Albumin Improves Stratification in the Low IPI Risk Patients with Diffuse Large B-Cell Lymphoma

Our previous study showed albumin at diagnosis can be used to predict survival in diffuse large B-cell lymphoma (DLBCL) patients, but whether albumin could improve the international prognostic index (IPI) risk stratification in DLBCL remains unknown. Herein, we retrospectively analyzed 440 de novo DLBCL patients treated with R-CHOP in this study. The cutoff value of albumin for survival analysis was 34.4 g/L with an area under the curve value of 0.642±0.0037 (p<0.001) by receiver operating characteristic curve. Patients with low serum albumin showed worse overall survival (OS) and event-free survival (EFS) (p<0.001 and p=0.002, respectively). Multivariate analysis revealed that low serum albumin, independent of IPI, indicated different survival in both OS(relative ratio [RR] .0481; 95% confidence interval [CI], 0.294 - 0.789, p=0.004) and EFS (RR, 0.617; 95% CI, 0.419 - 907, p=0.014) in DLBCL patients.According to IPI, there were 170 patients (40.2%) in low risk group, 101patients (23%) in low-intermediate risk group, 97(22.0%) patients in high-intermediate risk group and 65 patients (14.8%) in high-risk group. Low IPI risk patients showed favorable survival (p<0.05). However, there were no significant survival difference in low-intermediate, high-intermediate and high-risk group (p>0.05). Especially low albumin could identify a subgroup of patients with poorer overall survival in low/ low-intermediate IPI risk patients (p = 0.003). In conclusion, our study suggests that albumin at diagnosis is a simple and effective prognostic factor in DLBCL patients,allowing the identification of an inferior outcome subgroup in low/ low-intermediate DLBCL patients, which may help to guide treatment.