Abstract
The National Comprehensive Cancer Network (NCCN)-International Prognostic Index (IPI) and GELTAMO (Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea)-IPI were developed to enable better risk prediction of patients with diffuse large B-cell lymphoma (DLBCL). The present study compared the effectiveness of risk prediction between IPI, NCCN-IPI, and GELTAMO-IPI in patients with DLBCL particularly in terms of determining high-risk patients. Among 439 patients who were enrolled to a prospective DLBCL cohort treated with R-CHOP immunochemotherapy, risk groups were classified according to the three IPIs and the prognostic significance of individual IPI factors and IPI models were analyzed and compared. All three IPI effectively separated the analyzed patients into four risk groups according to overall survival (OS). Estimated 5-year OS of patients classified as high-risk according to the IPI was 45.7%, suggesting that the IPI is limited in the selection of patients who are expected to have a poor outcome. In contrast, the 5-year OS of patients stratified as high-risk according to NCCN- and GELTAMO-IPI was 31.4% and 21.9%, respectively. The results indicate that NCCN- and GELTAMO-IPI are better than the IPI in predicting patients with poor prognosis, suggesting the superiority of enhanced, next-generation IPIs for DLBCL.
Highlights
The International Prognostic Index (IPI) has been widely adapted in clinical practice since its introduction almost 25 years ago for patients with aggressive nonHodgkin lymphoma (NHL) [1]
Among 439 patients who were enrolled to a prospective diffuse large B-cell lymphoma (DLBCL) cohort treated with R-CHOP immunochemotherapy, risk groups were classified according to the three IPIs and the prognostic significance of individual IPI factors and IPI models were analyzed and compared
The results indicate that National Comprehensive Cancer Network (NCCN)- and GELTAMO-IPI are better than the IPI in predicting patients with poor prognosis, suggesting the superiority of enhanced, next-generation IPIs for DLBCL
Summary
The International Prognostic Index (IPI) has been widely adapted in clinical practice since its introduction almost 25 years ago for patients with aggressive nonHodgkin lymphoma (NHL) [1]. The IPI is clinically useful because it is reproducible, allows convenient scoring and categorizes patients. Several modified versions of IPI according to the subtypes of NHL have been described [2,3,4]. The modifications and the original IPI that comprises five factors, has been used in patients with aggressive NHL, including DLBCL [1]. The addition of rituximab to chemotherapy has improved the outcome of patients with DLBCL, and necessitated a re-evaluation of the role of the IPI. It was concluded that the IPI remains a valid prognostic indicator for patients with DLBCL in the rituximab era [5]
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