Development and Validation of a Prognostic Nomogram Incorporating Dynamic Monocyte-to-Lymphocyte Ratio and Multidimensional Biomarkers in Diffuse Large B-Cell Lymphoma
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Objective To develop and validate a prognostic nomogram integrating dynamic monocyte-to-lymphocyte ratio (MLR) and multidimensional biomarkers for diffuse large B-cell lymphoma (DLBCL). Methods To develop and validate a prognostic nomogram integrating dynamic monocyte-to-lymphocyte ratio (MLR) and multidimensional biomarkers for diffuse large B-cell lymphoma (DLBCL). Results Multivariate analysis confirmed CD5 positivity (HR = 3.470, 95%CI:1.503–8.012), elevated β2-microglobulin (HR = 1.245, 95%CI:1.123–1.380), and increased mid-treatment MLR (HR = 2.530, 95%CI:1.284–4.983) as independent OS risk factors. The nomogram achieved AUCs of 0.913 (1-year), 0.867 (3-year), and 0.884 (5-year) in the training cohort, with validation cohort AUCs of 0.756 (3-year) and 0.792 (5-year). Calibration curves showed optimal agreement at 5 years. DCA demonstrated significant clinical net benefit. Risk stratification using the optimal cutoff (− 0.17 points) revealed superior OS in low-risk groups (training: P < 0.001; validation: P = 0.013). Conclusion This validated nomogram dynamically integrates immune status (MLR), tumor biology (CD5), and clinical indicators (IPI) to individualize OS prediction in DLBCL, providing a practical tool for risk stratification and personalized therapy.
