Abstract
Diffuse large B-cell lymphoma (DLBCL) is a heterogenous disease with a variable prognosis. The International Prognostic Index (IPI), revised-IPI (R-IPI), and National Comprehensive Cancer Network-IPI (NCCN-IPI) have been developed and validated to predict prognosis in DLBCL. However, patients from the Middle East and North Africa (MENA) region were under-represented in such scores, and it is unclear whether ethnic background contributes to different disease biology or response to therapy. Following due Institutional Board Review approval, DLBCL patients diagnosed from January 2010 until December 2015 from the MENA region were retrospectively reviewed. A total of 122 were identified and further analyzed. There were 74 males (61%), and the median age at diagnosis for the cohort was 64 years (range: 18-98 years), with a median follow-up duration of 32.9 months (range: 0.2-123.7 months). Estimates of three-year progression-free survival found a significant difference among risk groups using all three prognostic models but were more discriminating among the groups using NCCN-IPI and R-IPI vs. IPI (p = 0.019 and 0.014 vs. 0.039, respectively). For overall survival estimates at three years, the NCCN-IPI was the best model compared to R-IPI and IPI (p = 0.0013 vs. 0.05 and 0.04, respectively). In conclusion, we validated that the IPI and its subsequent iterations were predictive of outcome in DLBCL patients from the MENA region; however, the NCCN-IPI appeared the most prognostic. These results warrant further confirmation.
Highlights
Diffuse large B-cell lymphoma (DLBCL) is a commonly diagnosed non-Hodgkin lymphoma (NHL), accounting for one-quarter of NHL cases [1]
Patients from the Middle East and North Africa (MENA) region were under-represented in such scores, and it is unclear whether ethnic background contributes to different disease biology or response to therapy
Estimates of three-year progression-free survival found a significant difference among risk groups using all three prognostic models but were more discriminating among the groups using National Comprehensive Cancer Network (NCCN)-International Prognostic Index (IPI) and R-IPI vs. IPI (p = 0.019 and 0.014 vs. 0.039, respectively)
Summary
Diffuse large B-cell lymphoma (DLBCL) is a commonly diagnosed non-Hodgkin lymphoma (NHL), accounting for one-quarter of NHL cases [1]. In Saudi Arabia, NHL is the third most commonly diagnosed malignancy with an incidence rate of 6/100,000, with the most prevalent NHL subtype being DLBCL [3]. DLBCL remains a heterogeneous disease with differing presentations and clinical outcome. The International Prognostic Index (IPI) was originally developed in order to assess the impact of pre-treatment factors on outcome. The identified factors included age > 60 years, lactate dehydrogenase level (LDH) above normal, Eastern Cooperative Oncology Group (ECOG) performance status > 2, stage III or IV disease, and the presence of more than one extra-nodal site [4]. Cumulative risks are tallied to estimate the risk status in one of four categories, low, low-intermediate, high-intermediate, or high-risk disease, with significantly differing overall survival (OS) and relapse-free survival (RFS) among the groups
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