Anemia as a useful biomarker in patients with diffuse large B‐cell lymphoma treated with R‐CHOP immunochemotherapy

The aim of the current study is to evaluate the prognostic value of anemia, an easily estimable parameter in patients with diffuse large B‐cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R‐CHOP) immunochemotherapy. A total of 157 patients with newly diagnosed diffuse large B‐cell lymphoma treated with ≥1 cycle of R‐CHOP were included. Hemoglobin level without red cell transfusion within 7 days of initiation of treatment was chosen as a parameter of baseline cancer‐induced anemia. To investigate the clinical significance of chemotherapy‐induced anemia and its recovery after completion of treatment, 87 patients in complete remission for ≥6 months from the time of the last cycle of R‐CHOP were grouped and analyzed separately. Patients with a cancer‐induced anemia of hemoglobin <10 g/dL showed inferior event‐free and disease‐free survival compared to those with hemoglobin ≥10 g/dL. This finding was observed irrespective of the status of pre‐treatment bone marrow involvement. In multivariate analysis, hemoglobin <10 g/dL was found to be an international prognostic index‐independent prognostic factor. Risk of relapse was significantly higher for patients who were still anemic at 6 months after R‐CHOP, compared to those who achieved complete recovery from chemotherapy‐induced anemia within 6 months.