Safaa Ramadan1,2, Giusy Ceparano1, Alessandro Cignetti3, Simona Sammassimo1, Vincenzo Bagnardi4, Eleonora Pagan4, Daniela Gottardi3, Stefano Fiori5, Rita Passerini6, Tommaso Radice1, Giuseppe Saglio3 and Corrado Tarella1,7.
1 Division of Onco-Hematology, European Institute of Oncology, IRCCS, Milan, Italy.
2 NCI-Cairo University, Egypt, Cairo, Egypt.
3 Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Torino, Italy.
4 Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milano, Italy.
5 Haemolymphopathology Unit, European Institute of Oncology IRCCS, Milan, Italy.
6 Divisione di Medicina di Laboratorio, European Institute of Oncology, Milano, Italy.
7 Dipartimento Universitario di Scienze della Salute (DISS), Università di Milano, Italy.
| This is an Open Access article distributed
under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
immune homeostasis as an independent prognostic indicator has been
inadequately evaluated in aggressive non-Hodgkin's lymphomas (NHL). The
present study addresses the prognostic significance in aggressive NHLs
of the immunologic profile evaluated by pretreatment serum levels of
immunoglobulins (Ig) and lymphocyte-monocyte ratio (LMR). In this
series of 90 patients with aggressive lymphoma, the median level for
IgG was 1,024mg/dl (range 436-2236), and for LMR was 2.2 (range
0.2-13.8). CR rate was higher with IgG levels ≥1,024mg/dL (91% vs 77%
p=0.059). LMR ≤ 2.2 was associated with lower 1-year PFS (73% vs. 92%,
p 0.016). Patients with good/very good R-IPI showed a reduced PFS if
IgG or LMR was low, while patients with poor R-IPI did better if LMR or
IgG levels were high. We combined both parameters with the R-IPI and
produced a four-risk prognostic score showing one-year PFS of 95% (95%
CI 68%-99%), 100% (95% CI 100%-100%), 73% (95% CI 52%-86%), and 59%
(95% CI 31%-79%), in patients with zero, one, two and three risk
factors, respectively. The results indicate for the first time
the value of baseline serum Ig levels in the prognostic assessment of
|Table 1. Univariate and multivariate analysis on PFS according to the revised International Prognostic Index (R-IPI) and immunological parameters.|
1. Progression-free survival, by R-IPI risk group (Panel A), by R-IPI risk group and IgG at diagnosis (Panel B), by R-IPI risk group and Lymphocytes/Monocytes ratio at diagnosis (Panel C), and by the 3-factors (poor R-IPI - low LMR - low IgG levels) new risk score (Panel D).