An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era

被引:701
作者
Zhou, Zheng [1 ]
Sehn, Laurie H. [2 ]
Rademaker, Alfred W. [1 ]
Gordon, Leo I. [1 ]
LaCasce, Ann S. [3 ]
Crosby-Thompson, Allison [3 ]
Vanderplas, Ann [4 ]
Zelenetz, Andrew D. [5 ]
Abel, Gregory A. [3 ]
Rodriguez, Maria A. [6 ]
Nademanee, Auayporn [7 ]
Kaminski, Mark S. [8 ]
Czuczman, Myron S. [9 ,10 ]
Millenson, Michael [11 ]
Niland, Joyce [4 ]
Gascoyne, Randy D. [2 ]
Connors, Joseph M. [2 ]
Friedberg, Jonathan W. [12 ]
Winter, Jane N. [1 ]
机构
[1] Northwestern Univ, Feinberg Sch Med, Robert H Lurie Comprehens Canc Ctr, Chicago, IL 60611 USA
[2] British Columbia Canc Agcy, Ctr Lymphoid Canc, Vancouver, BC V5Z 4E6, Canada
[3] Dana Farber Canc Inst, Boston, MA 02115 USA
[4] City Hope Natl Med Ctr, Biostat & Data Coordinating Ctr, Duarte, CA 91010 USA
[5] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
[6] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
[7] City Hope Natl Med Ctr, Duarte, CA 91010 USA
[8] Univ Michigan, Ctr Comprehens Canc, Ann Arbor, MI 48109 USA
[9] Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA
[10] Roswell Pk Canc Inst, Dept Immunol, Buffalo, NY 14263 USA
[11] Fox Chase Canc Ctr, Philadelphia, PA 19111 USA
[12] Univ Rochester, James P Wilmot Canc Ctr, Rochester, NY USA
关键词
NON-HODGKINS-LYMPHOMA; OUTCOME PREDICTION; ELDERLY-PATIENTS; R-CHOP; EXPRESSION; SURVIVAL; CHEMOTHERAPY; INTERGROUP; BIOMARKERS; SIGNATURES;
D O I
10.1182/blood-2013-09-524108
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The International Prognostic Index (IPI) has been the basis for determining prognosis in patients with aggressive non-Hodgkin lymphoma (NHL) for the past 20 years. Using raw clinical data from the National Comprehensive Cancer Network (NCCN) database collected during the rituximab era, we built an enhanced IPI with the goal of improving risk stratification. Clinical features from 1650 adults with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2000-2010 at 7 NCCN cancer centers were assessed for their prognostic significance, with statistical efforts to further refine the categorization of age and normalized LDH. Five predictors (age, lactate dehydrogenase (LDH), sites of involvement, Ann Arbor stage, ECOG performance status) were identified and a maximum of 8 points assigned. Four risk groups were formed: low (0-1), low-intermediate (2-3), high-intermediate (4-5), and high (6-8). Compared with the IPI, the NCCN-IPI better discriminated low-and high-risk subgroups (5-year overall survival [OS]: 96% vs 33%) than the IPI (5 year OS: 90% vs 54%), respectively. When validated using an independent cohort from the British Columbia Cancer Agency (n = 1138), it also demonstrated enhanced discrimination for both low-and high-risk patients. The NCCN-IPI is easy to apply and more powerful than the IPI for predicting survival in the rituximab era.
引用
收藏
页码:837 / 842
页数:6
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