Comparative Prognostic Performance of Nutritional and Inflammatory Indices in Diffuse Large B-Cell Lymphoma

Area of Science:

• Oncology
• Hematology
• Clinical Nutrition

Background:

• Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive non-Hodgkin lymphoma.
• Approximately 30-40% of DLBCL patients face relapsed or refractory disease despite current treatments.
• Nutritional and inflammatory markers may impact clinical outcomes, but their prognostic value in DLBCL is not fully established.

Purpose of the Study:

• To evaluate the prognostic significance of the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score.
• To assess the association of these indices with overall survival (OS) and progression-free survival (PFS) in DLBCL patients treated with rituximab-based regimens.

Main Methods:

• Retrospective analysis of 192 newly diagnosed DLBCL patients treated with R-CHOP or R-EPOCH.
• Utilized Receiver Operating Characteristic (ROC) curve analysis to determine optimal cutoff values for PNI, GNRI, and HALP.
• Employed Kaplan-Meier analysis and Cox proportional hazards regression to assess prognostic impact on OS and PFS.

Main Results:

• PNI, HALP, and GNRI showed significant discriminatory ability for OS, with PNI having the highest AUC (0.734).
• Low PNI, GNRI, and HALP were associated with adverse clinical factors including elevated LDH, advanced Ann Arbor stage, and higher IPI.
• Low PNI, GNRI, and HALP were significantly linked to inferior OS, but not PFS. PNI, HALP, and GNRI were independent predictors of OS.

Conclusions:

• PNI, GNRI, and HALP serve as independent prognostic markers in DLBCL patients undergoing rituximab-based therapy.
• These accessible and cost-effective baseline indices can aid in risk stratification and identifying high-risk patients.
• These markers may complement the International Prognostic Index (IPI) for improved patient management.