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Presentation Serum Selenium Predicts for Overall Survival, Dose Delivery, and First Treatment Response in Aggressive Non-Hodgkin’s Lymphoma

Kim W. Last, Victoria Cornelius, Trevor Delves, Christine Sieniawska, Jude Fitzgibbon, Andrew Norton, John Amess, Andy Wilson, Ama Z.S. Rohatiner, T. Andrew Lister

From the Cancer Research UK Medical Oncology Unit, Department of Medical Oncology, St Bartholomew’s Hospital, London; Cancer Research UK Department of Statistics, Oxford; Trace Elements Unit, Southampton General Hospital, Southampton, United Kingdom.

Address reprint requests to Kim W. Last, MD, Cancer Research UK Medical Oncology Unit, Department of Medical Oncology, 45 Little Britain, St Bartholomew’s Hospital, London EC1M 6BQ, United Kingdom; email: kim.last{at}cancer.org.uk.

Purpose: This study was undertaken to test the hypothesis that serum selenium concentration at presentation correlates with dose delivery, first treatment response, and overall survival in patients with aggressive B-cell non-Hodgkin’s lymphoma.

Patients and Methods: The patients presented between July 1986 and March 1999 and received anthracycline-based chemotherapy, radiotherapy, or both. The total selenium content was retrospectively analyzed in 100 sera, frozen at presentation, using inductively coupled plasma mass spectrometry.

Results: The serum selenium concentration ranged from 0.33 to 1.51 µmol/L (mean, 0.92 µmol/L; United Kingdom adult reference range, 1.07 to 1.88 µmol/L). Serum selenium concentration correlated closely with performance status but with no other clinical variable. Multivariate analysis revealed that increased dose delivery, summarized by an area under the curve, correlated positively with younger age (P < .001), advanced stage (P = .001), and higher serum selenium concentration (P = .032). Selenium level also correlated positively with response (odds ratio, 0.62; 95% confidence interval [CI], 0.43 to 0.90; P = .011) and achievement of long-term remission after first treatment (log-rank test, 4.38; P = .036). On multivariate analysis, selenium concentration was positively predictive of overall survival (hazard ratio [HR], 0.76 for 0.2 µmol/L increase; 95% CI, 0.60 to 0.95; P = .018), whereas age indicated negative borderline significance (HR, 1.09; 95% CI, 0.99 to 1.18; P = .066).

Conclusion: Serum selenium concentration at presentation is a prognostic factor, predicting positively for dose delivery, treatment response, and long-term survival in aggressive non-Hodgkin’s lymphoma. Unlike most existing prognostic factors in aggressive non-Hodgkin’s lymphoma, selenium supplementation may offer a novel therapeutic strategy in this frequently curable malignancy.

Supported by Cancer Research UK, Lincoln’s Inn Fields, London, UK.

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