Diffuse Large Cell Lymphomas: Identification of Prognostic Factors and Validation of the International Non-Hodgkin’s Lymphoma Prognostic Index

Abstract

Several clinical prognostic factors have been identified that predict treatment outcome in patients with diffuse large cell lymphomas. An International Non-Hodgkin’s Lymphoma Prognostic Index (IPI) has been recently formulated. We tried to identify the clinical prognostic factors that predict treatment outcome in Greek patients with diffuse large cell lymphomas and validated the IPI in these patients. The possible prognostic variables for tumor response, relapse-free (RFS) and overall survival (OS) were analyzed in 239 consecutive patients treated with anthracycline-based chemotherapy regimens. In univariate analysis, factors associated with poor response were stages III–IV, performance status (PS) ≥2, spleen and bone marrow involvement, more than one extranodal site involved, increased lactate dehydrogenase (LDH) value, hemoglobin (Hb) <12 g/dl, albumin <3.5 g/dl, erythrocyte sedimentation rate (ESR) >50 mm/h. Multivariate analysis identified stage, PS, more than one extranodal site involved, increased LDH level, and ESR > 50 mm/h as the factors more predictive of poor response. For RFS, multiple Cox analysis found stages III–IV and bone marrow involvement to be statistically significant. For OS, multiple Cox analysis identified stage III–IV, PS ≥2, bone marrow involvement, more than one extranodal site involved, increased LDH level and ESR > 50 mm/h as negative prognostic factors. Patients stratified in the different risk groups of the IPI had a significantly different outcome regarding complete response (CR) rate, RFS and OS. In conclusion, although age >60 years was not recognized as an adverse factor in this analysis, our patients stratified in the different groups of the IPI had significant differences in CR rate, 2-year RFS and OS verifying the prognostic significance of the index. Bone marrow involvement and ESR > 50 mm/h, parameters that are not included in the IPI, adversely affected survival.

Prognostic factors in nasopharyngeal carcinoma with synchronous liver metastasis: a retrospective study for the management of treatment

“…Elevated levels of LDH are considered a negative prognostic factor in many solid tumors, including advanced NPC, and have been associated with large tumor burden, tumor extension and high risk of metastasis [21-25]. Serum LDH levels twice normal levels are rarely seen in loco-regional disease but are commonly observed in NPC patients with liver metastasis or multiple organ metastases.…”

Prognostic significance of biochemical markers in African Burkitt’s lymphoma

“…The development of the international prognostic index (IPI) [3], based on pre-treatment clinical data, for NHLs has enabled clinicians to successfully manage several highgrade NHLs. The IPI has also proven valid for specifi c adult cancers [4][5][6] but not yet for paediatric cancers. Prognostic indices at the genetic, molecular, biochemical, clinical, demographic and/or socioeconomic level [7] are being proposed and used for specifi c cancers [8], but not without confl icting results [5][6][7][8][9].…”

“…The IPI has also proven valid for specifi c adult cancers [4][5][6] but not yet for paediatric cancers. Prognostic indices at the genetic, molecular, biochemical, clinical, demographic and/or socioeconomic level [7] are being proposed and used for specifi c cancers [8], but not without confl icting results [5][6][7][8][9]. This study, while acknowledging its limitations, addresses this issue in comparison to reported literature on prognostic indices for paediatric NHL [9].…”

Progression of Cutaneous B-Cell Pseudolymphoma to Cutaneous B-Cell Lymphoma

“…63,64 Extent of disease is determined by physical examination, followed by a thorough staging evaluation including CBC and evaluation of peripheral smear, serum chemistries, CXR or chest CT scan, abdominal and pelvic CT scan, and bone marrow studies. Serum lactate dehydrogenase (LDH), a marker for tumor load, 65 is monitored as well. Local radiation therapy following a negative staging evaluation should be considered in patients with CBPL in which a combination of clinical picture, histologic, immunohistologic, and/or clonality studies show features which may be considered worrisome 22 for potential progression to lymphoma.…”