A model for predicting the risk of developing mild anemia (MA) in patients with lymphoid malignancy. A study of the Gruppo Italiano Studio Linfomi (GISL)

Background: So far no predictive model has been defined to predict the risk of developing MA in cancer patients.Methods and objectives: All cases registered from 1991 to 2005 in one of GISL clinical trials, with a confirmed diagnosis of Aggressive lymphoma (AL), Follicular lymphoma (FL) or Hodgkin’s lymphoma (HL), were selected for the study. Patients should have available data on clinical features at diagnosis, treatment details and hematological toxicity. MA was defined as the presence of baseline Hb levels below11 g/dl or grade 1–4 hemoglobin toxicity defined according to WHO criteria. Theaim of the study was to develop a model to predict the risk of developing MA forpatients with Lymphoid Malignancy (LM).Results: One thousand eight hundred and seventy four patients were included inthe study: AL, FL and HL was the diagnosis in 830, 218 and 687 case respectively;median age was 54, 57 and 32 years for AL, FL and HL respectively and thefrequency of female patients was 43%, 48% and 49% for the three groups. MedianHb level at diagnosis was 12.9 g/dl, 13.2 g/dl and 12.3 g/dl for AL, FL and HLrespectively with 20% of patients with showing MA. All patients received an adequateanthracycline based CT regimen. Overall 38% of patients with Hb baseline levels above 11 g/dl developed MA during chemotherapy. CT regimens were divided intothree groups based on MA risk (group 1: MA risk 0 to 25%; group 2: MA risk 26% to50%; group 3; MA risk above 50%). In the Logit multivariate analysis Age (above 55yrs), Female gender, CT groups (2–3 versus 1) Hb levels and bulky disease were factorsindependently correlated with the risk of developing MA. A prediction model wasdefined using previously defined parameters which allowed the identification of threegroups of patient with a different risk of MA. Patients at low, intermediate-Low,Low-High and high risk had a probability of MA of 5%, 25%, 38% and 52%respectively (P < 0.0001).Conclusion: The risk of developingMA in patients with LM undergoing chemotherapycan be predicted with a simple assessment of clinical and treatment features. Patientsat high risk of MA could be considered for anemia prevention programs.