Lymphocyte count predicts survival after relapse of diffuse large B-cell lymphoma

NEW YORK (Reuters Health) - The peripheral blood absolute lymphocyte count (ALC) at the time of first relapse of diffuse large B-cell lymphoma (DLBCL) is a predictor of survival, according to a retrospective study by researchers at the Mayo Clinic, Rochester, Minnesota.

Although prior work had established that the ALC at diagnosis is an independent predictor of survival in patients with DLBCL, this study is reportedly the first to link ALC at first relapse (ALC-R) to prognosis in first relapsed DLBCL.

"The ALC-R is a simple, not expensive, standardized test that any clinician can use to determine which patients with relapsed DLBCL would do well with further treatment," Dr. Luis F. Porrata told Reuters Health.

The researchers reviewed the records of 97 patients who were diagnosed at Mayo with a first relapse of DLBCL between February 1987 and March 2006. The median age at first relapse was 65 years, and median follow-up from first relapse was 14.6 months, according to the report in the February issue of the American Journal of Hematology.

The patients were retrospectively separated into two groups: those with ALC-R of 1,000,000,000/L or more (60), and those with a lower ALC-R (37).

Both overall survival and progression-free survival were significantly longer in the patients with higher ALC-R.

Specifically, those with higher ALC-R had a 5-year overall survival rate of 39%, versus 14% in those with lower ALC-R. The 5-year progression-free survival rate was 21% in the higher ALC-R group, as against 8% in the other group.

Fifty-one of the 97 patients in the cohort underwent autologous stem cell transplantation as second-line therapy, and the other 46 underwent further chemotherapy. In both groups, median overall survival and progression-free survival were significantly longer for patients with a higher ALC-R than in those with a lower ALC-R.

Overall, the researchers conclude, these results suggest that "host immunity is an important variable predicting survival in first relapsed DLBCL."

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