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Serum beta-2 microglobulin as a prognostic factor in patients with Hodgkins lymphoma treated with A BVD or equivalent regimens with or without radiation therapy

Serum beta-2 microglobulin as a prognostic factor in patients with Hodgkins lymphoma treated with A BVD or equivalent regimens with or without radiation therapy

Blood 102(11): 273b, November 16

Serum beta-2 microglobulin (sbeta2m) is an established prognostic factor for multiple myeloma, non-Hodgkin's lymphoma, and B-chronic lymphocytic leukemia. However only the MD Anderson group has produced data suggesting an adverse prognostic role of sbeta2m in HL. Data from homogenously and optimally treated patient populations with HL are missing from the literature. We evaluated the impact of sbeta2m levels on the prognosis of 334 patients with HL, who were trated with ABVD or equivalent regimens with or without RT. sbeta2m levels were measured in pretreatment serum samples by a radioimmunoassay (upper normal limit 2.4 mg/l). Patients' characteristics were as follows: Median age 30 years (14-78); 54% males; 70% nodular sclerosis, 18% mixed cellularity, and 12% lymphocyte predominance; 33% B-symptoms; 26% Ann Arbor stage (AAS) I, 49% II, 17% III, and 9% IV; 14% gtoreq5 involved anatomic sites (IAS); 19% inguinal and/or iliac involvement; 38% anemia; 13% leukocytosis; 13% lymphocytopenia; 44% ESRgtoreq50; 28% serum albumin <4 g/dl; 28% elevated serum LDH. Elevated sbeta2m levels were detected in 112/334 patients (34%) and correlated strongly with all the above named clinical and laboratory parameters (p<0.01 for all comparisons), except of gender. With 48 events recorded so far, the 10-year failure free survival (FFS) was 75% vs. 69% for patients with normal vs. elevated sbeta2m levels (p=0.07). The corresponding 10-year overall survival (OS) rates were 88% vs. 60% (p=0.001). There was no evidence for a dose-response effect of sbeta2m on FFS or OS, e.g. the outcome of patients with significantly or only slightly elevated sbeta2m levels did not differ. In univariate analysis FFS was significantly influenced by the presence of B-symptoms, AAS IV, gtoreq5 IAS, inguinal/iliac involvement, anemia, albumin <4 g/dl, ESR gtoreq50, and elevated LDH. In multivariate analysis elevated sbeta2m levels were not predictive of FFS (p=0.18). The only independent prognostic factor was the number of IAS (p<0.001), while the significance of AAS IV was marginal (p=0.07). The inclusion of serum LDH (available in 86% of the patients) further reduced the level of significance of serum sb2m (p=0.59). However sbeta2m levels were independently associated with inferior OS (p=0.004), along with the number of IAS (p=0.002). Our data suggest that sbeta2m levels are not a potent prognostic factor for FFS in patients with HL treated with ABVD or equivalent regimens. This conclusion came from the analysis of a large series of homogenously treated HL patients (n=334), with 48 events recorded so far, which also failed to demonstrate a dose-response effect between sbeta2m levels and the outcome of the patients. The prognostic role of sbeta2m may be more significant with respect to OS.

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Accession: 035717832

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