For patients with de novo diffuse large B-cell lymphoma (DLBCL), the presence of hypercalcemia at diagnosis is associated with negative prognostic factors and a short diagnosis-to-treatment interval. These findings from a retrospective monocentric study were published in Hematological Oncology.
Researchers sought to evaluate the prevalence of hypercalcemia at the time of DLBCL diagnosis compared to transformed indolent lymphomas, and to assess its clinical significance.
Between January 2006 and June 2018, 305 patients (median age, 68 years) were identified with aggressive B-cell lymphomas: 248 patients with de novo DLBCL and 57 patients with transformed indolent lymphoma. At diagnosis, 72 patients had corrected calcemia over 10.5 mg/dL. Hypercalcemia was reported in 23% of patients with DLBCL and 26% of patients with transformed indolent lymphoma. The final study group consisted of 226 patients (48 with hypercalcemia).
The investigators reported B symptoms in half of patients, altered ECOG performance status in 39% of patients, and advanced-stage disease in 78% of patients.
Compared with normal calcium levels (≤10.5 mg/dL), hypercalcemia was significantly associated with older age (P =.0028), worse ECOG performance status (P <.0001), more frequent advanced-stage disease (P =.0024), more frequent extranodal involvement (P =.0173), and more elevated levels of serum LDH (P =.0032), as well as high International Prognostic Index (IPI) (P <.0001). In addition, hypercalcemia was associated with other adverse prognostic factors in DLBCL including, B symptoms, albumin levels, β2-microglobulin, and hemoglobin levels. These factors translated into lower event-free survival rates at 24 months (hazard ratio, 1.66), shorter progression-free survival (median 2.3 years), and overall survival (median 4.7 years) for patients with lymphoma-related hypercalcemia.
The researchers noted that cancer-related hypercalcemia can present in nearly 30% of patients, especially those with lung cancer, renal cell carcinoma, and multiple myeloma.
“In conclusion, our study, conducted on a homogeneous and routine clinical practice cohort of de novo DLBCL, demonstrates that hypercalcemia at diagnosis is strongly associated with adverse prognostic factors and a short diagnosis‐to treatment interval,” the authors concluded. “Its adverse impact on outcome appears to be closely linked to IPI parameters suggesting that hypercalcemia is rather a biomarker of the underlying biological aggressiveness of DLBCL.”
Gauchy A-C, Kanagaratnam L, Quinquenel A, et al. Hypercalcemia at diagnosis of diffuse large B-cell lymphoma is not uncommon and is associated with high-risk features and a short diagnosis-to-treatment interval [published online April 9, 2020]. Hematol Oncol. doi: 10.1002/hon.2735