Enlarged splenic volume predicts poor survival and is associated with inflammatory imbalance in patients with diffuse large B-cell lymphoma.

Abstract

Purpose: The spleen plays a significant role in innate and adaptive immunity. We aimed to evaluate the prognostic significance of the splenic volume in patients with diffuse large B-cell lymphoma (DLBCL), research on which is limited.

Methods: We retrospectively analyzed 175 patients diagnosed with DLBCL. Based on optimal thresholds, patients were stratified into small (< 185 cm³), medium (185-315 cm³), and large (≥ 315 cm³) splenic volume groups. Survival analysis was performed using Kaplan-Meier and Cox proportional hazards model.

Results: A significant decrease in progression-free survival (PFS) (P < 0.0001) and overall survival (OS) (P < 0.0001) was observed in the large group that received cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (CHOP) without or with rituximab (R-CHOP) treatment. Among the 139 patients who received R-CHOP, significant adverse effects on PFS (P < 0.0036) and OS (P < 0.0035) were observed in the large group. Univariate and multivariate analyses demonstrated that enlarged splenic volume (≥ 315 cm³) was associated with decreased PFS (P < 0.0001, P < 0.01, respectively) and OS (P < 0.001, P < 0.01, respectively). In terms of peripheral blood inflammatory markers, patients with enlarged splenic volume (≥ 315 cm³) exhibited lymphocytopenia, increased monocyte-to-lymphocyte ratio (MLR), increased neutrophil-to-lymphocyte ratio (NLR), and higher red blood cell distribution width (RDW) compared to that in those with smaller splenic volumes (P < 0.001, P < 0.001, P = 0.01, and P < 0.005, respectively).

Conclusion: Splenic volume exceeding 315 cm³ is a poor prognostic factor for PFS and OS in patients with DLBCL. An enlarged splenic volume may be associated with compromised anti-cancer immune responses and aberrant inflammatory conditions.