For patients with diffuse large B-cell lymphoma (DLBCL), presence of hypercalcemia at diagnosis correlates with negative prognostic factors and a short diagnosis-to-treatment interval, according to a retrospective analysis published in Hematological Oncology (online April 9, 2020; doi:10.1002/hon.2735).
While DLBCL is already considered an aggressive type of non-Hodgkin lymphoma, the prevalence of hypercalcemia in this disease and its prognostic significance is relatively uncertain.
A group of French researchers led by Eric Durot, MD, department of Hematology, University Hospital of Reims, retrospectively evaluated the prevalence of hypercalcemia at diagnosis of DLBCL vs transformed indolent lymphoma and explored associations between hypercalcemia and clinical factors and outcomes. A total of 305 patients were identified with aggressive B-cell lymphomas from January 2006 to June 2018, 248 of whom had de novo DLBCL and 57 of whom had transformed indolent lymphoma.
At diagnosis, hypercalcemia was reported in 23% of patients with DLBCL and 26% of patients with transformed indolent lymphoma. The final study group consisted of 226 patients, 48 of whom presenting with hypercalcemia.
The primary outcome of the study was event-free survival at 24 months, researchers noted.
Results of the analysis showed that hypercalcemia in de novo DLBCL was strongly associated with high-risk features, especially with International Prognostic Index (IPI) components. Additionally, hypercalcemia in these patients was associated with B symptoms, β2‐microglobulin, hemoglobin, and albumin levels. The diagnosis-to-treatment interval was significantly shorter for hypercalcemic patients (P = .001).
Dr Durot and colleagues further reported that these associations with adverse prognostic factors translated to lower rates of event-free survival at 24 months (HR, 1.66; 95% CI, 1.08-2.54) as well as shorter progression-free survival (P = .0059) and overall survival (P = .0003) for hypercalcemic patients.
“In conclusion, our study, conducted on a homogeneous and routine clinical practice cohort of de novo DLBCL, demonstrates that hypercalcemia at diagnosis is strongly associated with adverse prognostic factors and a short diagnosis-to-treatment interval,” authors of the study concluded. “Its adverse impact on outcome appears to be closely linked to IPI parameters, suggesting that hypercalcemia is rather a biomarker of the underlying biological aggressiveness of DLBCL.”—Zachary Bessette
