The Value of C-Reactive Protein, C-Reactive Protein Kinetics and C-reactive Protein to Albumin Ratio on Prognosis in Newly Diagnosed Indolent B-cell Non-Hodgkin Lymphoma

Abstract Objective: This study aimed to determine prognostic significance of C-reactive protein (CRP), CRP kinetics and CRP to albumin ratio (CAR) in indolent B-cell non-Hodgkin lymphoma (B-iNHL) patients. Methods: The association among these blood makers and overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) were analyzed in 243 B-iNHL patients. OS, DFS and PFS were determined by Kaplan–Meier curves. Cox proportional analysis was performed to examine the prognostic significance of clinicopathological variables. Results: Multivariate analyses identified that elevated pretreatment CRP (HR: 5.110, 95% CI: 1.904-13.717, p =0.001), post-treatment CRP (HR: 5.826, 95% CI: 1.659-20.458, p =0.006), continuously elevated CRP (HR: 6.461, 95% CI: 2.620-15.930, p <0.001) and elevated CAR (HR: 3.768, 95% CI: 1.415-10.034, p =0.008) had association with worse OS. Likewise, elevated pretreatment CRP (HR: 3.767, 95% CI: 1.777-7.984, p =0.001), post-treatment CRP (HR: 2.384, 95% CI: 1.027-5.534, p =0.043), ever-elevated CRP (HR: 2.425, 95% CI: 1.105-5.322, p =0.027), continuously elevated CRP (HR: 4.748, 95% CI: 2.114-10.660, p <0.001) and elevated CAR (HR: 2.824, 95% CI: 1.336-5.971, p =0.007) were in independent significance with worse DFS. Elevated pretreatment CRP (HR: 2.606, 95% CI: 1.338-5.076, p =0.005), ever-elevated CRP (HR: 2.086, 95% CI: 1.040-4.188, p =0.039), continuously elevated CRP (HR: 3.296, 95% CI: 1.594-6.818, p =0.001) and elevated CAR (HR: 1.991, 95% CI: 1.021-3.882, p =0.043) were determined in independent significance with poor PFS. The effect was statistically significant in both follicular lymphoma (FL) and chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/ SLL) patients. Conclusions: In conclusion, we demonstrate that CRP level, CRP kinetics and CAR could be potential prognostic indicators with independent significance in patients with B-iNHL, also in FL and CLL/ SLL subgroups. CRP and CAR make an implementation for prognostic evaluation more easily and effectively in B-iNHL patients.