Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy

Michael R. Clausen, Matthew J. Maurer, Sinna Pilgaard Ulrichsen, Thomas S. Larsen, Bodil Himmelstrup, Dorthe Rønnov-Jessen, Brian K. Link, Andrew L. Feldman, Susan L. Slager, Grzegorz S. Nowakowski, Carrie A. Thompson, Per Trøllund Pedersen, Jakob Madsen, Robert S. Pedersen, Jette Sønderskov Gørløv, James R. Cerhan, Mette Nørgaard, Francesco D’amore

Research output: Contribution to journalArticle

Abstract

Background: Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods: In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results: Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion: Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.

Original languageEnglish (US)
Pages (from-to)987-996
Number of pages10
JournalClinical Epidemiology
Volume11
DOIs
StatePublished - Jan 1 2019

Fingerprint

Lymphoma, Large B-Cell, Diffuse
Anthracyclines
Hemoglobins
Drug Therapy
Comorbidity
Survival
Molecular Epidemiology
Hodgkin Disease
Disease-Free Survival
Registries
Lymphoma
Reference Values

Keywords

  • Diffuse large B-cell lymphoma
  • Hemoglobin
  • NCCN-IPI
  • Prognosis

ASJC Scopus subject areas

  • Epidemiology

Cite this

Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy. / Clausen, Michael R.; Maurer, Matthew J.; Ulrichsen, Sinna Pilgaard; Larsen, Thomas S.; Himmelstrup, Bodil; Rønnov-Jessen, Dorthe; Link, Brian K.; Feldman, Andrew L.; Slager, Susan L.; Nowakowski, Grzegorz S.; Thompson, Carrie A.; Pedersen, Per Trøllund; Madsen, Jakob; Pedersen, Robert S.; Gørløv, Jette Sønderskov; Cerhan, James R.; Nørgaard, Mette; D’amore, Francesco.

In: Clinical Epidemiology, Vol. 11, 01.01.2019, p. 987-996.

Research output: Contribution to journalArticle

Clausen, MR, Maurer, MJ, Ulrichsen, SP, Larsen, TS, Himmelstrup, B, Rønnov-Jessen, D, Link, BK, Feldman, AL, Slager, SL, Nowakowski, GS, Thompson, CA, Pedersen, PT, Madsen, J, Pedersen, RS, Gørløv, JS, Cerhan, JR, Nørgaard, M & D’amore, F 2019, 'Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy', Clinical Epidemiology, vol. 11, pp. 987-996. https://doi.org/10.2147/CLEP.S219595
Clausen, Michael R. ; Maurer, Matthew J. ; Ulrichsen, Sinna Pilgaard ; Larsen, Thomas S. ; Himmelstrup, Bodil ; Rønnov-Jessen, Dorthe ; Link, Brian K. ; Feldman, Andrew L. ; Slager, Susan L. ; Nowakowski, Grzegorz S. ; Thompson, Carrie A. ; Pedersen, Per Trøllund ; Madsen, Jakob ; Pedersen, Robert S. ; Gørløv, Jette Sønderskov ; Cerhan, James R. ; Nørgaard, Mette ; D’amore, Francesco. / Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy. In: Clinical Epidemiology. 2019 ; Vol. 11. pp. 987-996.
@article{62b7116f450d4800968eb77073ce8d6a,
title = "Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy",
abstract = "Background: Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods: In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95{\%} CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results: Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion: Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.",
keywords = "Diffuse large B-cell lymphoma, Hemoglobin, NCCN-IPI, Prognosis",
author = "Clausen, {Michael R.} and Maurer, {Matthew J.} and Ulrichsen, {Sinna Pilgaard} and Larsen, {Thomas S.} and Bodil Himmelstrup and Dorthe R{\o}nnov-Jessen and Link, {Brian K.} and Feldman, {Andrew L.} and Slager, {Susan L.} and Nowakowski, {Grzegorz S.} and Thompson, {Carrie A.} and Pedersen, {Per Tr{\o}llund} and Jakob Madsen and Pedersen, {Robert S.} and G{\o}rl{\o}v, {Jette S{\o}nderskov} and Cerhan, {James R.} and Mette N{\o}rgaard and Francesco D’amore",
year = "2019",
month = "1",
day = "1",
doi = "10.2147/CLEP.S219595",
language = "English (US)",
volume = "11",
pages = "987--996",
journal = "Clinical Epidemiology",
issn = "1179-1349",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy

AU - Clausen, Michael R.

AU - Maurer, Matthew J.

AU - Ulrichsen, Sinna Pilgaard

AU - Larsen, Thomas S.

AU - Himmelstrup, Bodil

AU - Rønnov-Jessen, Dorthe

AU - Link, Brian K.

AU - Feldman, Andrew L.

AU - Slager, Susan L.

AU - Nowakowski, Grzegorz S.

AU - Thompson, Carrie A.

AU - Pedersen, Per Trøllund

AU - Madsen, Jakob

AU - Pedersen, Robert S.

AU - Gørløv, Jette Sønderskov

AU - Cerhan, James R.

AU - Nørgaard, Mette

AU - D’amore, Francesco

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods: In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results: Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion: Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.

AB - Background: Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods: In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results: Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion: Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.

KW - Diffuse large B-cell lymphoma

KW - Hemoglobin

KW - NCCN-IPI

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=85075066484&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075066484&partnerID=8YFLogxK

U2 - 10.2147/CLEP.S219595

DO - 10.2147/CLEP.S219595

M3 - Article

AN - SCOPUS:85075066484

VL - 11

SP - 987

EP - 996

JO - Clinical Epidemiology

JF - Clinical Epidemiology

SN - 1179-1349

ER -