In this study we assessed the prognostic significance of absolute monocyte count and elected the best cut-off value at diagnosis, in a large cohort of patients with diffuse large B-cell lymphoma. Data were retrieved for therapy-naive patients with diffuse large B-cell lymphoma followed in Israel and Italy during1993-2010. A final cohort of 1017 patients was analyzed with a median follow up of 48 months and a 5 year overall survival rate of 68%. The best absolute monocyte count cut-off level was<630/mm3 and the 5 years overall survival for these patients was 71% and 59% for those with >630mm3 (P=0.0002). Of the 1017 patients, 521 (51%) were treated with chemo-immunotherapy, and in this cohort, using multivariate analysis, elevated monocyte count retained a negative prognostic value even when adjusted for IPI (HR1.54, P=0.009). This large study shows that a simple parameter like absolute monocyte count (>630/mm3 ) can easily be used routinely in the evaluation of newly diagnosed diffuse largeB-cell lymphoma to identify high –risk patients with a worse survival in the rituximab era.

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