Prognostic value of hemoglobin in diffuse large B-cell lymphoma

Objective To discuss the prognostic value of hemoglobin (HGB) on patients with diffuse large B-cell lymphoma (DLBCL).Methods A total of 848 DLBCL patients from six medical centers of Huaihai Lymphoma Working Group from March 2013 to July 2022 were selected and their clinical data were retrospective analyzed. The optimal cutoff value of hemoglobin was calculated based on the maximum selection rank statistic (Maxstat). According to the cutoff value, the patients were divided into two groups, and matched with the closest neighbor at 1:1 using a propensity score matching (PSM) method. Univariable and multivariable analysis were conducted using Cox proportional risk models. Kaplan Meier survival curves were plotted, and log rank test was used for comparison.Results The median age of patients was 61 years (15-91 years), with 50.8% of male patients, and a 5-year survival rate of 64.8%. The optimal cutoff value for hemoglobin was 110 g/L, and the patients were divided into two groups according to the cutoff value (HGB <110 g/L; HGB ≥ 110 g/L). After PSM analysis, there was no statistical difference in each variable between the two groups except albumin level (P<0.05). Multivariable regression showed that hemoglobin level, age, central involvement, and B-cell lymphoma-2 (BCL-2) were independent factors for the prognosis of DLBCL patients. In addition, patients with low hemoglobin levels had a poor prognosis in the BCL-2+group, BCL-6- group, CD5+ group, non-germinal center B-cell (Non-GCB) group, Eastern Cooperative Oncology Group Performance Status (ECOG PS) score <2 group, and National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) medium and high-risk groups.Conclusions Low hemoglobin level was an adverse prognostic factor in patients with DLBCL.