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

Zhou, Zheng; Sehn, Laurie H.; Rademaker, Alfred; Li, Gordon; LaCasce, Ann S.; Crosby-Thompson, Allison; Vanderplas, Ann; Zelenetz, Andrew D.; Abel, Gregory A.; Rodriguez, Maria Alma; Nademanee, Auayporn; Kaminski, Mark; Czuczman, Myron S.; Millenson, Michael; Niland, Joyce C.; Gascoyne, Randy D.; Connors, Joseph M.; Friedberg, Jonathan W.; Winter, Jane N.

doi:10.1182/blood-2013-09-524108

Cited by 693 publications

(656 citation statements)

References 27 publications

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“…This is apparent as patients with an identical IPIaa score may exhibit a marked variability in OS, indicative of significant residual heterogeneity within each IPI category [6]. Efforts to improve the discrimination both within and between IPI categories have focused on the addition of novel prognostic factors [4]. Convergence between the different risk groups in the IPI and the varying outcome observed in patients despite having identical IPI scores highlights the need to search for and identify high risk subgroups in DLBCL.…”

Section: Discussionmentioning

confidence: 99%

“…The International Prognostic Index (IPI) was first developed in 1993 to aid in the risk stratification of patients diagnosed with aggressive non-Hodgkin lymphoma and to facilitate outcome prediction [4]. In the era of R-CHOP treatment, redistribution of the IPI factors into a Revised-IPI provided a more clinically useful means of predicting disease outcome [5].…”

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confidence: 99%

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A population-based study of cellular markers in R-CHOP treated diffuse large B-cell lymphoma patients

et al. 2016

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A population-based study of cellular markers in R-CHOP treated diffuse large B-cell lymphoma patients

et al. 2016

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“…It has since been revised, taking into account the effect of more recent treatments on the natural history of the disease. 2,3 Although attempts have been made to prove the usefulness of the IPI in low-grade lymphoma patients, 4,5 its aptness for other lymphoma subtypes has been questioned. This led to the proposal of lymphoma-specific prognostic indices, the follicular lymphoma international prognostic index (FLIPI and FLIPI2), 6,7 the mantle cell lymphoma international prognostic index (MIPI), 8,9 and others for less common conditions.…”

Section: Introductionmentioning

confidence: 99%

A MALT lymphoma prognostic index

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Conconi

et al. 2017

Blood

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There are no widely accepted prognostic indices for extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). This study aimed to develop and validate a specific prognostic tool to personalize and optimize lymphoma treatment of patients with MALT lymphoma. A prognostic index was built by Cox regression (stepwise selection) using data from 401 patients enrolled in the international randomized IELSG-19 trial (NCT 00210353). A validation set, including 633 patients, was obtained by merging three independent cohorts of MALT lymphoma patients. The three individual features maintaining the greatest prognostic significance for event-free survival (EFS, the main endpoint of the IELSG-19 trial) were age ≥70 years (HR 1.72, 95% CI 1.26-2.33), Ann Arbor stage III or IV (HR 1.79, 95% CI 1.35-2.38), and elevated LDH level (HR 1.87, 95% CI 1.27-2.77). The prognostic index (MALT-IPI) constructed using these three parameters identified three groups: low, intermediate and high risk (corresponding to the presence of 0, 1 or ≥2 of these factors, respectively). The 5-year EFS rates in the low, intermediate and high risk groups were 70%, 56% and 29%, respectively. The MALT-IPI also significantly discriminated between patients with different progression-free, overall and cause-specific survival. The prognostic utility was retained in gastric and non-gastric lymphomas, in each treatment arm (chlorambucil, rituximab, rituximab plus chlorambucil), and was confirmed in the validation set. The new index, MALT-IPI, is a simple, accessible and effective tool to identify MALT lymphoma patients at risk of poor outcomes. It may help define appropriate treatment approaches for individual patients

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“…[1][2][3] Furthermore, patients with high-risk International Prognostic Index (IPI) have a 5-year progression-free survival (PFS) of only 40% following R-CHOP. 4 Therefore, more intensive treatment protocols, such as high-dose therapy (HDT) and autologous stem cell transplantation (ASCT), have been advocated. 5,6 These, however, are associated with considerable increased cost and toxicity.…”

Section: Introductionmentioning

confidence: 99%

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

et al. 2016

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I n the treatment of diffuse large B-cell lymphoma, a persistently positive [ 18 F]fluorodeoxyglucose positron emission tomography (PET) scan typically carries a poor prognosis. In this prospective multi-center phase II study, we sought to establish whether treatment intensification with R-ICE (rituximab, ifosfamide, carboplatin, and etoposide) chemotherapy followed by 90Y-ibritumomab tiuxetan-BEAM (BCNU, etoposide, cytarabine, and melphalan) for high-risk diffuse large B-cell lymphoma patients who are positive on interim PET scan after 4 cycles of R-CHOP-14 (rituximab, cyclophosphamide, doxorubicin, and prednisone) can improve 2-year progression-free survival from a historically unfavorable rate of 40% to a rate of 65%. Patients received 4 cycles of R-CHOP-14, followed by a centrally-reviewed PET performed at day 17-20 of cycle 4 and assessed according to International Harmonisation Project criteria. Median age of the 151 evaluable patients was 57 years, with 79% stages 3-4, 54% bulk, and 54% International Prognostic Index 3-5. Among the 143 patients undergoing interim PET, 101 (71%) were PET-negative (96 of whom completed R-CHOP), 42 (29%) were PETpositive (32 of whom completed R-ICE and 90Y-ibritumomab tiuxetan-BEAM). At a median follow up of 35 months, the 2-year progressionfree survival for PET-positive patients was 67%, a rate similar to that for

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

Cited by 693 publications

References 27 publications

A population-based study of cellular markers in R-CHOP treated diffuse large B-cell lymphoma patients

A population-based study of cellular markers in R-CHOP treated diffuse large B-cell lymphoma patients

A MALT lymphoma prognostic index

Early treatment intensification with R-ICE and 90Y-ibritumomab tiuxetan (Zevalin)-BEAM stem cell transplantation in patients with high-risk diffuse large B-cell lymphoma patients and positive interim PET after 4 cycles of R-CHOP-14

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