FREQUENCY AND SIGNIFICANCE OF ANEMIA IN NON-HODGKINS-LYMPHOMA PATIENTS

Objectives: Retrospective evaluation of anemia frequency and its progn ostic value in patients with different subtypes of non-Hodgkin's lymph oma and comparison with other clinical characteristics. Patients and m ethods. Anemia was defined as a hemoglobin value less than or equal to 12 g/dl for all men and women over 50 years of age, and less than or equal to 11 g/dl for women under 50 years of age. The study included 1 077 adult lymphoma patients treated between 1980 and 1995 with the fol lowing histologic subtypes: 127 patients with small lymphocytic or lym phoplasmacytoid, 62 with marginal zone: 50 with mantle-cell, 208 with follicular, 104 with T-cell lymphoma, 426 with diffuse large-cell and, finally, 73 patients with other high-grade lymphomas. Results. Anemia was present in 341 patients (32%). It was an adverse prognostic facto r (P < 0.0001) for overall survival (OS) and progression-free survival (PFS) but not for relapse-free survival (RFS). When patients with and those without bone marrow involvement were considered separately, ane mia remained an adverse factor. Anemia was significantly associated wi th shorter PFS in small lymphocytic or lymphoplasmacytoid, mantle cell , diffuse large cell and high-grade lymphomas and with shorter OS in a ll histologic subgroups except marginal zone lymphoma. In multivariate analysis, anemia was a significant prognostic factor for OS and PFS f or the population as a whole (P = 0.0001 and P = 0.0048, respectively) and in patients with bone marrow involvement (P = 0.007 and P = 0.005 , respectively) but not in patients without bone marrow involvement. F inally, the addition of anemia to the International Prognostic Index l ed to an improvement for OS (P = 0.0004) and PFS (P = 0.0004). Conclus ions. Anemia is an important adverse prognostic factor for the outcome of lymphoma patients, particularly in some histologic subgroups and i n patients with bone marrow involvement.