Prognostic Value of Nutritional Index in Patients with Diffuse large B Cell Lymphoma

Background: Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma in adults (DLBCL), which has a variety of clinical characteristics and prognoses. PNI, or the Prognostic Nutritional Index, which combines immunological and nutritional factors, has shown prognostic value in various cancers, However, its function in DLBCL is still unknown. The purpose of this study was to assess the prognostic nutritional index's contribution to the early outcome prediction of patients with diffuse large B cell lymphoma. Methods: The Hematology Unit, Internal Medicine Department, Zagazig University Hospitals, treated 50 adult patients with histologically confirmed DLBCL with conventional R-CHOP treatment as part of this prospective cohort study. Associations between PNI and clinicopathological features, treatment response, and survival were examined. Results: The mean PNI was 30.93±5.81 (range23–43). Higher PNI correlated positively with hemoglobin, platelet count, MPV, and L/M ratio, and negatively with TLC, ANC, AMC, N/L ratio, and CRP (p<0.05). Patients with higher PNI had significantly greater complete remission (CR) rates after 4 and 6–8 cycles (p<0.05). ROC analysis identified optimal PNI cut-offs for predicting CR (≥30.0068; AUC 0.757) and mortality (≤30.011;AUC 0.700). In multivariate analysis, male sex, elevated TLC, and suboptimal response (PR or NR) independently predicted poorer survival, while low PNI showed a non-significant trend toward adverse outcomes. Conclusion: PNI is a straightforward, reasonably priced biomarker that indicates immunological and nutritional condition and has a high predictive value for treatment response and DLBCL mortality. Incorporating PNI into baseline assessment may improve early risk stratification and guide individualized treatment strategies.