7 %, and the negative predictive value with an ALC ≥ 1.215 × 109/L was 95.0 %. The 4-year cumulative incidence rate for an ALC < 1.215 × 109/L was 73.2 % compared with 3.2 % for an ALC ≥ 1.215 × 109/L (P < 0.001). In a multivariate regression analysis, ALC at the time of confirmed relapse or last follow-up remained to be a significant factor for relapse (P < 0.001). In conclusion, lymphopenia observed during routine follow-up can predict relapse in patients with ENKTL, which needs further validation in prospective trials.
KeywordsAbsolute lymphocyte count Lymphopenia Relapse Extranodal NK/T cell lymphoma
We thank all of the physicians at Sun Yat-sen University Cancer Center for allowing us to include their patients. We also appreciate the cooperation of all the pathologists at Sun Yat-sen University Cancer Center for their support.
This work received grant support from National Natural Science Foundation of China (contract/grant number: 81400159), Medical Research Foundation of Guangdong Province (grant number: B2014158), Young Teachers’ Cultivation Project of Sun Yat-sen University (No. 12ykpy54), and Outstanding Young Talents Project of Sun Yat-sen University Cancer Center (No. 04190101#).
Conflicts of interest
- 4.Wang L, Wang ZH, Chen XQ, Li YJ, Wang KF, Xia YF, et al. First-line combination of gemcitabine, oxaliplatin, and l-asparaginase (GELOX) followed by involved-field radiation therapy for patients with stage IE/IIE extranodal natural killer/T-cell lymphoma. Cancer. 2013;119:348–55.CrossRefPubMedGoogle Scholar
- 11.National Comprehensive Cancer Network (NCCN). Extranodal NK/T-cell lymphoma, nasal type. Pract Guidel Oncol. 2013;1.Google Scholar
- 12.National Comprehensive Cancer Network (NCCN). Diffuse large B-cell lymphoma. Practice Guidel Oncol. 2013;1.Google Scholar
- 17.Chan JK, Quintanilla-Martinez L, Ferry JA, Peh S-C. Extranodal NK/T-cell lymphoma, nasal type. In: Swerdlow SH, Campo E, Harris NL, et al., editors. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC; 2008. p. 285–8.Google Scholar
- 18.Wang L, Wang WD, Xia ZJ, Zhang YJ, Xiang J, Lu Y. Combination of gemcitabine, l-asparaginase, and oxaliplatin (GELOX) is superior to EPOCH or CHOP in thetreatment of patients with stage IE/IIE extranodal natural killer/T cell lymphoma: a retrospective study in a cohort of 227 patients with long-term follow-up. Med Oncol. 2014;31(3):860.CrossRefPubMedGoogle Scholar
- 20.Thompson CA, Maurer MJ, Ghesquieres H, et al. Utility of post-therapy surveillance scans in DLBCL. J Clin Oncol. 2013;(suppl; abstr 8504).Google Scholar
- 24.Porrata LF, Ristow KM, Habermann TM, 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 Mar 19.Google Scholar