Blood Res.  2017 Sep;52(3):200-206. 10.5045/br.2017.52.3.200.

Platelet to lymphocyte ratio (PLR) retains independent prognostic significance in advanced stage marginal zone lymphoma patients treated with rituximab, cyclophosphamide, vincristine, and prednisone combination chemotherapy (R-CVP): Consortium for Improving Survival of Lymphoma trial

• Seo J
• Kim WS
• Kim JS
• Kim SJ
• Lee JH
• Hong JS
• Lee GW
• Oh SY
• Lee JH
• Yoon DH
• Lee WS
• Kim HJ
• Kwak JY
• Kang HJ
• Jo JC
• Park Y
• Lee HS
• Kim HJ
• Suh C

• KMID: 2390982
• DOI: http://doi.org/10.5045/br.2017.52.3.200

Abstract

BACKGROUND
Rituximab plus cyclophosphamide, vincristine, and prednisone (R-CVP) is one of the effective chemotherapeutic regimens for patients with advanced stage marginal zone lymphoma (MZL). However, prognostic factors that affect the outcome of treatment for MZL are not well understood.
METHODS
Between August 2006 and June 2013, patients with newly diagnosed stage III and IV MZL treated with R-CVP as a first-line therapy from 15 institutions were retrospectively analyzed. Patients' clinical and laboratory data at diagnosis were collected by review of medical records.
RESULTS
A total of 80 patients were analyzed. Bone marrow involvement was observed in 30% cases. Twelve patients (15%) had nodal MZL, and 41.3% patients exhibited multiple mucosa-associated lymphoma tissue sites. Overall response rate was 91.3%, including 73.8% achieving complete response. Advanced MZL patients treated with R-CVP showed a 3-year progression-free survival (PFS) rate of 69.6%. Prognostic markers significantly affecting PFS in univariate analysis were platelet to lymphocyte ratio (PLR, <95 vs. ≥95, P=0.014), serum albumin (≤3.9 vs. >3.9 g/dL, P=0.008), and the International Prognostic Index (IPI) score (1 vs. 2-4, P=0.032). In multivariate analysis, only PLR (<95 vs. ≥95, HR 0.367, 95% CI, 0.139-0.971, P=0.043) was an independent risk factor for PFS.
CONCLUSION
PLR ≥95 at diagnosis is an independent prognostic marker for PFS in advanced stage MZL patients treated with R-CVP. This marker may aid clinicians in predicting the response to R-CVP chemotherapy in stage III and IV MZL patients.

Keyword

Marginal zone lymphoma; R-CVP; Prognosis; PLR

MeSH Terms

Blood Platelets*
Bone Marrow
Cyclophosphamide*
Diagnosis
Disease-Free Survival
Drug Therapy
Drug Therapy, Combination*
Humans
Lymphocytes*
Lymphoma*
Medical Records
Multivariate Analysis
Prednisone*
Prognosis
Retrospective Studies
Risk Factors
Rituximab*
Serum Albumin
Vincristine*
Cyclophosphamide
Prednisone
Rituximab
Serum Albumin
Vincristine

Figure

• 

  Fig. 1 Kaplan-Meier graph depicting progression-free survival (PFS) of patients with advanced stage marginal zone lymphoma (MZL) treated with R-CVP chemotherapy (PFS at 3 years was 69.6%).

• 

  Fig. 2 Kaplan-Meier survival plots; (A) Serum albumin level ≥3.9 g/dL was shown to be a significant predictor of progression free survival (PFS) (HR=0.243, 95% CI 0.086–0.691, P=0.004); (B) PLR was also significantly prognostic for PFS when evaluated for values of <95 (HR=0.298, 95% CI 0.114–0.779, P=0.009); (C) IPI, when categorized by a score of 1 versus 2–4, had prognostic significance for PFS (HR=0.444, 95% CI 0.211–0.933, P=0.017).

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