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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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
Issue number7
StatePublished - Jul 2010



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

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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