Prognostic value of clinical and laboratory features at diagnosis in patients wi̇th di̇ffused large B cell lymphoma; retrospective study

Purpose: Approximately 150.000 people in the world are diagnosed with Diffuse large B cell lymphoma (DLBCL) each year. Complete remission can be achieved in approximately 70% of patients with the addition of rituximab (anti-CD20 antibody) to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolon) chemotherapy. However, 30% of patients still relapse. In DLBCL; The International Prognostic Index (IPI) was developed as a result of analyzes made with clinical and laboratory parameters that affect treatment response, progression-free survival (PFS) and overall survival (OS). IPI is still widely used for this purpose. In recent years, as a result of a better understanding of the biology of DLBCL, studies have been carried out on new parameters effective in prognosis. One of these studies is subtypes determined according to gene expressions in DLBCL. There are studies in the literature that the antigen-activated subtype has a worse prognosis than the germinal center subtype (GCB). Although there are retrospective and prospective studies and prognostic indices in the literature investigating the effects on prognosis in DLBCL, variability in the biology of lymphoma and patient-related factors in different geographic and ethnic structures should also be considered. Thus, as real life data in our study; we aimed to investigate the effects of clinical, pathological, demographic and biochemical features at the time of diagnosis on remission rate, recurrence development, overall survival and progression-free survival in DLBCL patients. Material and Method: 100 DLBCL patients diagnosed and treated by Tekirdağ Namık Kemal University Medical Faculty Hematology Clinic between 2012-2022 were included in our study and the data of these patients were analyzed retrospectively. Age, sex, performance scores, stage of the disease, presence of B symptoms and extranodal involvement, risk groups of IPI and CNS-IPI, presence of splenomegaly, germinal or non-germinal type, hemoglobin, leukocyte, creatinine, platelet, ferritin, albumin, LDH, ALT, ALP values, treatments given, responses to treatments, recurrence and ex status, time parameters were noted. Statistical calculations were made with the IBM SPSS (Statistical Package of Social Science, version 26.0) program. Cox regression was used to determine mortality and recurrence risk among patient groups, Logistic regression was used to evaluate response to treatment and Kaplan Meier-Log rank method was used to compare survival times. Results: A total of 100 patients, 50 women and 50 men, were included in our study. There were 54 patients aged 60 and above, 58 patients with advanced stage, 65 patients with ECOG 2 and above, 23 patients with high risk IPI, 28 patients with high risk CNS-IPI and 49 patients with extranodal involvement. First-line treatment was given to all patients. %84 of the patients responded to the first-line treatment and %16 did not respond. During the follow-up period, mortality occurred in 24% of patients and recurrence in 27%. The rate of responding to first-line treatment was higher in those with low leukocytes than those with high leukocytes (HR=0.34, 95% CI:0.12-0.95, p=0.040). The rate of responding to first-line treatment was higher in those with low ferritin than those with high ferritin (HR=0.29, 95% CI:0.10-0.81, p=0.018). The risk of both mortality and recurrence was higher in those aged 60 and over, poor performance and extranodal involvement, high CNS-IPI and IPI scores, high creatinine and ferritin, and low albumin. İn our study; advanced age, poor performance, high IPI, high CNS-IPI, presence of extranodal involvement, low hemoglobin and low albumin, high creatinine and high ferritin adversely affected PFS. Advanced stage, advanced age, poor performance, high IPI, high CNS-IPI, presence of extranodal involvement, low albumin, high creatinine and high ferritin adversely affected OS. Consistent with the literature; the 5-year PFS and OS rates of the patients in our study were 61.9% and 65.4%, respectively. Conclusion: Consistent with the literature, prognostic indices such as IPI and CNS-IPI were found to be associated with OS and PFS in our study. Age, stage, performance and presence of extranodal involvement included in IPI were also associated with survival. However, there was no effect of LDH on OS, PFS, recurrence and mortality. Conflicting results have been reported in many studies investigating the effect of albumin level on lymphoma prognosis. However; in our study, albumin level was found to be associated with disease survival, recurrence and mortality risk. To date, there has been no study investigating the effect of ferritin level at the time of diagnosis on response to first-line treatment in DLBCL. In our study, a significant correlation was found between ferritin level at the time of diagnosis and response to treatment, recurrence and mortality risk. This makes our study original and contributes to the literature. Based on all the results in our study, it can be said that ferritin level is a prognostic parameter. Keywords: Lymphoma, Diffuse Large B Cell Lymphoma, Prognosis, Survival, Relapse, Mortality