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)

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.