TORNA ALL’ELENCO

The lymphocytes to monocytes ratio identifies a patient subgroup among high risk DLBCL that may benefit from upfront intensive treatment with autograft in Haematologica

2013
AO Ordine Mauriziano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (27)Vedi tutti...

Barbui AM

Masciulli A

Scarano M


et alii...

Abstract

Background. At diagnosis, a peripheral blood lymphocytes to monocytes ratio (LMR) lower than 2.6, identifies a group of DLBCL patients with a poor prognosis when treated with R-CHOP (Rambaldi et al, ASH 2012). No data are available for patients treated upfront with Rituximab containing high dose sequential chemotherapy programs (R-HDS) and autologous stem cell transplantation (AST) Aims. To investigate whether LMR ratio may identify a high-risk patient subgroup that benefits from a primary high-dose program with ASCT Methods. We analysed LMR ratio at diagnosis in a series of DLBCL patients enrolled into a trial comparing R-CHOP 14 with R-HDS associated with AST (R-HDS 0305, Clinical Trials.gov.number NCT00355199 by GITIL). Patients characteristics: DLBCL without CNS involvement, with an age between 18-60 years and an High IPI (stage > II B-bulk with ECOG-PS=0-3 and age adjusted IPI (aaIPI) 2-3 or age 61-65 years with ECOG-PS = 0-2 and IPI > 3). R-CHOP 14 (8 cycles) or R-HDS regimen and AST were carried out as previously reported(Tarella C et al, Leukemia 2007) Results. LMR data were collected in 216 evaluable DLBCL patients enrolled into this trial. We identified two groups of patients according to baseline LMR: 144 patients (67%) had a low LMR (<2.6), while 72 patients (33%) had a high (>2.6) LMR. The two groups were comparable for age, gender, stage, ECOG, extranodal sites, bone marrow infiltration while high LDH level was associated with a low LMR (p= 0.009). In multivariate analysis OS and EFS corrected by age, gender, stage, ECOG, LDH, extranodal sites, BM involvement and treatment arm, resulted significantly improved by RHDS and AST only in the low LMR group with an hazard ratio (HR) of 0.41 (95% IC 0.2-0.81), p=0.011. In the same patient population with a low LMR, a high ECOG was associated with a two times higher risk of events (HR 2.55, 95% IC 1.26-5.16, p=0.009). After a median observation of 35.4 months (0.3-89.2), the OS and EFS of patients treate

Keywords

central nervous system; chemotherapy; population; autologous stem cell transplantation; high risk patient; arm; leukemia; bone marrow; peripheral lymphocyte; multivariate analysis; hazard ratio; prognosis; gender; drug megadose; electrocorticography; diagnosis; large cell lymphoma; hematology; autograft; risk; human; patient; lymphocyte; monocyte; lactate dehydrogenase; rituximab;