TY - JOUR
T1 - Pretreatment hemoglobin adds prognostic information to the nccn-ipi in patients with diffuse large b-cell lymphoma treated with anthracycline-containing chemotherapy
AU - Clausen, Michael R.
AU - Maurer, Matthew J.
AU - Ulrichsen, Sinna Pilgaard
AU - Larsen, Thomas S.
AU - Himmelstrup, Bodil
AU - Rønnov-Jessen, Dorthe
AU - Link, Brian K.
AU - Feldman, Andrew L.
AU - Slager, Susan L.
AU - Nowakowski, Grzegorz S.
AU - Thompson, Carrie A.
AU - Pedersen, Per Trøllund
AU - Madsen, Jakob
AU - Pedersen, Robert S.
AU - Gørløv, Jette Sønderskov
AU - Cerhan, James R.
AU - Nørgaard, Mette
AU - D’amore, Francesco
N1 - Publisher Copyright:
© 2019 Clausen et al.
PY - 2019
Y1 - 2019
N2 - Background: Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods: In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results: Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion: Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.
AB - Background: Hemoglobin (Hgb) concentration at diagnosis is associated with outcome in cancer. In a recently reported simplified 3-factor prognostic score in Hodgkin lymphoma, Hgb, along with age and clinical stage, outperformed the classical International Prognostic Score with seven parameters. Methods: In the present study, we investigated if pretherapeutic Hgb concentration added prognostic information to the NCCN-IPI in diffuse large B-cell lymphoma. We included patients from the Danish Lymphoma Registry (LYFO; N = 3499) and from the Molecular Epidemiology Resource (MER; N = 1225), Mayo Clinic and University of Iowa. Four sex-specific Hgb groups were defined: below transfusion threshold, from transfusion threshold to below lower limit of normal, from lower limit of normal to the population mean, and above the mean. We used multivariable Cox regression to estimate the hazard rate ratios (HR) and 95% CIs for overall survival (OS) and event-free survival (EFS), adjusting for sex, NCCN-IPI, comorbidity, and rituximab treatment. Results: Approximately half of the patients had Hgb levels below the lower limit of normal. Compared to patients with Hgb levels above the mean, an inferior OS was directly correlated with lower pretreatment Hgb within the predefined groups (HR=1.23, HR=1.51, and HR=2.05, respectively). These findings were validated in the MER. Conclusion: Based on multivariable analysis, lower pretreatment Hgb, even within the normal range but below the mean, added prognostic information to established indices such as the NCCN-IPI and the Charlson comorbidity index.
KW - Diffuse large B-cell lymphoma
KW - Hemoglobin
KW - NCCN-IPI
KW - Prognosis
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U2 - 10.2147/CLEP.S219595
DO - 10.2147/CLEP.S219595
M3 - Article
AN - SCOPUS:85075066484
SN - 1179-1349
VL - 11
SP - 987
EP - 996
JO - Clinical Epidemiology
JF - Clinical Epidemiology
ER -