Prognostic Nutritional Index Predicts Early Mortality in Diffuse Large B-cell Lymphoma

Area of Science:

• Hematology
• Oncology
• Clinical Research

Background:

• The International Prognostic Index (IPI) and Revised IPI (R-IPI) are standard tools for assessing diffuse large B-cell lymphoma (DLBCL) prognosis.
• These existing indices may not adequately identify patients with extremely high-risk disease.
• The Prognostic Nutritional Index (PNI), derived from lymphocyte count and albumin levels, has emerged as a potential prognostic marker in various cancers, including DLBCL.

Purpose of the Study:

• To evaluate the prognostic value of the PNI in patients with high-risk DLBCL.
• To compare the predictive accuracy of PNI against established indices like R-IPI for survival outcomes in DLBCL.

Main Methods:

• A cohort of 110 DLBCL patients treated with standard chemoimmunotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) was analyzed.
• Pre-treatment scores for IPI, R-IPI, and PNI were calculated.
• Progression-free survival (PFS) and overall survival (OS) were assessed, with PNI cut-off values determined using the X-Tile program.

Main Results:

• While R-IPI showed prognostic value (p=0.001), PNI stratified patients into distinct risk groups (high <33, intermediate 33-42, low ≥42).
• High-risk PNI (<33) patients had significantly shorter median PFS (2 months) and OS (3 months) compared to intermediate (PFS 9 months, OS 19 months) and low-risk groups (median PFS/OS not reached).
• PNI identified a poorer prognosis (3-month OS) in the poor-risk group compared to R-IPI (17-month OS).

Conclusions:

• The PNI demonstrates superior ability in predicting early mortality in DLBCL compared to the R-IPI.
• PNI offers a valuable tool for identifying very high-risk DLBCL patients who may require more intensive or alternative treatment strategies.
• Integrating PNI into risk stratification could improve clinical management and outcomes for DLBCL patients.