Inflammation Marker Prognostic in DLBCL

Higher rates of the inflammation marker erythrocyte sedimentation rate (ESR) was associated with several unfavorable characteristics of and worse survival from diffuse large B-cell lymphoma (DLBCL), according to a retrospective study published in BMC Cancer.

“Our study suggests that pretreatment ESR is associated with overall survival (OS) and progression-free survival (PFS) in DLBCL patients treated with immunochemotherapy,” Shuang Wu, of The Third Affiliated Hospital of Nantong University, and colleagues wrote. “We recommend that ESR be used as an inexpensive biomarker for risk assessment in patients with DLBCL that can be determined without difficulty.”

Research has established that inflammation plays a critical role in certain processes associated with cancer progression. Wu and colleagues conducted this study to determine if ESR, a marker of inflammation routinely measured in clinical practice, has any prognostic value in patients with DLBCL.

The study included data from 182 patients with DLBCL from 2006–2017. The researchers defined ESR of more than 375 mm per hour as the optimal threshold value for predicting prognosis. The median age of the cohort was 55.

About one-third of the cohort had elevated ESR. Elevated ESR was associated with more frequent Ann Arbor stage (P = .0002), a poorer performance status (P < .0001), elevated LDH level (P < .0001), presence of B symptoms (P < .0001), high-risk International Prognostic Index (P < .0001), more extranodal involvement (P = .024), non-GEB subtypes (P = .0004), and more frequent Myc protein positivity (P = .006).

Those patients with ESR levels above the cutoff has significantly shorter OS compared with ESR-negative patients (2-year OS rate 89.0% vs 55.2%; P < .001). The same was true for PFS (2-year PFS rate 60.3% vs 37.5%; P < .001). Multivariable analysis showed that ESR was an independent prognostic factor for both overall and PFS.

The researchers conducted an analysis of survival with 20 patients who completed 6 cycles of standard treatment. Among patients who achieved complete remission, ESR decreased to below 37.5 mm per hour after the first cycle of treatment and never rose to greater than that level again. Among patients with partial response, the decrease in ESR did not occur until the second or third cycle, but remained below the cutoff.

However, those patients with stable disease or progressive disease had ESR levels above the cutoff or rebounded after the initial 2 cycles.

Based on these results, the researchers concluded that “ESR prior to treatment is a promising factor for monitoring treatment response and disease status.”