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1757 Validating the Halp Score (Hemoglobin,Albumin, Lymphocytes, and Platelets) and the Neutrophil/Lymphocyte Ratio (NLR) As Prognostic Factors for Overall Survival in Patients with Diffuse Large B-Cell Lymphoma. Retrospective Analysis By the Grupo De Estudio De Latino America De Linfoproliferativos (GELL)

Program: Oral and Poster Abstracts
Session: 627. Aggressive Lymphomas: Clinical and Epidemiological: Poster I
Hematology Disease Topics & Pathways:
Research, adult, epidemiology, elderly, Clinical Research, real-world evidence, young adult , Study Population, Human
Saturday, December 9, 2023, 5:30 PM-7:30 PM

Luis Mario Villela Martinez, MD, MSc1*, Brady E Beltran, MD2*, Myrna Candelaria, MD, PharmD3, Marialejandra Torres Viera, MD4*, Ana Florencia Ramirez, MD5*, Henry Idrobo Quintero6,7*, Carolina Oliver, MD8,9, Guilherme Fleury Perini, MD10, Efreen H Montano Figueroa, MD11*, Laura Korin, MD12*, Lorena Fiad, MD13*, German R. Stemmelin, MD14*, Fernando Perez-Jacobo, MD15*, Denisse Castro, MD16, Sally Rose Paredes, MD17*, Victoria Irigoín, MD18*, Perla R. Colunga-Pedraza, MD19, David Gomez-Almaguer, MD20, Guillermo Ruiz-Argüelles, MD21*, Fabiola Valvert, MD, FRCP22, Melani Otañez23*, Arianna Robles Rodriguez24*, Carlos Best25*, Jose A Hernandez-Hernandez, PhD26*, Luis Malpica, MD27* and Jorge J. Castillo, MD28

1Centro Medico Dr. Ignacio Chavez, Hermosillo, Sonora, MEX
2Servicio Oncología Médica, Hospital Edgardo Rebagliati, Lima, Peru
3Clinical Research, Instituto Nacional de Cancerología, Mexico, Mexico
4Unidad Linfomas, Instituto Hematología y Oncología Universidad Central Venezuela, Caracas, Venezuela (Bolivarian Republic of)
5Instituto Nacional de Cancerologia, MExico city, Mexico
6Universidad del Valle, Cali, Colombia
7Clinica la Estancia, Popayan, Colombia
8CASMU, Montevideo, Uruguay
9British Hospital, Montevideo, Uruguay
10Hospital Israelita Albert Einstein, São Paulo, Brazil
11Hospital General de Mexico, Mexico City, MEX
12CABA- Alexander Fleming Institute, Olivos, Argentina
13Italian Hospital, La Plata, Argentina
14Hospital Britanico BS.AS, Buenos Aires, Caba, ARG
15Hospital Central Norte Pemex, Ciudad de Mexico, Mexico
16Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
17Hospital Nacional Edgardo Rebagliati Martins. Lima Peru, lima, Peru
18Hospital De Clinicas, Montevideo, URY
19Servicio de Hematología, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Monterrey, NL, Mexico
20Servicio de Hematologia, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio Gonzalez", Monterrey, Mexico
21Clinica Ruiz. Puebla, Puebla, Mexico
22ICAN, Ciudad DE Guatemala, Guatemala
23Hospital de Alta Especialidad de Sonora, Sonora, Mexico
24Hematology, Hospital General de Occidente, Cdmx, MEX
25Universidad De Guadalajara, Guadalajara, AG, MEX
26TEC Monterrey, Monterrey, TX, MEX
27Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
28Dana-Farber Cancer Institute, Bing Center for Waldenström Macroglobulinemia, Boston, MA

Introduction. Diffuse large B-cell lymphoma (DLBCL) is the most common type of malignant lymphoid neoplasm. The international Prognostic Index (IPI) and its variants are the main prognostic tools used in DLBCL with value in the rituximab era. Certain molecular biomarkers and genetic signatures in DLBCL have been identified, but the cost and unavailability in Latin America (LATAM) are an issue. Therefore, using accesible tools in LATAM is a potencially unmet need. Vlatka (2021), reported a new score (HALP: hemoglobin, albumin, lymphocytes, and platelets) for overall survival (OS) in DLBCL. These parameters are easy to access in LATAM centers. Thus, we aim to validate this novel OS score in the GELL database, and expanding database from LATAM countries.

Methods. This was a retrospective analyses of patients with de novo DLBCLtreated with curative intent between 2010 and 2018. The classic 5 international prognostic index variables [age, ECOG, Extranodal (EN) involvement, Lactate dehydrogenase (LDH), and advanced stage] and low serum albumin defined as ≤3.5mg/dL(divided in low, 3.4-2.5 mg/dL, and very low, ≤2.4 mg/dL), as previously described by our group (Villela,2018&2019). We also calculated the NLR considering an adverse prognostic factor >4, as previously published by us (Beltran&Villela,2020). The HALP score was calculated using the following formula: hemoglobin(g/L) x albumin (g/L) x absolute lymphocyte count (k/μL) divided by platelets (k/μL). The ROC method was used to calculate the HALP cut-off. Demographic characteristics are reported using descriptive statistics. Cox proportional-hazard regression model was used to evaluate parameters associated with OS, and survival curves were estimated with the Kaplan-Meier (KM) method.

Outcomes. 1407 patients were included, who were treated with standard RCHOP (n=1112,79%), RminiCHOP (n=93,7%), REPOCH (n=111,8%), and CHOP (n=91,6%). The median follow-up was 36 months (IQR: 7 to 56). NLR >4 was observed in 18.5%. The median HALP score was 24 (IQR, 12 to 40), and the cut-off of ≤13 (AUC 0.58;95%CI 0.56 to 0.61; p<0.0001) was considered an adverse prognostic factor, which was observed in 451 patients (32.7%). Female sex, ECOG >1, EN >1. high LDH, advance stage, low and very low albumin, and NLR>4 were associated with HALP≤13, but age was not (Table 1). Patients with HALP ≤13 had a lower 3-years OS rate than HALP>13 (48% vs. 66%, respectively; p<0.001). Table 2 shows the univariate & multivariate analysis of the variables with independent influence on OS, including HALP & NLR. In multivariate analysis, HALP and EN involvement were left out of the model ( Harrell´s C-Index, 0.73;95%CI 0.69 to 0.76).

Conclusion: NLR>4, but not HALP ≤13, could prognosticate inferior OS in LATAM patients with DLBCL treated with curative intent. The adverse prognostic value of NLR>4 should be validated prospectively in other cohort of DLBCL patients.

Disclosures: Villela Martinez: Sanofi: Speakers Bureau; TEVA: Speakers Bureau; roche: Speakers Bureau; Merck Sharp and Dome: Speakers Bureau; astra zeneca: Speakers Bureau. Ramirez: roche: Speakers Bureau; merck sharp and dome: Speakers Bureau. Quintero: Takeda: Speakers Bureau; astra zeneca: Speakers Bureau; roche: Speakers Bureau; Merck Sharp and dome: Speakers Bureau. Perini: Abbvie: Consultancy, Speakers Bureau; Lilly: Consultancy, Speakers Bureau; MSD: Consultancy, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Merck: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Astra zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Gomez-Almaguer: AMGEN: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Novartis: Honoraria; AbbVie: Consultancy, Honoraria. Castillo: AstraZeneca: Consultancy, Research Funding; Loxo: Consultancy, Research Funding; Cellectar: Consultancy, Research Funding; BeiGene: Consultancy, Research Funding; Abbvie: Consultancy, Research Funding; Pharmacyclics: Consultancy, Research Funding; Mustang Bio: Consultancy; Kite: Consultancy.

*signifies non-member of ASH