Prognostic Value Of LMR,RDW And FIB In Newly Diagnosed Diffuse Large B-cell Lymphoma

Objective : To investigate the value of absolute lymphocyte count/absolute monocyte count(LMR),red cell distribution width(RDW)and plasma fibrinogen(FIB)for the evaluation of therapeutic efficacy and prognosis in patients with diffuse large B-cell lymphoma(DLBCL).Methods:The clinical data was retrospectively analyzed based on the study of105 patients with DLBCL.The patients were divided into high LMR group(> 3.50)and low LMR group(? 3.50)according to the median value of LMR at initial diagnosis of 3.50.After 4 ~ 6 courses of treatment with R-CHOP regimen,we assessed the changes of absolute lymphocyte count(ALC),absolute monocyte count(AMC)and LMR.According to the normal values of RDW(? 15%)and FIB(FIB ?4 g/L)in reports of our hospital,the patients were divided into low RDW group(?15%)and high RDW group(> 15%),low FIB group(FIB ? 4 g/L)and high FIB group(FIB > 4 g/L).The correlation between each factors and efficacy,prognosis was analyzed by univariate and multivariate regression.Results:The study showed that low LMR was associated with high Ann Arbor stage,high ECOG performance score,high lactate dehydrogenase level,high IPI score,high NCCN-IPI score,B symptoms and poor efficacy(P < 0.05).High RDW was associated with high ECOG performance score,high LDH level,high NCCN-IPI score and poor efficacy(P < 0.05).High FIB was associated with higher age,high Ann Arbor stage,high ECOG performance score,high IPI score,NCCN-IPI score,B symptoms and poor efficacy(P < 0.05).After 4 ~ 6 cycles of R-CHOP regimen,median ALC increased from 1.316(0.814 ~ 1.701)� 10 * 9/L to 1.430(0.963 ~ 1.856)� 10 * 9/L(P < 0.05),median LMR increased from 3.545(2.000 ~ 4.690)� 10 * 9/L to 3.555(2.133 ~ 6.200)� 10 * 9/L(P < 0.05),There isn't significant numerical variation of AMC(P > 0.05).The OS and PFS were poorer in the low LMR group compared with the high LMR group(P < 0.05).In high LMR group at initial diagnosis,the OS and PFS were poorer in the decreased LMR group compared with the increased LMR group after treatment(P < 0.05).In low LMR at initial diagnosis,the OS was poorer in the decreased LMR group compared with the increased LMR group after treatment(P < 0.05).The OS and PFS were poorer in the high RDW group compared with the low RDW group(P < 0.05).The PFS was poorer in the high Fib group compared with the low Fib group(P < 0.05).Multivariate analysis showed that high RDW was the independent risk factor for efficacy(OR=3.460,95 %CI:1.116~10.75,P=0.032)and low LMR was the independent risk factor for survival prognosis of DLBCL patients(OR=2.779,95%CI:1.161~6.654,P=0.022).Conclusion:Low LMR,high RDW and high FIB were associated with poor efficacy in DLBCL patients,It is suggesting that LMR,RDW and FIB can be used as clinical indicators for early prediction of DLBCL prognosis.