Prognostic significance of baseline hypoalbuminemia in lymphoma: a systematic review and meta-analysis

Abstract

Lymphomas remain clinically heterogeneous diseases with variable outcomes despite advances in therapy. Reliable prognostic factors are essential to guide treatment planning. Serum albumin, a marker of both nutritional status and systemic inflammation, has been proposed as a simple biomarker of prognosis, but its role across lymphoma subtypes remains unclear. Objectives were to evaluate the association between baseline hypoalbuminemia and survival outcomes in patients with Hodgkin and non-Hodgkin lymphoma (HL). A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Cochrane Library, and ScienceDirect were searched through June 2025. Cohort studies reporting hazard ratios (HRs) for overall survival (OS) or progression-free survival (PFS) in relation to baseline serum albumin were included. Pooled HRs were calculated using random-effects models. Eight cohort studies with 1,633 patients were included. Hypoalbuminemia was significantly associated with worse OS (HR=2.16; 95% CI: 1.82-2.57; p<0.00001) and poorer PFS (HR=2.49; 95% CI: 1.80-3.45; p<0.00001). These associations remained consistent across lymphoma subtypes, age groups, and treatment contexts, with low to negligible heterogeneity. Notably, patients who achieved albumin recovery during treatment experienced superior outcomes compared with those who remained hypo-albuminemic. The findings underscore albumin’s value as a universally available, inexpensive biomarker that adds prognostic information beyond established indices. Its integration into clinical models may improve risk stratification and support more personalized management. Baseline hypoalbuminemia is a significant adverse prognostic factor in lymphoma. Incorporating serum albumin into routine assessment and considering serial monitoring may enhance prognostic accuracy and patient care.