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Annals of Oncology Advance Access published online on November 3, 2009
Annals of Oncology, doi:10.1093/annonc/mdp505
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Influence of low absolute lymphocyte count of patients with nongerminal center type diffuse large B-cell lymphoma with R-CHOP therapy

M.-K. Song1, J.-S. Chung1,*, Y.-M. Seol1, S.-G. Kim1, H.-J. Shin1, Y.-J. Choi1, G.-J. Cho1 and D.-H. Shin2

1 Department of Hematology–Oncology, Pusan National University Hospital, Medical Research Institute, Busan, Republic of Korea
2 Department of Pathology, Pusan National University Hospital, Medical Research Institute, Busan, Republic of Korea

* Correspondence to: Dr J.-S. Chung, Department of Hematology–Oncology, School of Medicine, Pusan National University, 1-10 Ami-dong, Seo-gu, Busan 602-739, Republic of Korea. Tel: +82-51-240-7225; Fax: +82-51-254-3127; E-mail: hemon{at}pusan.ac.kr

Background: Rituximab has dramatic impact on outcome of patients with diffuse large B-cell lymphoma (DLBCL), especially nongerminal center (non-GC) type. A low absolute lymphocyte count (ALC) before rituximab, cyclophosphamide, vincristine, adriamycin, and prednisone (R-CHOP) therapy as a surrogate marker of immune status is associated with poor clinical outcome in DLBCL. Therefore, we hypothesized that low ALC before R-CHOP would have effect on the survival in non-GC type.

Patients and methods: One hundred and thirty-six DLBCL patients who were treated with R-CHOP from 2003 to 2007 were analyzed in the present study.

Results: ALC ≥1.0 x 109/l predicted a longer 3-year progression-free survival (PFS) and 3-year overall survival (OS) versus ALC <1.0 x 109/l (82.6% versus 60.0%, P = 0.005 and 87.2% versus 62.0%, P < 0.001, respectively). Non-GC type had similar PFS and OS to germinal center type (68.2% versus 80.0%, P = 0.074 and 72.7% versus 82.9%, P = 0.111, respectively). However, considering clinical influence of the ALC according to immunophenotype, low ALC in non-GC type DLBCL was associated with lower PFS and OS compared with others (PFS, P = 0.002; OS, P < 0.001). Multivariate analysis revealed that low ALC in non-GC type had lower PFS [hazard ratio (HR) = 3.324, P = 0.001] and OS (HR = 4.318, P < 0.001), independent of international prognostic index.

Conclusion: A low ALC in non-GC type DLBCL counteracted the beneficial effect of rituximab on survival.

absolute lymphocyte count, diffuse large B-cell lymphoma, nongerminal center, rituximab, survival

Received for publication June 8, 2009. Revision received September 23, 2009. Accepted for publication September 24, 2009.


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