Cox Maria Christina, Nofroni Italo, Ruco Luigi, Amodeo Rachele, Ferrari Antonella, La Verde Giacinto, Cardelli Patrizia, Montefusco Enrico, Conte Esmeralda, Monarca Bruno, Aloe-Spiriti Maria Antonietta
Department of Hematology, AO Sant'Andrea, La Sapienza University,Rome, Italy.
Leuk Lymphoma. 2008 Sep;49(9):1745-51. doi: 10.1080/10428190802226425.
The prognostic value of absolute lymphocytic count (ALC), has been a recent matter of debate in non-Hodgkin-lymphoma (NHL). We assessed prospectively the value of ALC at diagnosis and also after the completion of immuno-chemotherapy in 101 diffuse-large-B-cell-lymphoma (DLBCL). Analysis of prognostic factors with respect to overall survival (OS), event free survival (EFS) and progression free survival (PFS) was done by two-tailed log-rank test. The ALC cut-off value was calculated as <0.84 x 10(9)/L at diagnosis: this was a strong negative prognostic factor for OS (p = 0.0004), EFS (p < 0.00001) and PFS (p < 0.00001) and in multivariate analysis was independent from the revised-international-prognostic-index (R-IPI). ALC after chemo-immunotherapy was not of prognostic value. As R-IPI and ALC < 0.84 x 10(9)/L, were the factors better discriminating poor prognosis, a new trichotomous score (ALC/R-IPI) was built up: (1) low risk: R-IPI = very good or good and ALC < 0.84 x 10(9)/L; (2) intermediate risk: patients with at least one risk factor (R-IPI = poor or ALC < 0.84 x 10(9)/L). (3) high risk: patients with both risk factors. This new prognostic score was highly significant in univariate analysis for OS (p = 0.0002), EFS (p < 0.00001) and PFS (p < 0.00001). In multivariate analysis ALC/R-IPI was the most predictive factor for OS (OR = 2.954; p = 0.002) and EFS (OR = 2.381; p < 0.00001) and the only predictive factor for PFS (OR = 4.018; p < 0.00001). Our data, show that ALC at diagnosis has a strong prognostic relevance and is independent from the R-IPI. The new score including both values proved the most powerful predictor at multivariate analysis.
绝对淋巴细胞计数（ALC）的预后价值，近来一直是非霍奇金淋巴瘤（NHL）领域争论的焦点。我们前瞻性地评估了101例弥漫性大B细胞淋巴瘤（DLBCL）患者诊断时及免疫化疗完成后的ALC值。通过双尾对数秩检验分析了总生存期（OS）、无事件生存期（EFS）和无进展生存期（PFS）的预后因素。诊断时ALC的临界值计算为<0.84×10⁹/L：这对OS（p = 0.0004）、EFS（p < 0.00001）和PFS（p < 0.00001）是一个强烈的负性预后因素，并且在多因素分析中独立于修订后的国际预后指数（R-IPI）。免疫化疗后的ALC没有预后价值。由于R-IPI和ALC < 0.84×10⁹/L是更好区分不良预后的因素，构建了一个新的三分位数评分（ALC/R-IPI）：（1）低风险：R-IPI = 非常好或好且ALC < 0.84×10⁹/L；（2）中风险：至少有一个风险因素的患者（R-IPI = 差或ALC < 0.84×10⁹/L）。（3）高风险：有两个风险因素的患者。这个新的预后评分在单因素分析中对OS（p = 0.0002）、EFS（p < 0.00001）和PFS（p < 0.00001）具有高度显著性。在多因素分析中，ALC/R-IPI是OS（OR = 2.954；p = 0.002）和EFS（OR = 2.381；p < 0.00001）的最具预测性的因素，也是PFS（OR = 4.018；p < 0.00001）的唯一预测因素。我们的数据表明，诊断时的ALC具有很强的预后相关性且独立于R-IPI。包含这两个值的新评分在多因素分析中被证明是最有力的预测指标。
