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International prognostic indices in diffuse large B-cell lymphoma: a comparison of IPI, R-IPI, and NCCN-IPI
| Content Provider | Scilit |
|---|---|
| Author | Ruppert, Amy S. Dixon, Jesse G. Salles, Gilles Andre Wall, Anna Cunningham, David Poeschel, Viola Haioun, Corinne Tilly, Herve Ghesquieres, Herve Ziepert, Marita Flament, Jocelyne Flowers, Christopher Shi, Qian Schmitz, Norbert |
| Copyright Year | 2020 |
| Description | Great heterogeneity in survival exists for patients newly diagnosed with diffuse large B-cell lymphoma (DLBCL). Three scoring systems incorporating simple clinical parameters (age, lactate dehydrogenase, number/sites of involvement, stage, performance status) are widely used: the International Prognostic Index (IPI), revised IPI (R-IPI), and National Comprehensive Cancer Network IPI (NCCN-IPI). We evaluated 2124 DLBCL patients treated from 1998 to 2009 with frontline rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; or variant) across 7 multicenter randomized clinical trials to determine which scoring system best discriminates overall survival (OS). Median age was 63 years, and 56% of patients were male. Five-year OS estimates ranged from 54% to 88%, from 61% to 93%, and from 49% to 92% using the IPI, R-IPI, and NCCN-IPI, respectively. The NCCN-IPI had the greatest absolute difference in OS estimates between the highest- and lowest-risk groups and best discriminated OS (concordance index = 0.632 vs 0.626 [IPI] vs 0.590 [R-IPI]). For each given IPI risk category, NCCN-IPI risk categories were significantly associated with OS (P ≤ .01); the reverse was not true, and the IPI did not provide additional significant prognostic information within all NCCN-IPI risk categories. Collectively, the NCCN-IPI outperformed the IPI and R-IPI. Patients with low-risk NCCN-IPI had favorable survival outcomes with little room for further improvement. In the rituximab era, none of the clinical risk scores identified a patient subgroup with long-term survival clearly <50%. Integrating molecular features of the tumor and microenvironment into the NCCN-IPI or IPI might better characterize a high-risk group for which novel treatment approaches are most needed. |
| Related Links | https://ashpublications.org/blood/article-pdf/doi/10.1182/blood.2019002729/1719118/blood.2019002729.pdf |
| Ending Page | 2048 |
| Page Count | 8 |
| Starting Page | 2041 |
| DOI | 10.1182/blood.2019002729 |
| Journal | Blood |
| Issue Number | 23 |
| Volume Number | 135 |
| Language | English |
| Publisher | American Society of Hematology |
| Publisher Date | 2020-06-04 |
| Access Restriction | Open |
| Subject Keyword | Hematology Treatment Survival Prognostic Dlbcl Scoring Nccn Ipi Ipi Risk Journal: Blood (Vol- 137, Issue- 23) |
| Content Type | Text |
| Resource Type | Article |
