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3885 Lymphocyte-to-Monocyte Ratio at Diagnosis and Survival in De Novo Double/Triple Hit Diffuse Large B-Cell Lymphoma

Non-Hodgkin Lymphoma: Biology, excluding Therapy
Program: Oral and Poster Abstracts
Session: 622. Non-Hodgkin Lymphoma: Biology, excluding Therapy: Poster III
Monday, December 7, 2015, 6:00 PM-8:00 PM
Hall A, Level 2 (Orange County Convention Center)

Luis Porrata, MD1, Kay Ristow1*, Ellen D. McPhail, MD2, William Macon, MD1*, Matthew J Maurer, MS3, Grzegorz S. Nowakowski, MD4, Stephen Ansell, MD, PhD1, Thomas E. Witzig, MD5, Svetomir Markovic, MD, PhD1 and Thomas M. Habermann, MD4

1Mayo Clinic, Rochester, MN
2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
3Department of Health Sciences Research, Mayo Clinic, Rochester, MN
4Division of Hematology, Mayo Clinic, Rochester, MN
5Mayo Clinic Rochester, Rochester

The lymphocyte-to-monocyte ratio at diagnosis (LMR-D) has been reported to be a prognostic factor for clinical outcomes in both T-cell and B-cell lymphomas.  However, there are no reports testing the prognostic ability of LMR-D in patients diagnosed with de novo double/triple hit diffuse large B cell lymphoma (DLBCL).  Thus, we set out to investigate if the LMR-D is a prognostic factor for survival in de novo double/triple hit lymphomas.  From 10/5/1998 until 1/16/2015, thirty-four patients with de novo double/triple hit DLBCL were identified for this study.  Double and triple hit were defined by interphase FISH evaluating three fusion signals to identify the BCL2 translocation and IGK/MYC D-FISH probe to identify whether the partner is IG or non-IG.  Interphase fluorescence in situ hybridization (FISH) was performed on paraffin sections using probes that included 8q24 (5’MYC, 3’MYC); t (2;8), IGK/MYC; t(8,14), MYC/IGH; t(8;22), MYC/IGL; 3q27 (3’BCL6, 5’BCL’6); and 18q21 (3’BCL2, 5’BCL2).  The cohort included 14 females and 20 males.  The median follow-up for the cohort was 9.0 months (range: 0.4-72.6 months).  Using the median for the LMR-D as the cut-off value, patients with a LMR-D ≥ 1.2 experienced superior overall survival (OS) [Hazard ratio (HR) of 0.127, 95 % confidence interval (CI) of 0.019-0.530, p < 0.004] and progression-free survival (PFS) [HR of 0.107, 95 CI of 0.024-0.335, p < 0.0001].  The median follow up for OS for patients with a LMR-D ≥ 1.2 was not reached with a 5-year OS rate of 82% (95% CI of 49%-95%) compared with a median follow-up of 10 months for patients with a LMR-D < 1.2 with a  0% 5 year OS rate, p < 0.003 (Figure 1A).  The median PFS for patients with a LMR-D ≥ 2 was not reached with a 5 years PFS of 74% (95%CI, of 43%-91%) compared with a median follow-up of 4.7 months for patients with a LMR-D < 1.2 and 0% 5 year PFS rate, p < 0.0001 (Figure 1B).  After adjusting for the International Prognostic Index, multivariate analysis showed that the LMR-D remained an independent prognostic factor for OS [HR = 0.180, 95% CI of 0.254-0.784, p < 0.02] and for PFS [HR of 0.127, 95%CI of 0.029-0.409, p < 0.0003].   In spite of the small cohort of de novo double/triple hit DLBCL, the LMR-D was identified as a prognostic factor for clinical outcomes for this specific set of aggressive lymphomas.  Further studies are warranted to confirm our findings.

LMR-D ≥ 1.2, N = 18

Events = 2

LMR-D < 1.2, N = 16

Events = 8

P < 0.003

LMR-D ≥ 1.2, N = 18

Events = 3

LMR-D < 1.2, N = 16

Events = 14

P < 0.0001

Figure 1

A

B

Disclosures: Maurer: Kite Pharma: Research Funding . Ansell: Bristol-Myers Squibb: Research Funding ; Celldex: Research Funding . Off Label Use: New agent in a combination regimen..

*signifies non-member of ASH