The Geriatric Prognostic Index: a clinical prediction model for survival of older diffuse large B-cell lymphoma patients treated with standard immunochemotherapy

Abstract

International prognostic Index (IPI) is the most widely used clinical prediction model for diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP), but may be suboptimal in older patients. We aimed to develop and externally validate a clinical prediction model for older, R-CHOP treated DLBCL patients by examining geriatric assessment and lymphoma-related parameters in real-world cohorts. A population-based training set of 365 R-CHOP treated DLBCL patients ≥70 years was identified through the Cancer Registry of Norway. The external test set consisted of a population-based cohort of 193 patients. Data on candidate predictors was retrieved from the Cancer Registry and through review of clinical records. Cox regression models for 2-year overall survival (OS) were used for model selection. Activities of daily living (ADL), Charlson Comorbidity index (CCI), age, sex, albumin, stage, ECOG and LDH were identified as independent predictors and combined into a Geriatric prognostic index (GPI). The GPI demonstrated good discrimination (optimism-corrected C-index 0.752), and identified a low-, intermediate- and high-risk group with significantly different survival (2-year OS 94%, 65%, 25%). At external validation, the continuous and grouped GPI demonstrated good discrimination (C-index 0.727, 0.710) and the GPI groups had significantly different survival (2- year OS 95%, 65%, 44%). Both the continuous and grouped GPI showed better discrimination than IPI, R-IPI and NCCN-IPI (C-index 0.621, 0.583, 0.670) We have developed and externally validated the GPI for older DLBCL patients treated with RCHOP that outperformed IPI, R-IPI and NCCN-IPI. A web-based calculator is available at https://wide.shinyapps.io/GPIcalculator/.

Validation and modification of simplified Geriatric Assessment and Elderly Prognostic Index: Effective tools for older patients with diffuse large B‐cell lymphoma

“… 14 , 15 When assessing the objective health of older adults across multiple domains, including cognitive impairment, functional or physical impairment, and multimorbidity, geriatric assessment may affect cancer prognosis, treatment choices, and tolerance. 16 , 17 , 18 , 19 , 20 , 21 Notably, the G‐8 screening tool has demonstrated high sensitivity and acceptable specificity, and possess prognostic value in hematological malignancies. 22 , 23 The Vulnerable Elders Survey‐13 is a stronger predictor of 1‐year mortality in older patients with DLBCL.…”

Prognostic impact of absolute peripheral blood NK cell count after four cycles of R-CHOP-like regimen treatment in patients with diffuse large B cell lymphoma

“…Furthermore, we found that low NKCC4 synergistically decreased the OS and PFS among DLBCL patients with high IPI. IPI is now still the most extensive utilized prognostic index in DLBCL, although in the era of rituximab, which notably improves patient cure ratio [ 26 , 27 ]. However, the use of IPI, revised-IPI, or National Comprehensive Cancer Network IPI to classify high-risk subgroup with long-term survival less than 50% is limited [ 28 ].…”

Prognostic tools for older patients with DLBCL: complex patients require complex solutions and a personal touch.

“…The authors demonstrated that the new index performed better than conventional prognostic indices like the International Prognostic Index (IPI), the Revised (R)-IPI, and the National Comprehensive Cancer Network (NCCN)-IPI. 1 …”