Risk Stratification for Diffuse Large B-Cell Lymphoma by Integrating Interim Evaluation and International Prognostic Index: A Multicenter Retrospective Study.

Xue Shi,Dongyue Lu,Xin Wang,Yuanfeng Zhang,Shunfeng Hu,Xiaosheng Fang,Xue Sun,Xiaoqian Liu,Yahan Li,Haiping Chen,Xiaomei Li,Xiangxiang Zhou,Ying Li

doi:10.3389/fonc.2021.754964

Abstract

The baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with diffuse large B-cell lymphoma (DLBCL) treated with R‐CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The aims of this study were to evaluate the prognostic relevance of early risk stratification in DLBCL and develop a new stratification system that combines an interim evaluation and IPI. This multicenter retrospective study enrolled 314 newly diagnosed DLBCL patients with baseline and interim evaluations. All patients were treated with R-CHOP or R-CHOP-like regimens as the first-line therapy. Survival differences were evaluated for different risk stratification systems including the IPI, interim evaluation, and the combined system. When stratified by IPI, the high-intermediate and high-risk groups presented overlapping survival curves with no significant differences, and the high-risk group still had >50% of 3-year overall survival (OS). The interim evaluation can also stratify patients into three groups, as 3-year OS and progression-free survival (PFS) rates in patients with stable disease (SD) and progressive disease (PD) were not significantly different. The SD and PD patients had significantly lower 3-year OS and PFS rates than complete remission and partial response patients, but the percentage of these patients was only ~10%. The IPI and interim evaluation combined risk stratification system separated the patients into low-, intermediate-, high-, and very high-risk groups. The 3-year OS rates were 96.4%, 86.7%, 46.4%, and 40%, while the 3-year PFS rates were 87.1%, 71.5%, 42.5%, and 7.2%. The OS comparison between the high-risk group and very high-risk group was marginally significant, and OS and PFS comparisons between any other two groups were significantly different. This combined risk stratification system could be a useful tool for the prognostic prediction of DLBCL patients.

Highlights

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma (NHL) and accounts for about 30%–40% of all NHL cases [1]
We retrospectively investigated the clinical data of 314 adult patients diagnosed with DLBCL not otherwise specified (NOS) at the Shandong Provincial Hospital affiliated to the First Medical University of Shandong, the Affiliated Hospital of Qingdao University, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, and Dongying People’s Hospital from December 2008 to December 2019
The median age was 52, 129 (41%) patients were older than 60 years, and there was a slight predominance of males (164/314, 52%)

Summary

Introduction

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma (NHL) and accounts for about 30%–40% of all NHL cases [1]. This heterogeneous disease can be subdivided into several types according to different manifestations and molecular characteristics using the WHO classification [2]. The IPI has been widely used in clinical applications and is the standard practical prognostic tool for DLBCL patients. It was established before the immunochemotherapy era, which has dramatically increased the survival rate. The IPI system failed to identify a high-risk group after immunochemotherapy [5,6,7,8]

Objectives

Methods

Results

Conclusion