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Jelicic J, Juul-Jensen K, Bukumiric Z, Roost Clausen M, Ludvigsen Al-Mashhadi A, Pedersen RS, Poulsen CB, Brown P, El-Galaly TC, Stauffer Larsen T. Prognostic indices in diffuse large B-cell lymphoma: a population-based comparison and validation study of multiple models. Blood Cancer J 2023; 13:157. [PMID: 37833260 PMCID: PMC10575851 DOI: 10.1038/s41408-023-00930-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Currently, the International Prognostic Index (IPI) is the most used and reported model for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). IPI-like variations have been proposed, but only a few have been validated in different populations (e.g., revised IPI (R-IPI), National Comprehensive Cancer Network IPI (NCCN-IPI)). We aimed to validate and compare different IPI-like variations to identify the model with the highest predictive accuracy for survival in newly diagnosed DLBCL patients. We included 5126 DLBCL patients treated with immunochemotherapy with available data required by 13 different prognostic models. All models could predict survival, but NCCN-IPI consistently provided high levels of accuracy. Moreover, we found similar 5-year overall survivals in the high-risk group (33.4%) compared to the original validation study of NCCN-IPI. Additionally, only one model incorporating albumin performed similarly well but did not outperform NCCN-IPI regarding discrimination (c-index 0.693). Poor fit, discrimination, and calibration were observed in models with only three risk groups and without age as a risk factor. In this extensive retrospective registry-based study comparing 13 prognostic models, we suggest that NCCN-IPI should be reported as the reference model along with IPI in newly diagnosed DLBCL patients until more accurate validated prognostic models for DLBCL become available.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Vejle Hospital, Sygehus Lillebaelt, Vejle, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Karen Juul-Jensen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Zoran Bukumiric
- Institute for Medical Statistics and Informatics, University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | - Ahmed Ludvigsen Al-Mashhadi
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Peter Brown
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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2
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Bai Y, He T, Zhang L, Liu Q, Yang J, Zhao Z, Yang K, Zhang M. Prognostic value of FOXP3 + regulatory T cells in patients with diffuse large B-cell lymphoma: a systematic review and meta-analysis. BMJ Open 2022; 12:e060659. [PMID: 36691128 PMCID: PMC9454056 DOI: 10.1136/bmjopen-2021-060659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/12/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES We aimed to comprehensively evaluate the relationship between forkhead box P3 (FOXP3+) regulatory T cell (Treg) expression and diffuse large B-cell lymphoma (DLBCL) prognosis and to explore the sources of heterogeneity of the results. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched the Cochrane Library, PubMed, Embase and Web of Science databases up to 5 December 2021. ELIGIBILITY CRITERIA We included studies that analysed the prognostic significance of FOXP3+ Tregs in DLBCL. We included studies reported in Chinese or English that reported HRs and related 95% CIs for prognosis. DATA EXTRACTION AND SYNTHESIS We extracted data from eligible studies. HRs and 95% CIs were used to assess the prognostic value. RESULTS Fourteen eligible studies were identified. FOXP3+ Treg expression was not associated with overall survival (OS) (HR=0.72, 95% CI 0.45 to 1.16) or progression-free survival (HR=0.86, 95% CI 0.54 to 1.38). The three approaches used to measure FOXP3+ Treg expression (pinteraction<0.001) may be the source of the heterogeneity of the results. Subgroup analysis found that a higher expression of FOXP3+ Tregs was associated with better OS in all populations and in Asians when FOXP3+ Treg expression was measured by the number of positive cells (HR=0.36 (95% CI 0.22 to 0.58) in the former, HR=0.33 (95% CI 0.20 to 0.55) in the latter) or the percentage of positive cells (HR=0.49 (95% CI 0.27 to 0.89) in the former, HR=0.38 (95% CI 0.21 to 0.70) in the latter). However, when measured by the score, inverse results were found (HR=1.56, 95% CI 1.01 to 2.42). CONCLUSIONS Approaches to measuring FOXP3+ Treg expression might be the major source of heterogeneity in studies of the prognostic significance of FOXP3+ Tregs in DLBCL. FOXP3+ Treg expression might be used to predict the prognosis of patients with DLBCL when FOXP3+ Treg expression is calculated by the number or the percentage of positive cells, especially in Asian populations.
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Affiliation(s)
- Yuping Bai
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Tingting He
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Liyan Zhang
- Department of Pathology, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, China
| | - Qianqian Liu
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jing Yang
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ziru Zhao
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, Lanzhou, China
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Tiu A, Jorge V, Moussa P, Djibo DA, Gupta S, Alpdogan O, Dourado C. Survival Disparities of Diffuse Large B-Cell Lymphoma in a Community-Based Inner-City Cancer Center. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:205-215. [PMID: 33139233 DOI: 10.1016/j.clml.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/04/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) comprises approximately 30% of all non-Hodgkin lymphomas. Multiple studies have demonstrated race-based disparities in survival among patients with DLBCL across all stages of disease, in the era both before and after rituximab. The etiology for the racial disparities in survival among patients with DLBCL is still unknown. Moreover, the Revised International Prognostic Index (R-IPI), a tool that predicts the DLBCL patients' outcome, has not yet been validated in African Americans (AA). PATIENTS AND METHODS We conducted a cohort study of patients diagnosed with DLBCL from January 1, 2007, to December 31, 2017, from our tumor registry in a single community-based inner-city cancer center. We abstracted demographic, clinical, histopathologic, treatment, and R-IPI variables. A total of 181 patients (47.5%) with biopsy-proven DLBCL were included in the retrospective analysis. The median age was 65 years, 47% were men, 41% were AA, and 44% were white. RESULTS The AA group had a younger median age, higher lactate dehydrogenase levels, higher frequency of B symptoms, and higher HIV infection than the non-AA group. The AA group had significantly decreased median overall survival than the non-AA group (15.7 months; 95% confidence interval, 10.3 to 23.9, vs. 93.6 months; 95% confidence interval, 61.5 to 142.6, respectively; P < .001). The survival disparities persisted after excluding patients with HIV and who did not receive chemotherapy. In addition, AA race predicts a reduced survival by univariate and multivariate analysis. CONCLUSION AA with DLBCL may have a poorer prognosis than the non-AA population. Further studies should investigate the biology of DLBCL in the AA population.
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Affiliation(s)
- Andrew Tiu
- Department of Medicine, Einstein Medical Center, Philadelphia, PA.
| | - Vinicius Jorge
- Division of Hematology and Medical Oncology, Einstein Medical Center, Philadelphia, PA
| | - Peter Moussa
- Department of Medicine, Einstein Medical Center, Philadelphia, PA
| | - Djeneba Audrey Djibo
- Division of Research, Department of Medicine, Einstein Medical Center, Philadelphia, PA
| | - Sorab Gupta
- Division of Hematology and Medical Oncology, Einstein Medical Center, Philadelphia, PA
| | - Onder Alpdogan
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Claudia Dourado
- Division of Hematology and Medical Oncology, Einstein Medical Center, Philadelphia, PA
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4
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Jelicic J, Larsen TS, Frederiksen H, Andjelic B, Maksimovic M, Bukumiric Z. Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models - A Systematic Review. Clin Epidemiol 2020; 12:537-555. [PMID: 32581596 PMCID: PMC7266947 DOI: 10.2147/clep.s244294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background and Aim Based on advances in the diagnosis, classification, and management of diffuse large B-cell lymphoma (DLBCL), a number of new prognostic models have been proposed. The aim of this study was to review and compare different prognostic models of DLBCL based on the statistical methods used to evaluate the performance of each model, as well as to analyze the possible limitations of the methods. Methods and Results A literature search identified 46 articles that proposed 55 different prognostic models for DLBCL by combining different clinical, laboratory, and other parameters of prognostic significance. In addition, six studies used nomograms, which avoid risk categorization, to create prognostic models. Only a minority of studies assessed discrimination and/or calibration to compare existing models built upon different statistical methods in the process of development of a new prognostic model. All models based on nomograms reported the c-index as a measure of discrimination. There was no uniform evaluation of the performance in other prognostic models. We compared these models of DLBCL by calculating differences and ratios of 3-year overall survival probabilities between the high- and the low-risk groups. We found that the highest and lowest ratio between low- and high-risk groups was 6 and 1.31, respectively, while the difference between these groups was 18.9% and 100%, respectively. However, these studies had limited duration of follow-up and the number of patients ranged from 71 to 335. Conclusion There is no universal statistical instrument that could facilitate a comparison of prognostic models in DLBCL. However, when developing a prognostic model, it is recommended to report its discrimination and calibration in order to facilitate comparisons between different models. Furthermore, prognostic models based on nomograms are becoming more appealing owing to individualized disease-related risk estimations. However, they have not been validated yet in other study populations.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bosko Andjelic
- Department of Haematology, Blackpool Victoria Hospital, Lancashire Haematology Centre, Blackpool, UK
| | - Milos Maksimovic
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Zoran Bukumiric
- Department of Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Jelicic J, Larsen TS, Maksimovic M, Trajkovic G. Available prognostic models for risk stratification of diffuse large B cell lymphoma patients: a systematic review. Crit Rev Oncol Hematol 2018; 133:1-16. [PMID: 30661646 DOI: 10.1016/j.critrevonc.2018.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022] Open
Abstract
The International Prognostic Index (IPI) has been used for risk stratification for a long time in diffuse large B cell lymphoma (DLBCL). Based on new clinical and biological prognostic markers, many new prognostic models have been described. This review aims to present the progress in development and validation of these prognostic models. A comprehensive literature review was performed to identify studies that proposed a new prognostic model in DLBCL. A total of 38 studies met the inclusion criteria. The IPI, revised IPI (R-IPI), and National Comprehensive Cancer Network (NCCN)-IPI were the most studied prognostic indexes, externally validated and commonly used to compare to other models. Despite an increasing number of prognostic models have been proposed lately, most of them lack external validation. Further studies, that combine biological and clinical markers with prognostic significance, are needed to determine the optimal prognostic tool for more personalized treatment approach to DLBCL patients.
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Affiliation(s)
- Jelena Jelicic
- Clinic for Haematology, Clinical Centre of Serbia, Dr Koste Todorovica 2, 11000, Belgrade, Serbia
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, Sdr. Boulevard 29, Indgang 85 Pavillon, 5000, Odense C, Denmark.
| | - Milos Maksimovic
- Clinic for Ophthalmology, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Goran Trajkovic
- Department of Statistics, Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia
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Han X, Ruan J, Zhang W, Zhou D, Xu D, Pei Q, Ouyang M, Zuo M. Prognostic implication of leucocyte subpopulations in diffuse large B-cell lymphoma. Oncotarget 2018; 8:47790-47800. [PMID: 28548962 PMCID: PMC5564605 DOI: 10.18632/oncotarget.17830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/08/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent studies have suggested that variables related to host adaptive immunity and the tumor microenvironment may predict the outcome in patients with non-Hodgkin's lymphoma. This study was undertaken to determine the prognostic value of peripheral blood leucocyte subpopulations in diffuse large-B-cell lymphoma patients. METHODS We prospectively analyzed the 16 leukocyte subpopulations using Cytodiff flow cytometric technique in a cohort of 45 diffuse large-B-cell lymphoma patients at a single institution between February and December 2014. The Cox proportional hazards model was used to evaluate prognostic factors for overall survival and progression free survival. RESULTS Diffuse large-B-cell lymphoma patients had decreased cytotoxic and non-cytotoxic NK&T cells as well as increased CD16+ monocytes, CD16- monocytes and mature neutrophils. The decreased CD16- monocyte/CD16+ monocyte ratio and increased mature neutrophil/cytotoxic NK&T cell ratio were related to poor progression-free and overall survival outcome in single and multivariate analysis. The co-constructed model using International Prognostic Index and mature neutrophil/cytotoxic NK&T cell ratio can also help discriminate the clinical outcome. CONCLUSIONS The decreased CD16-monocyte/CD16+monocyte ratio and increased mature neutrophil/cytotoxic NK&T cell ratio predict poor prognosis in diffuse large-B-cell lymphoma patients. This finding provides a strong rationale for the study of cellular immunotherapy in B-cell lymphoma.
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Affiliation(s)
- Xiao Han
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
| | - Jing Ruan
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
| | - Dongsheng Xu
- Department of Hematopathology, CBLPath, Sonic Healthcare, Rye Brook, NY 10573, USA
| | - Qiang Pei
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
| | - Mingqi Ouyang
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
| | - Mengxuan Zuo
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China 100730
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Prognostic and biological significance of survivin expression in patients with diffuse large B-cell lymphoma treated with rituximab-CHOP therapy. Mod Pathol 2015; 28:1297-314. [PMID: 26248897 DOI: 10.1038/modpathol.2015.94] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/30/2015] [Indexed: 12/14/2022]
Abstract
Survivin, a member of the inhibitor of apoptosis protein family, is overexpressed in a variety of human neoplasms. The prognostic significance of survivin expression in diffuse large B-cell lymphoma patients treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) is unclear. We used standard immunohistochemistry methods to quantify survivin expression in 463 patients with de novo diffuse large B-cell lymphoma who received the R-CHOP. Of the 463 patients, 269 (58%) had survivin overexpression with a cutoff of >25%, associated with an International Prognostic Index score of >2 (P=0.015), disease in ≥2 extranodal sites (P=0.011), and a high Ki-67 index (P<0.0001). Among patients with activated B cell-like disease, the overall survival rate of survivin-positive patients was significantly lower than that of survivin-negative patients (P=0.033); multivariate analysis confirmed that in these patients, survivin overexpression was an independent prognostic factor for survival. Among patients with wild-type p53 overexpression, the overall survival and progression-free survival rates of the survivin-positive group were significantly lower than those of the survivin-negative group (P=0.035 and P=0.04 respectively). In STAT3-positive patients, survivin overexpression was associated with significantly better survival. Among patients with activated B cell-like disease, survivin-positive compared with survivin-negative groups had significantly different gene expression signatures, including genes involved in mitosis or tumor cell proliferation. Our results indicate that survivin is an independent prognostic factor for poor outcome in patients with activated B cell-like disease treated with the R-CHOP regimen, and patients with survivin-positive activated B cell-like diffuse large B-cell lymphoma seem to benefit less from this treatment and may require additional novel agents.
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Zhang Y, Wang J, Sui X, Li Y, Lu K, Fang X, Jiang Y, Wang X. Prognostic and Clinicopathological Value of Survivin in Diffuse Large B-cell Lymphoma: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1432. [PMID: 26356696 PMCID: PMC4616623 DOI: 10.1097/md.0000000000001432] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Up to date, survivin, a well-known inhibitor of apoptosis, has attracted considerable attention as a potential biomarker and therapeutic target in diffuse large B-cell lymphoma (DLBCL). Nevertheless, there still remains no consensus on heterogeneous results. Herein, a meta-analysis was performed to clarify a convincing significance of survivin status on prognosis and clinicopathology of DLBCL patients.Eligible studies were identified by searching Medline, Embase, Scopus, CNKI, and Wanfang databases (last updated on November 30, 2014). Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Heterogeneity and sensitivity were also analyzed. Moreover, Begg, Egger test, and funnel plots were applied to evaluate the publication bias.We finally included 17 eligible studies with the total number of 1352 patients in the meta-analysis. The pooled results showed that positive survivin expression in DLBCL was associated with inferior overall survival (OS) (HR: 1.880, 95% CI: 1.550-2.270) in patients. Moreover, a significant association was revealed between survivin expression and advanced clinical stage (III + IV) (OR: 0.611, 95% CI: 0.452-0.827), higher International Prognosis Index (IPI) score (Score 3-5) (OR: 0.559; 95% CI: 0.410-0.761), elevated serum lactic dehydrogenase (LDH) (OR: 0.607, 95% CI: 0.444-0.831), presence of bone marrow involvement (OR: 2.127, 95% CI: 1.154-3.921) together with reduced complete remission (CR) rate (OR: 0.478, 95% CI: 0.345-0.662).The results suggest that survivin could be a useful prognostic biomarker, and a promising target for DLBCL therapeutic intervention. Considering limited HR data adjusted for standard prognostic variables could be retrieved, future high-quality studies will be needed in evaluating the independent prognostic value of survivin expression in DLBCL.
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Affiliation(s)
- Ya Zhang
- From the Department of Hematology, Shandong Provincial Hospital affiliated to Shandong University (YZ, JW, XS, YL, KL, XF, YJ, XW); and Institute of Diagnostics, Shandong University School of Medicine, Jinan, Shandong, P.R. China (XW)
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9
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Troppan KT, Melchardt T, Deutsch A, Schlick K, Stojakovic T, Bullock MD, Reitz D, Beham-Schmid C, Weiss L, Neureiter D, Wenzl K, Greil R, Neumeister P, Egle A, Pichler M. The significance of pretreatment anemia in the era of R-IPI and NCCN-IPI prognostic risk assessment tools: a dual-center study in diffuse large B-cell lymphoma patients. Eur J Haematol 2015; 95:538-44. [PMID: 25677782 DOI: 10.1111/ejh.12529] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anemia is frequently identified at the time of diagnosis in patients with diffuse large B-cell lymphoma (DLBCL); however, studies addressing the prognostic significance of this important clinical parameter are lacking. METHODS In this dual-center study of patients with DLBCL (n = 556) treated with rituximab-containing regimens, we evaluated the prognostic relevance of anemia at diagnosis in a training set (n = 211) and validated our findings in a second independent patient cohort (n = 345). Using Kaplan-Meier curves as well as univariate and multivariate Cox regression models, we analyzed the impact of anemia on 5-year overall survival (OS) and 5-year disease-free survival (DFS) alongside established prognostic indicators including age, tumor stage, the revised International Prognostic Index (R-IPI), and the recently published NCCN-IPI. The influence of anemia on the predictive accuracy of IPI, R-IPI, and NCCN-IPI prognosis scores was subsequently determined using the Harrell's concordance index. RESULTS Anemia was an independent predictor of impaired OS and DFS at 5 years in both DLBCL patient cohorts (P < 0.001, log-rank test). In multivariate analysis, hemoglobin level was also a strong and independent prognostic indicator in patients stratified according to R-IPI or NCCN-IPI score. In survival analysis, the estimated concordance index, using IPI, R-IPI, and NCCN-IPI stratification measures (0.69, 0.64, and 0.70, respectively), improved to 0.70, 0.68, and 0.73, respectively, when anemia was also considered. CONCLUSION In this study, we have demonstrated that anemia at the time of diagnosis is an independent predictor of impaired clinical outcome in DLBCL. Furthermore, consideration of hemoglobin levels may improve the accuracy of recently established prognostic tools in lymphoma. Our data encourage further evaluation of the prognostic utility of this readily accessible biological parameter in prospective clinical trials.
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Affiliation(s)
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Deutsch
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Konstantin Schlick
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz (MUG), Graz, Austria
| | - Marc D Bullock
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel Reitz
- Division of Oncology, Medical University of Graz (MUG), Graz, Austria
| | | | - Lukas Weiss
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Kerstin Wenzl
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Richard Greil
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz (MUG), Graz, Austria
| | - Alexander Egle
- 3rd Medical Department with Hematology and Medical Oncology, Hemostaseology, Rheumatology and Infectious Diseases, Laboratory for Immunological and Molecular Cancer Research, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Martin Pichler
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Division of Oncology, Medical University of Graz (MUG), Graz, Austria
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Kurita D, Miura K, Nakagawa M, Ohtake S, Sakagami M, Uchino Y, Takahashi H, Kiso S, Hojo A, Kodaira H, Yagi M, Hirabayashi Y, Kobayashi Y, Iriyama N, Kobayashi S, Hatta Y, Kura Y, Sugitani M, Takei M. Dose-intensified CHOP with rituximab (R-Double-CHOP) followed by consolidation high-dose chemotherapies for patients with advanced diffuse large B-cell lymphoma. Int J Hematol 2015; 101:585-93. [DOI: 10.1007/s12185-015-1780-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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11
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Panizo C, Rodríguez AJ, Gutiérrez G, Díaz FJ, González-Barca E, de Oña R, Grande C, Sancho JM, García-Álvarez MF, Sánchez-González B, Peñalver FJ, Cannata J, Espeso M, Requena MJ, Gardella S, Durán S, González AP, Alfonso A, Caballero MD. Evaluation of clinical and biological prognostic factors in relapsed or refractory diffuse large B-cell lymphoma patients after previous treatment with rituximab and chemotherapy: results of the PRO-R-IPI study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:398-403. [PMID: 25843416 DOI: 10.1016/j.clml.2015.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/26/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity, showing a highly variable outcome. In patients with DLBCL relapsed/refractory to first-line treatment with rituximab the usefulness of the revised International Prognostic Index (R-IPI) as a prognostic tool remains unexplored. Some biological parameters (B-cell lymphoma 6 [Bcl-6], Bcl-2, p53, and multiple myeloma 1 [MUM1]) and blood populations (lymphocyte and monocyte counts) have been described as International Prognostic Index-independent prognostic factors. The objective was to evaluate the R-IPI to predict the outcome of DLBCL patients at the time of relapse after a front-line treatment with chemotherapy and rituximab and to establish in this population the relationship between biological parameters and outcome. PATIENTS AND METHODS We included patients with refractory/relapsed DLBCL after first-line treatment with rituximab-containing regimens; patients must have already finished a rescue treatment also including rituximab. Immunohistochemical assessment of Bcl-2, Bcl-6, p53, and MUM1 expression were undertaken in available biopsies. R-IPI factors were identified from the clinical data at diagnosis and at relapse. Response was assessed using National Cancer Institute-sponsored Working Group guidelines. RESULTS R-IPI prognosis at relapse was not significantly associated with overall response rate (ORR) after Rituximab-chemotherapy rescue therapy. None of the immunohistochemical parameters analyzed correlated with rescue therapy results. In contrast, patients with absolute lymphocyte count (ALC) ≥ 1 × 10(9)/L at relapse were more likely to respond than patients with ALC < 1 × 10(9)/L (P = .05). CONCLUSION The R-IPI score calculated at relapse could not predict the ORR to second-line treatment. Lymphopenia is a simple and useful predictor for outcome in relapsed/refractory DLBCL and the only prognostic factor that in our hands could predict the overall response to a second-line treatment with rituximab and chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Alfonso
- Clínica Universidad de Navarra, Pamplona, Spain
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Huntington SF, Nasta SD, Schuster SJ, Doshi JA, Svoboda J. Utility of interim and end-of-treatment [18F]-fluorodeoxyglucose positron emission tomography–computed tomography in frontline therapy of patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2015; 56:2579-84. [DOI: 10.3109/10428194.2015.1007506] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wu CY, Hsiao LT, Chiou TJ, Gau JP, Liu JH, Yu YB, Wu YT, Liu CJ, Huang YC, Hung MH, Chen PM, Huang YH, Tzeng CH. Lymphocyte/monocyte ratio and cycles of rituximab-containing therapy are risk factors for hepatitis B virus reactivation in patients with diffuse large B-cell lymphoma and resolved hepatitis B. Leuk Lymphoma 2015; 56:2357-64. [PMID: 25459444 DOI: 10.3109/10428194.2014.991922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Reactivation of hepatitis B virus (HBV) following rituximab (R)-containing chemotherapy for lymphoma is a major concern, and risk factors remain to be defined. We enrolled 190 patients diagnosed with diffuse large B-cell lymphoma (DLBCL) and resolved hepatitis B, receiving first-line R-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone)-based regimens. Twenty-seven patients (14.2%) developed HBV reactivation during a median follow-up of 23.6 months. Two independent risk factors were identified: cycles of rituximab>8 (hazard ratio [HR], 2.797; 95% confidence interval [CI], 1.184-6.612) and lymphocyte/monocyte ratio (LMR)<2.50 (HR, 2.733; 95% CI, 1.122-6.657). Two-year overall survival in patients with or without HBV reactivation was 53.8% vs. 77.6% (p=0.025). Regarding the negative impact on clinical outcome, patients at "super high risk" of HBV reactivation, including those receiving more than eight cycles of R and having low LMR at diagnosis, may warrant first priority for antiviral prophylaxis.
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Affiliation(s)
- Chia-Yun Wu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Liang-Tsai Hsiao
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Tzeon-Jye Chiou
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.,c Division of Transfusion Medicine, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Jyh-Pyng Gau
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Jin-Hwang Liu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yuan-Bin Yu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yi-Tsui Wu
- d Department of Nursing , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Chia-Jen Liu
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yu-Chung Huang
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.,e Division of Hematology and Medical Oncology, Department of Medicine , Taipei Veterans General Hospital , Taoyuan Branch, Taoyuan , Taiwan
| | - Man-Hsin Hung
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Po-Min Chen
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
| | - Yi-Hsiang Huang
- b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.,f Division of Gastroenterology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Cheng-Hwai Tzeng
- a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.,b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan
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Song YH, Zhong MZ, Gan PP, Yi PY, Tang YH, Liu YP, Jiang JQ, Li L. ALDH1A1 mediates resistance of diffuse large B cell lymphoma to the CHOP regimen. Tumour Biol 2014; 35:11809-17. [PMID: 25344211 DOI: 10.1007/s13277-014-2335-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/08/2014] [Indexed: 01/25/2023] Open
Abstract
Although there have been substantial advances in our knowledge of the resistance of diffuse large B cell lymphoma (DLBCL) to chemotherapy, there are few efficient treatment strategies for recurrent/refractory DLBCL. The aim of this study was to investigate the role of aldehyde dehydrogenase (ALDH) 1A1 in the resistance of diffuse large B cell lymphoma to the chemotherapeutic mixture consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). The involvement of ALDH1A1 in DLBCL was elucidated by knockdown and pharmacologic inhibition; Cell Counting Kit-8 (CCK-8) and clone formation assays were used to determine its role in CHOP sensitivity and clone formation ability. Caspase colorimetric assay was used to measure the extent of apoptosis. Western blot analysis was used to measure signal transducer and activator of transcription 3 (STAT3)/nuclear factor kappa B (NF-κB) signaling proteins, and quantitative real-time PCR (RT-PCR) was used to measure the differential expression of ALDH1A1 of DLBCL patients and healthy donors. ALDH1A1 showed a 5.64-fold higher expression in malignant B cells than in normal B cells. Diethylaminobenzaldehyde (DEAB) decreased the half maximal inhibitory concentration (IC50) of the CHOP regimen in Farage cells from 344.78 ± 65.75 to 183.88 ± 49.75 ng/ml (P = 0.004). Both knockdown and inhibition of ALDH1A1 reduced clonogenicity, increased caspase-3/caspase-9 activity, and attenuated the phosphorylation status of STAT3/NF-κB. The prognosis of patients with a high level of ALDH1A1 expression was poor compared with that of patients with low levels of expression (P = 0.044). ALDH1A1 is a new mediator for resistance of DLBCL to CHOP; it is a predictor of clinical prognosis and may serve as a potential target to improve chemotherapy responsiveness of human DLBCL.
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Affiliation(s)
- Ying-Hui Song
- Department of Oncology, Xiangya Hospital, Central South University, 88 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
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Vajpayee N, Burack R, Wang D, Hutchison RE, Gajra A. Immunohistochemical expression of mTOR in germinal center and nongerminal center group of diffuse large B-cell lymphoma: a clinicopathological study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 15:159-63. [PMID: 25458080 DOI: 10.1016/j.clml.2014.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/25/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The mammalian target of rapamycin (mTOR) pathway regulates many major cellular processes and is implicated in an increasing number of neoplasms, including lymphoma. PATIENTS AND METHODS We correlated immunohistochemical expression of mTOR with germinal center and nongerminal center phenotype, B cell lymphoma-2 (bcl-2) and cellular homolog of the retroviral v-myconcogene (c-myc) expression, and International Prognostic Index (IPI) score in 31 patients with diffuse large B-cell lymphoma (DLBCL). RESULTS Virtually all patients in our study with high mTOR scores had a germinal center phenotype. Furthermore within the germinal center subgroup, patients with high mTOR scores were associated with higher IPI scores (P < .001). CONCLUSION Based on our results we propose that within the category of germinal center phenotype of DLBCL, mTOR expression might help identify a subset of patients with potentially more aggressive tumors who might benefit from use of targeted therapy using mTOR inhibitors.
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Affiliation(s)
- Neerja Vajpayee
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY.
| | - Richard Burack
- Department of Pathology, University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY
| | | | - Ajeet Gajra
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
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Huang KC, Yang KC, Lin H, Tsao Tsun-Hui T, Lee WK, Lee SA, Kao CY. Analysis of schizophrenia and hepatocellular carcinoma genetic network with corresponding modularity and pathways: novel insights to the immune system. BMC Genomics 2013; 14 Suppl 5:S10. [PMID: 24564241 PMCID: PMC3852078 DOI: 10.1186/1471-2164-14-s5-s10] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Schizophrenic patients show lower incidences of cancer, implicating schizophrenia may be a protective factor against cancer. To study the genetic correlation between the two diseases, a specific PPI network was constructed with candidate genes of both schizophrenia and hepatocellular carcinoma. The network, designated schizophrenia-hepatocellular carcinoma network (SHCN), was analysed and cliques were identified as potential functional modules or complexes. The findings were compared with information from pathway databases such as KEGG, Reactome, PID and ConsensusPathDB. Results The functions of mediator genes from SHCN show immune system and cell cycle regulation have important roles in the eitology mechanism of schizophrenia. For example, the over-expressing schizophrenia candidate genes, SIRPB1, SYK and LCK, are responsible for signal transduction in cytokine production; immune responses involving IL-2 and TREM-1/DAP12 pathways are relevant for the etiology mechanism of schizophrenia. Novel treatments were proposed by searching the target genes of FDA approved drugs with genes in potential protein complexes and pathways. It was found that Vitamin A, retinoid acid and a few other immune response agents modulated by RARA and LCK genes may be potential treatments for both schizophrenia and hepatocellular carcinoma. Conclusions This is the first study showing specific mediator genes in the SHCN which may suppress tumors. We also show that the schizophrenic protein interactions and modulation with cancer implicates the importance of immune system for etiology of schizophrenia.
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