Risk classification as the basis for clinical staging of diffuse large- cell lymphoma derived from 10-year survival data

Abstract

Two hundred and fifty previously untreated adult patients with diffuse large-cell lymphomas were treated with a chemotherapy combination of cyclophosphamide, adriamycin, vincristine, prednisone, and low-dose bleomycin (CHOP-Bleo) with or without radiotherapy between 1974 and 1984. The 10-year survival rates for patients with Ann Arbor stages II, III, or IV disease of 55%, 42%, and 40%, respectively, were not significantly different. However, the survival rate of 76% for patients with stage I disease was clearly better. Factors more indicative of prognosis than stage, as found by univariant analysis, were tumor burden, serum lactic dehydrogenase level (LDH), age, and constitutional symptoms. From these, a multivariant analysis selected tumor burden, LDH level, and age as major independent factors for predicting survival (P less than .001). A prognostic risk model constructed on the basis of tumor burden and LDH levels identified four distinct risk groups (A, B, C, D) with 10-year survival rates of 85%, 66%, and 43% for A, B, and C. No patient in group D survived 10 years. These risk groups also had a strong correlation with complete remission rates and with relapse rates. Thus this model proved more effective for identifying patient populations according to their expected responses, durations of remission, and survivals than the Ann Arbor staging system. Detailed information supporting the use of this system for predicting prognosis and for treatment selection for patients with diffuse large-cell lymphomas is provided.

A phase II trial of promace‐cytabom in previously untreated non‐hodgkin's lymphoma of intermediate‐ or high‐grade histology

“…Yet LDH level proved to be a highly significant adverse prognostic factor both for the achievement of CR and for survival. This data confirms similar results obtained in larger studies using different treatment regimens (Danieu el al., 1986;Velasquez et al, 1989).…”

High‐dose cyclophosphamide, etoposide and BCNU (CVB) with autologous stem cell rescue in malignant lymphomas

“…This report summarizes our experience with CVB regimen followed by autograft in NHL and HL patients. At the time of transplantation all patients were considered to have a poor expectancy of cure with conventional treatment regimens (4, 34,35). In light of the lower risk of relapse in patients with minimal disease at autograft, we treated all patients with detectable disease with conventional aggressive salvage therapy in order to minimize tumor burden prior to autograft.…”

Extracorporeal photochemotherapy in patients with cutaneous T‐cell lymphoma: is clinical response predictable?

“…16 Serum level of beta2-microglobulin ( β 2 -M), which normally constitutes the invariant chain of the HLA class I molecules, is reported to be of prognostic value in other variants of non-Hodgkin's lymphomas. 17 Cytolytic T cells contain granules of enzymes, which, after binding to a target cell, are released into the intercellular space. The granules released from the cytolytic CD8+-cell contain a pore-forming protein (perforin), allowing exogenous serine proteases (granzymes) to enter the cytosol of the target cells through the transmembrane pores.…”