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Troppan, KT; Melchardt, T; Deutsch, A; Schlick, K; Stojakovic, T; Bullock, MD; Reitz, D; Beham-Schmid, C; Weiss, L; Neureiter, D; Wenzl, K; Greil, R; Neumeister, P; Egle, A; Pichler, M.
The significance of pretreatment anemia in the era of R-IPI and NCCN-IPI prognostic risk assessment tools: a dual-center study in diffuse large B-cell lymphoma patients.
Eur J Haematol. 2015; 95(6):538-544
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Autor/innen der Med Uni Graz:
Beham-Schmid Christine
Deutsch Alexander
Neumeister Peter
Pichler Martin
Prochazka Katharina
Schlick Konstantin
Stojakovic Tatjana
Wenzl Kerstin
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Abstract:
Anemia is frequently identified at the time of diagnosis in patients with diffuse large B-cell lymphoma (DLBCL); however, studies addressing the prognostic significance of this important clinical parameter are lacking. In this dual-center study of patients with DLBCL (n = 556) treated with rituximab-containing regimens, we evaluated the prognostic relevance of anemia at diagnosis in a training set (n = 211) and validated our findings in a second independent patient cohort (n = 345). Using Kaplan-Meier curves as well as univariate and multivariate Cox regression models, we analyzed the impact of anemia on 5-year overall survival (OS) and 5-year disease-free survival (DFS) alongside established prognostic indicators including age, tumor stage, the revised International Prognostic Index (R-IPI), and the recently published NCCN-IPI. The influence of anemia on the predictive accuracy of IPI, R-IPI, and NCCN-IPI prognosis scores was subsequently determined using the Harrell's concordance index. Anemia was an independent predictor of impaired OS and DFS at 5 years in both DLBCL patient cohorts (P < 0.001, log-rank test). In multivariate analysis, hemoglobin level was also a strong and independent prognostic indicator in patients stratified according to R-IPI or NCCN-IPI score. In survival analysis, the estimated concordance index, using IPI, R-IPI, and NCCN-IPI stratification measures (0.69, 0.64, and 0.70, respectively), improved to 0.70, 0.68, and 0.73, respectively, when anemia was also considered. In this study, we have demonstrated that anemia at the time of diagnosis is an independent predictor of impaired clinical outcome in DLBCL. Furthermore, consideration of hemoglobin levels may improve the accuracy of recently established prognostic tools in lymphoma. Our data encourage further evaluation of the prognostic utility of this readily accessible biological parameter in prospective clinical trials. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Find related publications in this database (using NLM MeSH Indexing)
Adult -
Aged -
Anemia - diagnosis
Anemia - drug therapy
Anemia - etiology
Anemia - mortality
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Erythrocyte Indices -
Female -
Humans -
Kaplan-Meier Estimate -
Lymphoma, Large B-Cell, Diffuse - complications
Lymphoma, Large B-Cell, Diffuse - drug therapy
Lymphoma, Large B-Cell, Diffuse - mortality
Male -
Middle Aged -
Patient Outcome Assessment -
Prognosis -
Proportional Hazards Models -

Find related publications in this database (Keywords)
prognostic factors
diffuse large B-cell lymphoma
hemoglobin
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