Development and validation of platelet-to-albumin ratio as a clinical predictor for diffuse large B-cell lymphoma

IntroductionDiffuse large B-cell lymphoma (DLBCL) is the most common subtypes of lymphoma. Clinical biomarkers are still required for DLBCL patients to identify high-risk patients. Therefore, we developed and validated the platelet-to-albumin (PTA) ratio as a predictor for DLBCL patients.MethodsA group of 749 patients was randomly divided into a training set (600 patients) and an internal validation set (149 cases). The independent cohort of 110 patients was enrolled from the other hospital as an external validation set. Penalized smoothing spline (PS) Cox regression models were used to explore the non-linear relationship between the PTA ratio and overall survival (OS) as well as progression-free survival (PFS), respectively.ResultsA U-shaped relation between the PTA ratio and PFS was identified in the training set. The PTA ratio less than 2.7 or greater than 8.6 was associated with the shorter PFS. Additionally, the PTA ratio had an additional prognostic value to the well-established predictors. What’s more, the U-shaped pattern of the PTA ratio and PFS was respectively validated in the two validation sets.DiscussionA U-shaped association between the PTA ratio and PFS was found in patients with DLBCLs. The PTA ratio can be used as a biomarker, and may suggest abnormalities of both host nutritional aspect and systemic inflammation in DLBCL

HAG (Homoharringtonine, Cytarabine, G-CSF) Regimen for the Treatment of Acute Myeloid Leukemia and Myelodysplastic Syndrome: A Meta-Analysis with 2,314 Participants

<div><p>Background</p><p>In China, the combination of homoharringtonine, cytarabine, and G-CSF (HAG) has been extensively applied for treatment of acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS).</p><p>Methods</p><p>We performed a meta-analysis of 2,314 patients (AML, n = 1754; MDS, n = 560) to determine the overall safety and efficacy of this regimen.</p><p>Results</p><p>The complete response (CR) rate of AML patients (53%) was significantly higher than that of MDS/transformed-AML patients (45%; <i>P</i> = 0.007). The CR rate of patients with newly diagnosed AML (62%) was significantly higher than in patients with relapsed/refractory AML (50%; <i>P</i> = 0.001). There were no significant difference in CR rates between elderly AML patients (54%) and all AML patients (<i>P</i> = 0.721). When compared with non-HAG regimens for AML/MDS induction therapy, the CR rate of patients treated with HAG was significantly higher than in treated with intensive chemotherapy (<i>P</i> = 0.000). No significant differences in CR rates were observed between patients treated with HAG and those treated with CAG (cytarabine, aclarubicin, G-CSF) regimens (<i>P</i> = 0.073). HAG regimen was well tolerated, with early death (ED) in 2%, grade IV myelosurrpression in 52% and infection in 50%. Reports of ED and rates of myelosuppression were reduced as compared with intensive chemotherapy (<i>P</i> = 0.000 and <i>P</i> = 0.000, respectively).</p><p>Conclusion</p><p>The HAG regimen is an effective and safe regimen for the treatment of AML and MDS, and appears to be more effective and better tolerated than intensive chemotherapy. Future randomized controlled trials and further meta-analyses are strongly needed to confirm its efficacy and safety, especially in comparison with intensive chemotherapy.</p></div

Clinical information of trials using HAG regimen in this study.

<p>Clinical information of trials using HAG regimen in this study.</p

Complete response rate of elderly AML and advanced MDS patients treated with HAG.

<p>Complete response rate of elderly AML and advanced MDS patients treated with HAG.</p

HAG regimen versus intensive chemotherapy for AML/MDS induction.

<p>HAG regimen versus intensive chemotherapy for AML/MDS induction.</p

Clinical information of trials using CAG regimen in this study.

<p>Clinical information of trials using CAG regimen in this study.</p

Infection rate in patients treated with the HAG regimen.

<p>Infection rate in patients treated with the HAG regimen.</p