Prognosis Evaluation of the Progression of Diffuse Large B-Cell Lymphoma within 24 Months

Research Article

Ann Hematol Oncol. 2022; 9(3): 1398.

Prognosis Evaluation of the Progression of Diffuse Large B-Cell Lymphoma within 24 Months

Hong H1,2, Lin T2*, Wan M1, Li X2, Huang H1, Fang X2, Chen Y1, Zhang W1, Tian Y2, Yao Y2, Pan F1, Weng H2, Chen Z1, Yu L1, Shen Y2 and Li X1

1Department of Medical Oncology, School of Medicine University of Electronic Science & Technology of China, China

2Department of Medical Oncology, Sichuan Cancer Hospital & Institute, School of Medicine University of Electronic Science & Technology of China, China

*Corresponding author: Tongyu Lin, Department of Medical Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine University of Electronic Science & Technology of China, Sichuan, Province, Chengdu, 610041, China

Received: June 16, 2022; Accepted: July 19, 2022; Published: July 26, 2022

Abstract

Purpose: The progression of disease within 24 months (POD24) has been considered to be a strong prognostic indicator for various types of malignant lymphoma. However, the value of POD24 in Diffuse Large B-Cell Lymphoma (DLBCL) is unclear. We evaluated the value of POD24 in patients with DLBCL.

Methods: A total of 476 newly diagnosed DLBCL patients were analyzed in this study. Overall Survival (OS) was evaluated by Kaplan Meier method. We performed univariate and multivariate analyses to evaluate the potential prognostic value of POD24.

Results: A total of 476 newly diagnosed patients with DLBCL were analyzed in our study. The 5-year OS rates of patients in the POD24 group and non-POD24 group were 22.6% and 82.5%, respectively (HR 7.397; 95% CI 5.403-10.125; p < 0.001). The 5-year OS rates of patients in the POD24 group and non-POD24 group in Complete Release (CR) were 26.5% and 73.7%, respectively (HR 4.374; 95% CI 2.521-7.590; p<0.001). These results were similar in patients with non-CR: the 5-year OS rates were 20.5% and 83.7% (HR 8.697; 95% CI 5.934-12.746; p<0.001). The 5-year OS rates of the POD24 group and the non-POD24 group in the low stage (stage I and II) were 48% and 85.6%, respectively (HR 5.122; 95% CI 2.803-9.363; p<0.001). The results were the same in the high stage (stage III and IV): 10.2% and 79.4% (HR 5.122; 95% CI 2.803-9.363; p<0.001). Only stage was an independent prognostic factor for OS in the POD24 group in the multivariate analysis (P=0.001).

Conclusion: The association between POD24 and OS was confirmed, and POD24 can predict poor OS in patients with DLBCL. These marked differences in outcome suggest that POD24 is useful for patient counseling, study design, and risk stratification in DLBCL.

Introduction

DLBCL is the most common subtype of lymphoma in the United States and Europe [1]. The disease is biologically and clinically heterogeneous and the clinical outcomes are often poor [2,3]. Without treatment, the expected OS rate is less than 1 year [4,5]. However, many patients receive immunochemotherapy treatment that consists of Rituximab plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) [6-8]. Although most patients receiving standard chemotherapy respond to treatment, 20% to 40% of patients fail to achieve remission or experience relapse [9]. Most relapses occur within the first 12 to 18 months [9-10]. Patients with relapsed or refractory DLBCL experience low survival rates, disease progression within 24 months, and poor prognosis [9]. Therefore, early identification of patients at risk for recurrence or progression is critical for the timely delivery of appropriate treatment.

POD24 is considered a reliable prognostic factor in various types of malignant lymphoma, including follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma, and PTCL (peripheral t-cell lymphoma) [11-14], where there is high evidence to confirm that patients who experience disease progression within 24 months have a poor prognosis [15,16]. Previous studies have explored the event-free survival at 24 months factor of patients with DLBCL, where relapse, repeated therapy and death are commonly used as events [17,18]. POD24 has not been studied in DLBCL. Therefore, POD24 was specifically explored in this study.

We aimed to analyze the value of POD24 in DLBCL to evaluate its clinical significance in clinical practice.

Materials and Methods

Patients

Patients aged 18-80 who were newly diagnosed with DLBCL in Sichuan Cancer Hospital and Institute and Sun Yat-sen University Cancer Center from February 2012 to November 2019 were included in this study. The inclusion criteria of this study were as follows: patients with a histological confirmation of DLBCL, patients who received first-line therapy with R-CHOP and had complete clinical information. Clinical information included age, sex, clinical stage, hepatitis B surface antigen, Lactate Dehydrogenase (LDH) level, Eastern Cooperative Oncology Group (ECOG) score, and number of extralymphatic lesions, which were used to calculate the patients risk stratification according to the International Prognostic Index (IPI). The study was approved by the ethics committee of Sun Yat-sen University Cancer Center, and a waiver of consent was allowed by the ethics committee because there were no conflicts of interest or risk to patients. We guaranteed confidentiality of patient data according to the requirements of the ethics committee.

Clinical Outcomes

POD24 and OS were the endpoints of this retrospective study. POD24 was defined as the recurrence or progression of the disease within 24 months after diagnosis. OS is defined as the time from diagnosis to the end of follow-up or death. If the patient is censored (lost to follow-up, etc.) or POD24 cannot be assessed if no patient has died from POD within a month.

Statistical Analysis

OS was assessed by the Kaplan–Meier method, and differences between the groups were estimated by the log-rank test. Univariate and multivariate Cox proportional hazards analyses were performed to examine the potential independent influences of clinical variables on POD24. All statistical analyses were performed using GraphPad Prism 7, and P<0.1 was considered statistically significant.

Result

Patient Characteristics

This study included 476 newly diagnosed patients with DLBCL. (Table 1) shows the clinical characteristics of the 476 patients with DLBCL are shown in. The median age at diagnosis was 52 years. There were 277 males (58.2%) and 199 females (41.8%). A total of 182 patients (38.2%) were stage I-II, and 294 patients (61.8%) were stage III-IV. Most patients (92.4%) had a lower ECOG performance status. For cell-of-origin subtypes, 214 (44.9%) were GCB subtypes, and 262 (55.1%) were non-GCB subtypes. Based on IPI scores, 184 patients (38.6%) were low risk, 119 patients (25%) were low-intermediate risk, 106 patients (22.3%) were high-intermediate risk and 67 patients (14.1%) were high risk. We found that in the POD24 group and non- POD24 group, significant differences existed in age (p=0.02), ECOG performance status (p=0.01), B symptoms (p=0.01), extranodal sites (p=0.004), and international prognostic index (IPI) (p=0.001). However, there were no significant differences between the POD24 group and the non-POD24 group in sex, stage, LDH, cell-of-origin subtype, HBsAg status or other clinical characteristics. The details of the clinical characteristics are shown in (Table 1).