The effects of serum ferritin and calcium level, body mass index, blood group, peripheral blood absolute lymphocyte/monocyte count ratio and red cell distribution width (RDW) value on prognosis before treatment in patients with diffuse large B-cell lymphoma; retrospective evaluation

Objective: Diffuse Large B-Cell Lymphoma (DLBCL) develops through clonal proliferation of germinal or post-germinal malignant B-cells, accounting for approximately one-third of all non-Hodgkin lymphomas (NHLs). The most commonly used tool for determining disease prognosis is the Revised International Prognostic Index (R-IPI). However, patients with the same R-IPI score can exhibit different clinical courses, and scoring systems may not always be sufficient for determining prognosis. Therefore, research continues to identify additional prognostic factors. This study aims to retrospectively evaluate the impact of pre-treatment serum ferritin and calcium levels, body mass index (BMI), blood type, peripheral blood lymphocyte/monocyte ratio (LMR), and red cell distribution width (RDW) on prognosis in DLBCL patients followed at the Department of Hematology, Karadeniz Technical University Faculty of Medicine. Materials and Methods: 94 patients followed in the hematology outpatient clinic and ward of Karadeniz Technical University Faculty of Medicine between 2016 and 2021 were included in the study. Data on patient's gender, age, height, weight, diagnosis date, pre-treatment laboratory findings [serum ferritin level, serum calcium level, absolute lymphocyte/monocyte ratio (LMR), RDW value], blood type, disease of stage, initial chemotherapy regimen, post-treatment disease progression and date of death were collected and analyzed to determine their impact on treatment response and survival. Results: Of the 94 patients included in the study, 57 (61%) were male and 37 (39%) were female, with a male-to-female ratio of 1.54:1 and a median age of 62 years. Elevated ferritin levels were observed in 17 patients, elevated calcium levels in 9 patients, and elevated RDW values in 17 patients. LMR was ≥3 in 34 patients and 62 patients were overweight or obese. 60 patients received first-line treatment, 16 received second-line treatment and 6 received third-line treatment. 11 patients underwent autologous stem cell transplantation (ASCT). 54 patients were in remission after first-line treatment, while in 40 patients disease progressed. At the last evaluation, 56 patients were alive, and 38 had died. When we examined the effect of pre-treatment findings on survival, ferritin levels on overall survival (OS) and progression-free survival (PFS) (p-values of 0.435 and 0.832, respectively). Patients with hypercalcemia had shorter OS, but no significant difference in PFS (p-values of 0.018 and 0.093, respectively). LMR did not affect OS and PFS (p-values of 0.632 and 0.094, respectively). Patients with RDW ≥16 had shorter PFS and a higher rate of disease progression (p-values of 0.009 and 0.021, respectively), but no significant difference in OS (p=0.103). BMI did not affect OS and PFS (p-values of 0.514 and 0.171, respectively). When the effect of blood groups on survival was examined, no significant difference was observed. Conclusion: In our study, pre-treatment ferritin level, LMR, BMI, and blood type did not impact prognosis in DLBCL patients. Elevated RDW was associated with shorter PFS and higher progression rates, while hypercalcemia was associated with shorter OS. These parameters, which are low-cost and easily accessible, could be useful for predicting prognosis, but comprehensive studies are needed for a better understanding. Keywords: Diffuse large B cell lymphoma, Hypercalcemia, Lymphoma, Prognosis, RDW