Clinical Characteristics And Prognosis Prediction Model For Patients With Relapsed/refractory Diffuse Large B-cell Lymphoma

Purpose: To research the clinical characteristics and prognostic factors of relapsed / refractory diffuse large B cell lymphoma,and develop a more effective prognosis stratified model that suitable for individualized treatment.Method: A total of 90 relapsed/refractory DLBCL patients who were treated in Fujian Medica University Union Hospital from January 2010 to January 2017 were included in this study.The following clinical information was analyzed: sex,age,GCB/non-GCB pathological subtype,lymphoma B symptoms,ECOG,Ann Arbor phase,blood lactate dehydrogenase(LDH),extranodal extension sites,IPI score,NCCN-IPI score,peripheral blood cell count,serum albumin and serum beta 2 microglobulin at the beginning of the treatment of the disease or in the relapsed / refractory period,ALT,AST,GGT,ALP and fibrinogen before treatment,treatment strategies and so on.The effects of these indicators on overall survival time of patients were analyzed.Survival functions were estimated using the Kaplan-Meier method and compared by the log-rank test.Univariate hazard estimates were generated with unadjusted Cox proportional hazards.Multivariate survival analysis was performed using a Cox regression model in which significant variables in the univariate analysis were included.Two yuan Logistic regression was used to calculate the prediction probability of the prognostic model.The area under the ROC curve was used to compare the diagnostic efficiency of the diagnostic test and calculate the best cut-off point of the prognostic factor.P > 0.05 was considered no statistically significant.All statistical analyses were carried out using Statistical Package for the Social Sciences(SPSS)18.0 software.Result:In the 90 cases patients of relapsed/refractory DLBCL,53 cases(58.9%)were male,male: female =1.43:1,the median age of all patients was 51 years old(rang from 15 to 86 years old),30cases(33.3%)were older than 60 years old,20 cases(22.2%)were diagnosed as relapsed disease,70 cases(77.8%)were diagnosed as refractory disease.The median survival period was 22 months(4-73 months).32 cases(35.6%)had initial Lymphoma B symptoms,33cases(36.7%)had relapsed/refractory Lymphoma B symptoms,45 cases(59.2%)had initial elevated lactate dehydrogenase level,43 cases(55.8%)had relapsed/reflactory elevated lactate dehydrogenase level,64 cases(71.1%)were initial stage III/IVdisease,43 cases(55.8%)were relapsed/reflactory stage III/IVdisease,36 cases(43.9%)were GCB pathological subtype,46 cases(56.1%)were non-GCB pathological subtype.54 cases(61.4%)had normal liver function before the treatment,34 cases(38.6%)had abnormal liver function before the treatment,48 cases(54.5%)AST≥19.5IU/L.22 cases(24.4%)were initial Eastern Cooperative Oncology Group Score(ECOG Score)≥2,24 cases(26.7%)were relapsed/reflactory Eastern Cooperative Oncology Group Score(ECOG Score)≥2,21 cases(23.3%)were initial extranadal extension sites ≥2,23 cases(25.6%)were initial extranadal extension sites ≥2.Univariate analysis showed that the initial lymphoma B symptoms(P=0.001)the relapsed/refractory lymphoma B symptoms(P=0.001),the initial LDH level(P=0.004),the relapsed/refractory LDH level(P=0.002),the initial IPI score(P=0.000),the relapsed/refractory IPI score(P=0.002),the initial NCCN-IPI score(P=0.000),the relapsed/refractory NCCN-IPI score(P=0.005),the liver function before treament(P=0.044),AST(P=0.003)were significantly associated with OS in relapsed/refractory DLBCL.Multivariate analysis showed that the relapsed/refractory lymphoma B symptoms(P=0.023)and relapsed/ refractory LDH level(P=0.004),initial NCCN-IPI score(P=0.000),AST(P=0.050)were independent prognostic factors of 90 cases relapsed/refractory DLBCL.We have designed a new prognostic model(area under the ROC curve 0.817,P<0.000)that based on the relapsed/refractory lymphoma B symptoms,relapsed/ refractory LDH,and AST(≥19.5IU/L),patients were divided into three groups by the new model: less than 1 adverse prognostic factors group(48 cases,53.3%),2 adverse prognostic factors group(28 cases,31.1%),and 3 adverse prognostic factor group(14 cases,15.6%).3 year OS of each group were separately 66.57%,25.30% and 1.01%(P=0.000).Conclusion:1.The morbidity of female is higher than that of male in 90 cases of relapsed / refractory DLBCL.The most common location of disease is lymph node.The proportion of Ann Arbor staging for III-IV and case subtypes for non-GCB was relatively higher.2.Relapsed/refractory lymphoma B symptoms,relapsed/refractory blood lactate dehydrogenase,NCCN-IPI score,AST(≥19.5IU/L)were independent prognostic factors for overall survival.3.The new prognostic model based on relapsed/refractory lymphoma B symptoms,relapsed/refractory blood lactate dehydrogenase and AST has better ability of risk stratification,can distinguish each risk group well,and identify the high risk group with only 1.01% for 3 years OS.It may provide the more information for individual treatment,but the model still need other central patients to further verify its feasibility.