Can the Prognosis of Diffuse Large B-Cell Lymphoma be Predicted by a Simple CBC Count?

Objective: In this study, we aimed to develop a new prognostic model using the neutrophil-to-lymphocyte ratio (NLR) and defined prognostic indexes to improve the results in patients with diffuse large B-cell lymphoma (DLBCL). Methods: The data of 340 newly diagnosed patients with DLBCL, who underwent at least two cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), were evaluated retrospectively. A receiver operating characteristic (ROC) curve analysis was used to determine the NLR cut-off value. The NLR cut-off value was 4.76. In the study, a total of 231 patients (67.9%) were in the low NLR <= 4.76 group, while 109 patients (32.1%) were in the high NLR (NLR >4.76) group. Results: The 5-year overall survival (OS) was 37.1%, and 78.9% in the high NLR group, and low NLR group, respectively. A high pre-treatment NLR was associated with a worse OS and progression-free survival (PFS) (both p<0.001, respectively). In the multivariate analysis, a high pre-treatment NLR and a high National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) status were found to be as an independent risk factors of poor OS (hazard ratio [HR]=2.28; 95% confidence interval [CI]=1.51-3.45; p=0.001; HR=5.59; 95% CI=3.22-9.70; p=0.001, respectively) and PFS. Conclusion: The study found that a high NLR was associated with a poor treatment response, poor PFS, and OS. In view of these data, we believe that the creation of an inflammation-based cumulative prognostic score system (IBCPSS), by adding NLR among the factors whose prognostic importance has been proven in DLBCL, can especially shed light on the early diagnosis of patients with a poor prognosis, aggressive treatment decision, and individualization of treatment.