International prognostic indices in diffuse large B-cell lymphoma: a comparison of IPI, R-IPI, and NCCN-IPI

Abstract

Great heterogeneity in survival exists for patients newly diagnosed with diffuse large B-cell lymphoma (DLBCL). Three scoring systems incorporating simple clinical parameters (age, lactate dehydrogenase, number/sites of involvement, stage, performance status) are widely used: the International Prognostic Index (IPI), revised IPI (R-IPI), and National Comprehensive Cancer Network IPI (NCCN-IPI). We evaluated 2124 DLBCL patients treated from 1998 to 2009 with frontline rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; or variant) across 7 multicenter randomized clinical trials to determine which scoring system best discriminates overall survival (OS). Median age was 63 years, and 56% of patients were male. Five-year OS estimates ranged from 54% to 88%, from 61% to 93%, and from 49% to 92% using the IPI, R-IPI, and NCCN-IPI, respectively. The NCCN-IPI had the greatest absolute difference in OS estimates between the highest- and lowest-risk groups and best discriminated OS (concordance index = 0.632 vs 0.626 [IPI] vs 0.590 [R-IPI]). For each given IPI risk category, NCCN-IPI risk categories were significantly associated with OS (P ≤ .01); the reverse was not true, and the IPI did not provide additional significant prognostic information within all NCCN-IPI risk categories. Collectively, the NCCN-IPI outperformed the IPI and R-IPI. Patients with low-risk NCCN-IPI had favorable survival outcomes with little room for further improvement. In the rituximab era, none of the clinical risk scores identified a patient subgroup with long-term survival clearly <50%. Integrating molecular features of the tumor and microenvironment into the NCCN-IPI or IPI might better characterize a high-risk group for which novel treatment approaches are most needed.

Differential diagnosis of sinonasal extranodal NK/T cell lymphoma and diffuse large B cell lymphoma on MRI

“…Originally, ENKTL arises predominantly from natural killer cell and DLBCL arises from mature B lymphocytes. Treatment strategies for the two histologic subtypes of lymphomas are different [ 3 – 5 ]. For sinonasal DLBCL, the chemotherapy treatment known as R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and predisone) is most common [ 3 , 4 ].…”

“…Treatment strategies for the two histologic subtypes of lymphomas are different [ 3 – 5 ]. For sinonasal DLBCL, the chemotherapy treatment known as R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and predisone) is most common [ 3 , 4 ]. On the other hand, the current standard approach for sinonasal ENKTL is the non-anthracycline-containing chemotherapy with or without radiotherapy [ 5 ].…”

Identification and Validation of a Prognostic Gene Signature for Diffuse Large B-Cell Lymphoma Based on Tumor Microenvironment-Related Genes

“…In the rituximab era, IPI, R-IPI, and NCCN-IPI risk scores are calculated using easily obtained clinical features that are part of standard diagnostic procedures. However, all three scoring systems fail to identify a very high-risk group with long-term OS clearly below 50% ( 10 ). Moreover, the progression of a tumor is affected not only by its intrinsic characteristics but also by the extrinsic TME.…”

“…In the era of rituximab and immunotherapy, the ability of the International Prognostic Index (IPI) to predict the prognosis of individual DLBCL patients has decreased ( 10 ). A better understanding of the interactions between the TME and IPI scores may provide new approaches to improve response rates to current treatment strategies.…”

Changing Management of Hematological Malignancies With COVID-19: Statement and Recommendations of the Lebanese Society of Hematology and Blood Transfusion

“…For younger patients R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone) every 3 weeks is the preferable regimen; however, intensive but more toxic therapy such as DA-EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, rituximab) or R-ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone, and rituximab) for high-risk or double hit could be administered if the center has the capacity to deliver it. In this case, patients should receive G-CSF to minimize neutropenia (32).…”