A Prognostic Immune Risk Score For Diffuse Large B-Cell Lymphoma

We constructed a prognostic score for persons with diffuse large B-cell lymphoma (DLBCL) based on infiltrating immune cells. Data of 956 consecutive subjects were retrieved from the Gene Expression Omnibus database and assigned to training (, n = 305) or validation ( n = 206 and n = 445 combined) cohorts. Proportions of non-lymphoma cells in the sample were inferred using the ESTIMATE algorithm. An immune risk score was constructed comprised of eight types of non-lymphoma immune cells calculated using the CIBERSORT algorithm. Five-year survival of subjects with an immune risk score <= 0 center dot 45 in the training cohort was better than that of subjects with a score > 0 center dot 45 (hazard ratio [HR] = 3 center dot 99; 95% confidence interval [CI] = 2 center dot 74, 5 center dot 82; P < 0 center dot 001). HR in the validation cohort was HR = 2 center dot 17 (1 center dot 47, 3 center dot 21; P < 0 center dot 001). Enrichment analyses indicated correlations with genes controlling immune-related biological processes and pathways. A nomogram comprised of the immune risk score and most covariates including age, lactate dehydrogenase concentration (LDH), lymphoma-type (germinal centre B cell [GCB] versus non-GCB), Eastern Cooperative Oncology Group performance status (ECOG-PS) and rituximab therapy had a C-statistic of 0 center dot 76 compared with C-statistics of 0 center dot 69 and 0 center dot 69 for the International Prognostic Index (IPI) and Revised International Prognostic Index (R-IPI). These data indicate the immune risk score is an accurate, independent survival predictor in persons with DLBCL.