Immunonutritional profiling for prognostic assessment in diffuse large B-cell lymphoma: an initial evaluation of the C-reactive Protein–Albumin–Lymphocyte (CALLY) Index

Aims: Diffuse large B-cell lymphoma (DLBCL) demonstrates wide heterogeneity, complicating risk stratification with conventional prognostic instruments, particularly the International Prognostic Index (IPI). The C-reactive Protein (CRP)-Albumin-Lymphocyte (CALLY) Index, an immunonutritional marker that integrates inflammation, nutritional status, and immune competence, has demonstrated prognostic relevance in solid tumors. The present analysis was designed to determine the clinical utility of the CALLY Index for prognostication in newly diagnosed DLBCL patients and to assess its added value when integrated with traditional prognostic scores. Methods: In this retrospective cohort, 112 patients presenting with newly diagnosed DLBCL and treated at Bursa Uludağ University between 2015 and 2019 were evaluated. The CALLY Index was calculated as (serum albumin × absolute lymphocyte count) / (CRP×10⁴). An optimal cutoff value of 0.78 was derived using log-rank testing and used to stratify patients into low (≤0.78) and high (>0.78) CALLY categories. Baseline clinical features were compared between groups. Kaplan-Meier curves and multivariable Cox proportional hazards modeling were applied to examine overall survival (OS). Multivariable analysis included IPI score and serum beta-2-microglobulin. Results: Cases in the low CALLY subgroup (68.8%) were significantly older, had poorer Eastern Cooperative Oncology Group performance, lower albumin, higher CRP, and more advanced disease (p