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2985 Validating the Prognostic Value of Anemia and Thrombocytopenia in Latin American Patients with Diffuse Large B-Cell Lymphoma: A Study from the Grupo De Estudio Latinoamericano De Linfoproliferativos (GELL)

Program: Oral and Poster Abstracts
Session: 627. Aggressive Lymphomas: Clinical and Epidemiological: Poster II
Hematology Disease Topics & Pathways:
Research, epidemiology, Clinical Practice (Health Services and Quality), Lymphomas, Clinical Research, B Cell lymphoma, Diseases, real-world evidence, aggressive lymphoma, registries, Lymphoid Malignancies
Sunday, December 11, 2022, 6:00 PM-8:00 PM

Luis Mario Villela Martinez, MD, MSc1,2*, Brady E. Beltrán, MD3,4*, Marialejandra Alejandra Torres Viera, MD5*, Henry Idrobo, MD, Professor6,7*, Myrna Candelaria, MD, PharmD8,9, Guilherme Fleury Perini, MD10*, Ana Carolina Oliver, MD11,12, Denisse Castro, MD3,4, Rosa Oliday13*, Sally Rose Paredes, MD3,14*, Ana Florencia Ramirez-Ibarguen, MD15*, Lidiane Andino16*, Silvia Rivas-Vera, MD17, Seisha Alana Von Glasenapp Gossen18*, Victoria Irigoin, MD19*, Gladys P Agreda, MD, PhD20*, Fernando Perez-Jacobo, MD21*, Perla R. R. Colunga-Pedraza, MD22, Efreen Montaño Figueroa, MD, PhD23*, Lorena Fiad, MD24*, Fabiola Valvert, MD25, Camila Peña, MD26, Jose A Hernández-Hernández, PhD27*, Virginia Otero, MD28*, Melani Otañez, MD29*, Guillermo J. Ruiz-Arguelles, FRCP30, Arianna Robles, MD31*, Carlos Best, MD32*, David Gomez-Almaguer, MD33, Rosio Baena, MD34*, Saul Urquijo, MD35*, Eleazar Hernandez, MD36*, Jose Luis Álvarez37*, Melissa Castro, MD38*, Jorge J. Castillo, MD39,40 and Luis Enrique Malpica Castillo, MD41,42

1Escuela de Medicina Del Tecnológico de Monterrey, Hermosillo, SO, Mexico
2Servicio de hematología, Centro Medico Dr. Ignacio Chavez del ISSSTESON, Hermosillo, SO, Mexico
3Departamento de Oncología y Radioterapia, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
4Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, Peru
5Srvicio de hematologia, Universidad de Caracas, Caracas, Venezuela (Bolivarian Republic of)
6RENEHOC, Bogotá, Colombia
7Universidad del Valle, Hospital Universitario Del Valle Evaristo García E.S.E, Cali, Colombia
8Research Division, Instituto Nacional de Cancerología, Mexico, Mexico
9Research Division: Instituto Nacional de Cancerología, Mexico City, Mexico
10Hospital Israelita Albert Einstein, Sao Paulo, PA, Brazil
11Hematology Department, British Hospital, Montevideo, Uruguay
12Hematology Department, Hospital Britanico, CASMU, Montevideo, Uruguay
13Sociedad Científica de Hematología de Cuba, Cuba, Cuba
14Centro de Investigacion de Medicina de Precision, Universidad de San Martin de Porres, LIMA, Peru
15Instituto Nacional de Cancerologia, Mexico, Mexico
16Hematology Service, Hospital Central del Instituto de Previsión Social, Asuncion, Paraguay
17Hematology Department, INCAN, Benito Juarez, Mexico
18Department of Hematology, Instituto de Prevision Social, Asuncion, Paraguay
19HEmatology Department, Hospital Britanico CASMU, montevideo, Uruguay
20Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
21Hematology and blood bank services, Hospital Central Norte PEMEX, CDMX, Mexico
22Servicio De Hematología, Hospital Universitario, Monterrey, Mexico
23Hospital General de Mexico, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, DF, Mexico
24Departamento de Hematologia, Hospital Italiano de La Plata, La Plata, Argentina
25Instituto De Cancerología y Hospital Dr. Bernardo Del Valle (INCAN), Ciudad de Guatemala, Guatemala
26Hematology Department, Hospital Del Salvador, Santiago, Chile
27Tecnológico de Monterrey, Escuela de Medicina. TecSalud, Monterrey, NL, Mexico
28Hematology Service, Hospital Italiano, Buenos Aires, Argentina
29Hospital General del Estado de Sonora, Hermosillo, SO, Mexico
30Centro De Hematologia Medicina Interna, Puebla, Pue, Mexico
31Universidad de Guadalajara, CUCS, HGO, Zapopan, MEX
32Hematologia, Universidad de Guadalajara, Hospital General de Occidente, Zapopan, Mexico
33Servicio de Hematología, Universidad Autónoma de Nuevo León. Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Monterrey, NL, Mexico
34Instituto Oncológico Nacional Caja Petrolera de Salud, Cochabamba, Bolivia
35Hospital Fernando Ocaranza del ISSSTE, Universidad Autonoma de Sinaloa. Facultad de Medicina, Hermosillo, SO, Mexico
36Centro Medico 20 de Noviembre del ISSSTE, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, DF, Mexico
37Centro Medico 20 de noviembre del ISSSTE, UNAM, Ciudad de Mexico, DF, Mexico
38Hospital Fernando Ocaranza del ISSSTE, Universidad Autonoma de Sinaloa, Hermosillo, SO, Mexico
39Bing Center for Waldenstrom's macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA
40Dana Farber Cancer Institute, Boston, MA
41University of Texas MD Anderson Cancer Center, Houston, TX
42Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX

Introduction. There are different biological variables associated to overall survival (OS) in Diffuse Large B-cell lymphoma (DLBCL). Anemia (Adams HJ et al 2015) and thrombocytopenia (Chen LP et al 2012) have been previously reported as clinical variables associated with worse outcomes. A Japanese group integrated these two prognostic factors to develop an index that classified patients into three risk groups: low risk (0 factors, 3-year OS 79%), intermediate risk (1 factor, 3-year OS 52%), and high risk (2 factors, 3-year OS 30%) (Nakayama et al, 2019). Therefore, our group aimed to examine the prognostic value of such approach using the retrospective GELL database for DLBCL.

Methods. We conducted a retrospective review of 1090 patients with a diagnosis of DLBCL treated with standard RCHOP/RminiCHOP/REPOCH (n=972) and CHOP (n=118) with a curative intent between 2010 and 2018. RminiCHOP was given to patients over 70 years. Data were obtained from 10 LATAM countries: Argentina, Colombia, Cuba, Chile, Guatemala, Mexico, Paraguay, Peru, Uruguay, and Venezuela. The five International Prognostic Index (IPI) variables (i.e, age ≥60 years, ECOG performance status ≥2, >1 site of extranodal involvement, elevated serum LDH, and advanced clinical stage) and low serum albumin defined as ≤3.5 g/dl, as previously described by our group, were analyzed together with hemoglobin (Hgb) level and platelet count. Anemia and thrombocytopenia were defined as Hgb level <12 g/dL and platelet count <135 K/uL, respectively, as defined by Nakayama and colleagues. The cohort was then grouped in 0 factors, 1 factor (anemia or thrombocytopenia), and 2 factors (anemia and thrombocytopenia)

Outcomes. The median of follow up of the entire cohort was 34 months (95% CI, 32 to 36 months). Demographic characteristics of the groups according to the number of factors are shown in Table 1. It is important to remark that bone marrow involvement was not a factor associated with anemia and/or thrombocytopenia (p=0.09). When we analyzed OS in the whole cohort according to the Japanese score, we observed 3-year OS rates of 67%, 49%, and 27% for patients with low, intermediate, and high risk, respectively (p<0.0001). When analyzed by regimen type, the 3-year OS rates for R-CHOP were 72%, 57% and 40% (p<0.0001); for R-mini-CHOP were 67%, 37% and 0% (p=0.003); and for CHOP were 49%, 29% and 0% (p=0.005) patients with low, intermediate, and high risk, respectively. When we analyzed OS by Cox proportional-hazard regression for classic IPI variables, serum albumin and the Japanese score, we could observe that only low serum albumin, poor performance status, age ≥60 years, advanced stage, and high serum LDH were independent prognostic variables associated with a worse OS (table 1).

Conclusion: Anemia and/or thrombocytopenia could be useful tools to assess prognosis in patients with DLBCL regardless of regimen type (RCHOP, CHOP or R-mini-CHOP). However, these novel markers did not add to the prognostic value of the IPI score and low serum albumin in LATAM patients with DLBCL.

Disclosures: Villela Martinez: Roche Mexico: Speakers Bureau; AstraZeneca Mexico: Speakers Bureau; Janssen Mexico: Speakers Bureau; Sanofi Mexico: Speakers Bureau; Asofarma Mexico: Speakers Bureau. Beltrán: Bristol Myer Squib: Speakers Bureau. Idrobo: roche: Speakers Bureau; astra Zeneca: Speakers Bureau; bristol myer squib: Speakers Bureau. Oliver: Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Agencia Nacional De Investigacion e innovacion: Research Funding; Janssen: Speakers Bureau; Nolver: Membership on an entity's Board of Directors or advisory committees; Roche: Speakers Bureau. Ramirez-Ibarguen: Bristol Myer Squib: Speakers Bureau; Roche: Speakers Bureau; Astra Zeneca: Speakers Bureau. Otero: Astra Zeneca: Current Employment. Gomez-Almaguer: Takeda: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Janssen: Consultancy, Honoraria. Álvarez: Novartis: Speakers Bureau; Abbvie: Speakers Bureau; Bristol: Speakers Bureau; Janssen: Speakers Bureau; Takeda: Speakers Bureau; Teva: Speakers Bureau. Castillo: Roche: Consultancy; Abbvie: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Cellectar: Consultancy; Beigene: Consultancy, Research Funding; AstraZeneca: Research Funding; TG Therapeutics: Research Funding; Janssen: Consultancy.

*signifies non-member of ASH