Baseline renal function as a prognostic indicator in patients with newly diagnosed diffuse large B-cell lymphoma

• Published in: Blood research Vol. 51; no. 2; pp. 113 - 121
• Main Authors: Hong, Junshik, Lee, Sojung, Chun, Gayoung, Jung, Ji Yong, Park, Jinny, Ahn, Jeong Yeal, Cho, Eun Kyung, Shin, Dong Bok, Lee, Jae Hoon
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society of Hematology; Korean Society of Blood and Marrow Transplantation; Korean Society of Pediatric Hematology-Oncology; Korean Society on Thrombosis and Hemostasis 01.06.2016; 대한혈액학회
• Subjects: Original; 병리학; Rituximab; Renal insufficiency; Prognosis; Diffuse large B-cell lymphoma
• ISSN: 2287-979X; 2288-0011
• DOI: 10.5045/br.2016.51.2.113

The association between baseline renal impairment (RI) and the prognosis of diffuse large B-cell lymphoma (DLBCL) was previously not defined. The aim of this study was to evaluate the prognostic value of RI in patients with DLBCL treated with three-weekly rituximab plus cyclophosphamide, Adriamycin, vincristine, and prednisolone immunochemotherapy (R-CHOP21). Patients with newly diagnosed de novo DLBCLs treated with ≥1 cycle of R-CHOP21 were analyzed retrospectively. Pretreatment blood samples were collected and the glomerular filtration rate (GFR) was calculated. RI was defined by a GFR of <60 mL/min/1.73 m(2) according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Of the 185 patients enrolled in the present study, 19 patients (10.3%) had RI. The reasons for baseline RI were pre-existing CKD (N=5), acute kidney injury due to either obstruction (N=2) or electrolyte imbalance (N=2) related to DLBCL, and undefined causes (N=10). Patients with baseline RI showed inferior overall survival (OS) compared to those without RI (P<0.001). In multivariate analysis, RI was identified as an International Prognostic Index (IPI)-independent prognostic indicator. A baseline hemoglobin level of <10 g/dL and the presence of RI effectively discriminated a portion of the patients with far inferior event-free survival and OS among the patients having high or high-intermediate risk cancers according to either the standard- or the National Comprehensive Cancer Network-IPI. Pretreatment RI was an independent prognostic marker for inferior OS in patients with DLBCL treated with R-CHOP21 immunochemotherapy.