The Role Of Modified Glasgow Prognostic Score As Predictor In Diffuse Large B Cell Lymphoma Treated With The R-CHOP Regimen

The modified Glasgow Prognostic Score (mGPS), an inflammation-based prognostic score consisting of serum C-reactive protein (CRP) levels and serum albumin levels, shows significant prognostic value in several types of tumors. However, the prognostic value of GPS in lymphoma remains unclear. In this study, we evaluated the prognostic significance of mGPS in patients with diffuse large B cell lymphoma (DLBCL).

The medical records of 285 DLBCL patients (156 males, 128 females) who were treated with R-CHOP chemotherapy at Yonsei University Severance Hospital were retrospectively reviewed. Patients with an elevated CRP level (³10 mg/L) and hypoalbuminemia (<3.5 g/dL) were given a score of 2, patients with CRP elevated were assigned a score of 1, and patients with neither of these abnormalities were scored 0.

The study population included 285 patients with a median age of 58 years (range, 21-87 years). According to mGPS classification, 204 patients (71.5%) had an mGPS of 0, 57 patients (20%) had an mGPS of 1, and 24 patients (8.5%) had an mGPS of 2. Our study found that high mGPS were associated with poor prognostic factors including older age (>60 years), extranodal (EN) involvement, advanced disease stage, unfavorable IPI scores, and the presence of B symptoms. After 3 cycles of R-CHOP chemotherapy, 144 of the 285 treated patients (50.5%) achieved complete response (CR) or CR unconfirmed (CRu). The CR rate after 3 cycles of R-CHOP chemotherapy was significantly higher in patients with mGPS of 0 (53.8%) compared to those with mGPS of 1 (33.3%) or 2 (25.0%) (P=0.001). Fifty-four (30.2%) patients eventually died. The estimated 5-year progression-free survival (PFS) and overall survival (OS) rates for 285 patients were 77.2% and 72.8%, respectively. Patients with mGPS of 0 had significantly better OS than those with scores of 1 (5-year PFS, vs. 74.1%) or 2 (80.9% vs. 54.7; P=0.036). Patients with mGPS of 0 also displayed significantly better OS than patients with mGPS of 2 (P<0.001). The 5-year PFS rate was 76.1% in patients with mGPS scores of 0, 62.3% in patients with scores of 1, and 66.4% in those with scores of 2. Patients with lower mGPS scores tended to have longer PFS compared to patients with higher mGPS, although it was statistically insignificant (P=0.112). Multivariate analyses revealed that the GPS score was a prognostic factor for the CR rate of 3 cycle R-CHOP therapy (P=0.044) as well as OS (P=0.037).

Similar to several other cancers, GPS can be an independent predictor of survival outcomes in DLBCL patients treated with R-CHOP therapy.

No relevant conflicts of interest to declare.