The significance of pretreatment anemia in the era of R-IPI and NCCN-IPI prognostic risk assessment tools: a dual-center study in diffuse large B-cell lymphoma patients

Background Anemia is frequently identified at the time of diagnosis in patients with diffuse large B‐cell lymphoma (DLBCL); however, studies addressing the prognostic significance of this important clinical parameter are lacking. Methods In this dual‐center study of patients with DLBCL (n = 556) treated with rituximab‐containing regimens, we evaluated the prognostic relevance of anemia at diagnosis in a training set (n = 211) and validated our findings in a second independent patient cohort (n = 345). Using Kaplan–Meier curves as well as univariate and multivariate Cox regression models, we analyzed the impact of anemia on 5‐year overall survival (OS) and 5‐year disease‐free survival (DFS) alongside established prognostic indicators including age, tumor stage, the revised International Prognostic Index (R‐IPI), and the recently published NCCN‐IPI. The influence of anemia on the predictive accuracy of IPI, R‐IPI, and NCCN‐IPI prognosis scores was subsequently determined using the Harrell's concordance index. Results Anemia was an independent predictor of impaired OS and DFS at 5 years in both DLBCL patient cohorts (P