Lymphopenia assessed during routine follow-up after immunochemotherapy (R-CHOP) is a risk factor for predicting relapse in patients with diffuse large B-cell lymphoma

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Abstract

A specific predictor during routine follow-up to ascertain risk for relapse after standard chemotherapy in non-Hodgkin's lymphoma (NHL) has not been identified. Thus, we studied absolute lymphocyte count (ALC) as a marker of poststandard chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP)) NHL relapse in patients with diffuse large B-cell lymphoma (DLBCL). ALC was obtained at the time of confirmed relapse and at last follow-up. From 2000 until 2006, 149 consecutive DLBCL patients, originally diagnosed, treated with R-CHOP and followed up at Mayo Clinic, Rochester, were included in this study. Patients at last follow-up without relapse (N112) had a higher ALC compared with those with relapsed lymphoma ((N37) median ALC × 109 /l of 1.43 (range: 0.33-4.0) versus 0.67 (range: 0.18-1.98), P0.0001, respectively). ALC at the time of confirmed relapse was a strong predictor for relapse with an area under the curve 0.91 (P0.0001). An ALC 0.96 × 10 9 /l at the time of confirmed relapse had a positive predictive value of 72% and a positive likelihood ratio of 7.4 to predict relapse after R-CHOP in DLBCL. Patients with an ALC0.96 × 10 9 /l (N103) had a cumulative incidence of relapse of 6 versus 79% with an ALC 0.96 × 10 9 /l (N46) (P0.0001). This study suggests that lymphopenia measured by ALC can be used as a marker to assess risk of DLBCL relapse during routine follow-up after standard chemotherapy.

Original languageEnglish (US)
Pages (from-to)1343-1349
Number of pages7
JournalLeukemia
Volume24
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Lymphopenia
Lymphoma, Large B-Cell, Diffuse
Lymphocyte Count
Recurrence
Drug Therapy
Non-Hodgkin's Lymphoma
Vincristine
Prednisone
Doxorubicin
Cyclophosphamide
Area Under Curve
Lymphoma

Keywords

  • absolute lymphocyte count
  • diffuse large B-cell lymphoma
  • relapse

ASJC Scopus subject areas

  • Hematology
  • Cancer Research
  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

@article{989acb4f8f5740caa705426034bd917d,
title = "Lymphopenia assessed during routine follow-up after immunochemotherapy (R-CHOP) is a risk factor for predicting relapse in patients with diffuse large B-cell lymphoma",
abstract = "A specific predictor during routine follow-up to ascertain risk for relapse after standard chemotherapy in non-Hodgkin's lymphoma (NHL) has not been identified. Thus, we studied absolute lymphocyte count (ALC) as a marker of poststandard chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP)) NHL relapse in patients with diffuse large B-cell lymphoma (DLBCL). ALC was obtained at the time of confirmed relapse and at last follow-up. From 2000 until 2006, 149 consecutive DLBCL patients, originally diagnosed, treated with R-CHOP and followed up at Mayo Clinic, Rochester, were included in this study. Patients at last follow-up without relapse (N112) had a higher ALC compared with those with relapsed lymphoma ((N37) median ALC × 109 /l of 1.43 (range: 0.33-4.0) versus 0.67 (range: 0.18-1.98), P0.0001, respectively). ALC at the time of confirmed relapse was a strong predictor for relapse with an area under the curve 0.91 (P0.0001). An ALC 0.96 × 10 9 /l at the time of confirmed relapse had a positive predictive value of 72{\%} and a positive likelihood ratio of 7.4 to predict relapse after R-CHOP in DLBCL. Patients with an ALC0.96 × 10 9 /l (N103) had a cumulative incidence of relapse of 6 versus 79{\%} with an ALC 0.96 × 10 9 /l (N46) (P0.0001). This study suggests that lymphopenia measured by ALC can be used as a marker to assess risk of DLBCL relapse during routine follow-up after standard chemotherapy.",
keywords = "absolute lymphocyte count, diffuse large B-cell lymphoma, relapse",
author = "Porrata, {L. F.} and K. Rsitow and Inwards, {D. J.} and Ansell, {Stephen Maxted} and Ivana Micallef and Johnston, {Patrick Bruce} and Habermann, {Thomas Matthew} and Witzig, {Thomas Elmer} and Colgan, {J. P.} and Nowakowski, {Grzegorz S} and Thompson, {Carrie A} and Markovic, {Svetomir Nenad}",
year = "2010",
month = "7",
doi = "10.1038/leu.2010.108",
language = "English (US)",
volume = "24",
pages = "1343--1349",
journal = "Leukemia",
issn = "0887-6924",
publisher = "Nature Publishing Group",
number = "7",

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TY - JOUR

T1 - Lymphopenia assessed during routine follow-up after immunochemotherapy (R-CHOP) is a risk factor for predicting relapse in patients with diffuse large B-cell lymphoma

AU - Porrata, L. F.

AU - Rsitow, K.

AU - Inwards, D. J.

AU - Ansell, Stephen Maxted

AU - Micallef, Ivana

AU - Johnston, Patrick Bruce

AU - Habermann, Thomas Matthew

AU - Witzig, Thomas Elmer

AU - Colgan, J. P.

AU - Nowakowski, Grzegorz S

AU - Thompson, Carrie A

AU - Markovic, Svetomir Nenad

PY - 2010/7

Y1 - 2010/7

N2 - A specific predictor during routine follow-up to ascertain risk for relapse after standard chemotherapy in non-Hodgkin's lymphoma (NHL) has not been identified. Thus, we studied absolute lymphocyte count (ALC) as a marker of poststandard chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP)) NHL relapse in patients with diffuse large B-cell lymphoma (DLBCL). ALC was obtained at the time of confirmed relapse and at last follow-up. From 2000 until 2006, 149 consecutive DLBCL patients, originally diagnosed, treated with R-CHOP and followed up at Mayo Clinic, Rochester, were included in this study. Patients at last follow-up without relapse (N112) had a higher ALC compared with those with relapsed lymphoma ((N37) median ALC × 109 /l of 1.43 (range: 0.33-4.0) versus 0.67 (range: 0.18-1.98), P0.0001, respectively). ALC at the time of confirmed relapse was a strong predictor for relapse with an area under the curve 0.91 (P0.0001). An ALC 0.96 × 10 9 /l at the time of confirmed relapse had a positive predictive value of 72% and a positive likelihood ratio of 7.4 to predict relapse after R-CHOP in DLBCL. Patients with an ALC0.96 × 10 9 /l (N103) had a cumulative incidence of relapse of 6 versus 79% with an ALC 0.96 × 10 9 /l (N46) (P0.0001). This study suggests that lymphopenia measured by ALC can be used as a marker to assess risk of DLBCL relapse during routine follow-up after standard chemotherapy.

AB - A specific predictor during routine follow-up to ascertain risk for relapse after standard chemotherapy in non-Hodgkin's lymphoma (NHL) has not been identified. Thus, we studied absolute lymphocyte count (ALC) as a marker of poststandard chemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP)) NHL relapse in patients with diffuse large B-cell lymphoma (DLBCL). ALC was obtained at the time of confirmed relapse and at last follow-up. From 2000 until 2006, 149 consecutive DLBCL patients, originally diagnosed, treated with R-CHOP and followed up at Mayo Clinic, Rochester, were included in this study. Patients at last follow-up without relapse (N112) had a higher ALC compared with those with relapsed lymphoma ((N37) median ALC × 109 /l of 1.43 (range: 0.33-4.0) versus 0.67 (range: 0.18-1.98), P0.0001, respectively). ALC at the time of confirmed relapse was a strong predictor for relapse with an area under the curve 0.91 (P0.0001). An ALC 0.96 × 10 9 /l at the time of confirmed relapse had a positive predictive value of 72% and a positive likelihood ratio of 7.4 to predict relapse after R-CHOP in DLBCL. Patients with an ALC0.96 × 10 9 /l (N103) had a cumulative incidence of relapse of 6 versus 79% with an ALC 0.96 × 10 9 /l (N46) (P0.0001). This study suggests that lymphopenia measured by ALC can be used as a marker to assess risk of DLBCL relapse during routine follow-up after standard chemotherapy.

KW - absolute lymphocyte count

KW - diffuse large B-cell lymphoma

KW - relapse

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