NT-ProBNP Is the Strongest Prognostic Factor for Survival in Lymphoma Patients Following Treatment with Curative Intent

Introduction: High blood levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), a sensitive indicator of cardiac abnormalities, have been associated with poor outcome in patients with amyloidosis. However, its clinical value in lymphoma is unknown.

Aim: To assess the value of NT-proBNP as a prognostic variable for survival in patients with lymphoma treated with chemotherapy with curative intent.

Patients and methods: Clinical heart examination, evaluation of cardiovascular risk factors, determination of NT-proBNP (ECLIA; Roche) blood levels and high resolution ultrasound echocardiography were done at diagnosis. Clinical variables related with patient characteristics, lymphoma risk and cardiovascular risk were analyzed.

Results: 117 consecutive pts have been analyzed: median age: 63 years (range: 18–88); male: 56%; NHL: 80%; HL: 20%; ECOG/PS ≥2: 29%; III–IV: 56%; B-symptoms: 16%; LDH >1 nv: 34%; b2-microglobulin >1 nv: 57%; albumin <35 g/L: 32%; haemoglobin <105 g/L: 25%; extranodal ≥2: 20%; number of comorbidities ≥2: 51%; previous cardiac disease: 10%; median NT-proBNP: 107 pg/mL (4–9102); median left ventricular ejection fraction (LVEF): 66% (41–83). High blood levels of NT-proBNP were associated with previous cardiologic history but not with LVEF. With a median follow-up of 15.8 moths (0.2–48.9), 16 patients died. Overall survival (OS) at 24 months was 84% (95% CI: 77– 91%). In the univariate analysis, factors associated with worse OS were: NT-proBNP >900, ECOG/PS ≥2, LDH >1 nv, b2-microglobulin >1 nv, albumin < 35 g/L, haemoglobin <105 g/L, comorbidities ≥2, previous cardiologic history, extranodal sites ≥2, age >60. In multivariate analysis, factors predicting for survival were NT-proBNP >900 (HR 15, 95%CI: 3.9–57.8) (p<0.0001) and ECOG/PS ≥2.(HR 4.1, 95%CI: 1.1–16.3) (p=0.04).

Conclusions:

1. NT-proBNP >900 pg/mL is the strongest prognostic factor for survival in patients with lymphoma following treatment with curative intent.

2. NT-proBNP is an easy, fast, widely available and well-standardized parameter that could be useful in addition to other well-established prognostic indexes.