Baseline renal function as a prognostic indicator in patients with newly diagnosed diffuse large B-cell lymphoma.
- Author:
Junshik HONG
1
;
Sojung LEE
;
Gayoung CHUN
;
Ji Yong JUNG
;
Jinny PARK
;
Jeong Yeal AHN
;
Eun Kyung CHO
;
Dong Bok SHIN
;
Jae Hoon LEE
Author Information
- Publication Type:Original Article
- Keywords: Diffuse large B-cell lymphoma; Renal insufficiency; Prognosis; Rituximab
- MeSH: Acute Kidney Injury; B-Lymphocytes*; Cooperative Behavior; Cyclophosphamide; Disease-Free Survival; Doxorubicin; Epidemiology; Glomerular Filtration Rate; Humans; Lymphoma, B-Cell*; Multivariate Analysis; Prednisolone; Prognosis; Renal Insufficiency; Renal Insufficiency, Chronic; Retrospective Studies; Rituximab; Vincristine
- From:Blood Research 2016;51(2):113-121
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: The association between baseline renal impairment (RI) and the prognosis of diffuse large B-cell lymphoma (DLBCL) was previously not defined. The aim of this study was to evaluate the prognostic value of RI in patients with DLBCL treated with three-weekly rituximab plus cyclophosphamide, Adriamycin, vincristine, and prednisolone immunochemotherapy (R-CHOP21). METHODS: Patients with newly diagnosed de novo DLBCLs treated with ≥1 cycle of R-CHOP21 were analyzed retrospectively. Pretreatment blood samples were collected and the glomerular filtration rate (GFR) was calculated. RI was defined by a GFR of <60 mL/min/1.73 m2 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. RESULTS: Of the 185 patients enrolled in the present study, 19 patients (10.3%) had RI. The reasons for baseline RI were pre-existing CKD (N=5), acute kidney injury due to either obstruction (N=2) or electrolyte imbalance (N=2) related to DLBCL, and undefined causes (N=10). Patients with baseline RI showed inferior overall survival (OS) compared to those without RI (P<0.001). In multivariate analysis, RI was identified as an International Prognostic Index (IPI)-independent prognostic indicator. A baseline hemoglobin level of <10 g/dL and the presence of RI effectively discriminated a portion of the patients with far inferior event-free survival and OS among the patients having high or high-intermediate risk cancers according to either the standard- or the National Comprehensive Cancer Network-IPI. CONCLUSION: Pretreatment RI was an independent prognostic marker for inferior OS in patients with DLBCL treated with R-CHOP21 immunochemotherapy.
