Elevated C-reactive protein level is associated with poor prognosis in follicular lymphoma patients undergoing rituximab
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ORIGINAL ARTICLE
Elevated C‑reactive protein level is associated with poor prognosis in follicular lymphoma patients undergoing rituximab‑containing chemotherapy Yukiko Kawaguchi1 · Bungo Saito1 · Ayaka Nakata1 · Tomoharu Matsui1 · Yohei Sasaki1 · Shotaro Shimada1 · Maasa Abe1 · Megumi Watanuki1 · Yuta Baba1 · So Murai1 · Nana Arai1 · Shun Fujiwara1 · Nobuyuki Kabasawa1 · Hiroyuki Tsukamoto1 · Yui Uto1 · Kouji Yanagisawa1 · Norimichi Hattori1 · Hiroshi Harada2 · Tsuyoshi Nakamaki1 Received: 20 October 2019 / Revised: 4 May 2020 / Accepted: 27 May 2020 © Japanese Society of Hematology 2020
Abstract Although follicular lymphoma (FL) is a pathological entity characterized by relatively uniform histological and molecular findings, its clinical course is highly variable. Establishment of therapeutic strategies based on a simple and practical prognostic model is important. C-reactive protein (CRP) is an adverse prognostic marker for various tumors and aggressive lymphomas. However, the significance of serum CRP levels as a prognostic index in low-grade lymphomas, such as FL, has not been thoroughly investigated. We retrospectively analyzed the relationship between serum CRP levels at diagnosis and the prognosis in patients with FL (n = 61) undergoing rituximab-containing chemotherapy. Elevated CRP levels showed a significant association with elevated fibrinogen (P = 0.002) in univariate analysis. Patients with higher CRP levels (> 5 mg/L) had a significantly shorter progression-free survival in multivariate analysis (P = 0.044). We concluded that serum CRP levels are important in prognostic stratification of patients with FL. Keywords C-reactive protein · Follicular lymphoma · Rituximab-containing chemotherapy
Introduction Follicular lymphoma (FL) is the most common low-grade B-cell lymphoma in Japan and constitutes 13–28% of all B-cell lymphomas [1]. The clinical course of FL varies. In general, it follows an indolent clinical course, with some patients staying alive for decades without the need for treatment. However, in some cases, FL progresses to aggressive lymphoma such as diffuse large B-cell lymphoma (DLBCL), which occurs in 10–30% of patients with FL over time, with a risk of 2–3% per year [2, 3]. Establishment of therapeutic strategies based on an accurate and practical prognostic model is important. * Yukiko Kawaguchi [email protected]‑u.ac.jp 1
Division of Hematology, Department of Medicine, Showa University School of Medicine, 142‑8666 1‑5‑8 Hatanodai, Shinagawa‑Ku, Tokyo, Japan
Division of Hematology, Department of Medicine, Showa University Fujigaoka Hospital, Kanagawa, Japan
2
The FL International Prognostic Index (FLIPI) and FLIPI2 are prognostic indices based mainly on clinical parameters, which were proposed and widely incorporated into clinical practice [4, 5]. Prognostic indices based on the biology of FL have also been reported. They are based on the analyses of molecular signatures of both lymphoma cells and lymphoma microenvironments [6, 7]. Correspondingly, several types of me
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