The Kyoto Prognostic Index for patients with diffuse large B-cell lymphoma in the rituximab era

Kobayashi, Tsutomu; Kuroda, Junya; Yokota, Isao; Tanba, Kazuna; Fujino, Takahiro; Kuwahara, Saeko; Isa, Reiko; Yamaguchi, Junko; Kawata, Eri; Akaogi, Teruaki; Uchiyama, Hitoji; Kaneko, Hiroto; Uoshima, Nobuhiko; Kobayashi, Yutaka; Teramukai, Satoshi

doi:10.1038/bcj.2015.111

Cited by 13 publications

(21 citation statements)

References 14 publications

(13 reference statements)

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“…24 Seven studies of 46 used training and validation sets to develop a prognostic index and to validate it. 1,2,16,31,[34][35][36] Among the studies using nomograms, three used both internal and external validation, [26][27][28] one used internal validation only, 25 and two did not assess the performance through validation. 29,30 Model performance was evaluated using different methods, which are discussed in the following subsections.…”

Section: Discussionmentioning

confidence: 99%

“…As a measure of discrimination, the area under the receiver operating characteristics (ROC) curve for survival outcomes (the c-index) was used in seven of 46 studies. 7,16,32,34,[37][38][39] Higher values of the c-index indicated better discrimination. The value of the c-index for the novel prognostic models ranged from 0.708 for the comorbidity National Comprehensive Cancer Network-IPI (cNCCN-IPI) to 0.830 for the lipoprotein prognostic index (Lipo-PI).…”

Section: C-statisticsmentioning

confidence: 99%

“…Fifteen of 46 studies reported 3-year OS for novel prognostic models, while OS was calculated from Kaplan-Meier curves for the rest 3,9,10,16,31,34,35,39,40,44,52,[56][57][58][59] (Tables 1-3). Only the minority of studies (six of 46) reported 3-year OS for compared indices.…”

Section: Difference and Ratio In 3-year Overall Survival Between Riskmentioning

confidence: 99%

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<p>Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models – A Systematic Review</p>

Jelicic

Larsen

Frederiksen

et al. 2020

CLEP

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Background and Aim: Based on advances in the diagnosis, classification, and management of diffuse large B-cell lymphoma (DLBCL), a number of new prognostic models have been proposed. The aim of this study was to review and compare different prognostic models of DLBCL based on the statistical methods used to evaluate the performance of each model, as well as to analyze the possible limitations of the methods. Methods and Results: A literature search identified 46 articles that proposed 55 different prognostic models for DLBCL by combining different clinical, laboratory, and other parameters of prognostic significance. In addition, six studies used nomograms, which avoid risk categorization, to create prognostic models. Only a minority of studies assessed discrimination and/or calibration to compare existing models built upon different statistical methods in the process of development of a new prognostic model. All models based on nomograms reported the c-index as a measure of discrimination. There was no uniform evaluation of the performance in other prognostic models. We compared these models of DLBCL by calculating differences and ratios of 3-year overall survival probabilities between the high-and the low-risk groups. We found that the highest and lowest ratio between low-and high-risk groups was 6 and 1.31, respectively, while the difference between these groups was 18.9% and 100%, respectively. However, these studies had limited duration of follow-up and the number of patients ranged from 71 to 335. Conclusion: There is no universal statistical instrument that could facilitate a comparison of prognostic models in DLBCL. However, when developing a prognostic model, it is recommended to report its discrimination and calibration in order to facilitate comparisons between different models. Furthermore, prognostic models based on nomograms are becoming more appealing owing to individualized disease-related risk estimations. However, they have not been validated yet in other study populations.

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Section: Discussionmentioning

confidence: 99%

Section: C-statisticsmentioning

confidence: 99%

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<p>Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models – A Systematic Review</p>

Jelicic

Larsen

Frederiksen

et al. 2020

CLEP

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“…The common first-line immunochemotherapy for DLBCL is the so-called R-CHOP therapy, which combines the anti-CD20 monoclonal antibody rituximab and the genotoxic agents of cyclophosphamide, doxorubicin, vincristine, and prednisolone. Although R-CHOP or R-CHOP-like therapies generally cure >60% of patients with newly diagnosed DLBCL [ 4 , 5 , 6 , 7 , 8 ], the remaining patients require more intensive, but frequently more toxic, immunochemotherapeutic strategies and novel approaches with chimeric antigen T-cell therapy, bispecific T-cell engager, or antibody-drug conjugates [ 9 , 10 , 11 ]. To avoid inappropriate treatment for high-risk disease and overtreatment with excess toxicity for standard-risk disease, it is important to predict treatment success or failure with the current standard first-line treatment in patients with DLBCL.…”

Section: Introductionmentioning

confidence: 99%

“…To avoid inappropriate treatment for high-risk disease and overtreatment with excess toxicity for standard-risk disease, it is important to predict treatment success or failure with the current standard first-line treatment in patients with DLBCL. In this regard, various prognostic indices of clinical manifestations have been used in daily clinical practice [ 4 , 5 , 6 , 7 ]. Furthermore, various molecular classifications have been proposed to understand disease pathophysiology and predict prognosis in DLBCL [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma

et al. 2021

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Bone marrow (BM) involvement is associated with prognosis in diffuse large B-cell lymphoma (DLBCL), the most prevalent disease subtype of malignant lymphoma. We conducted this multi-institutional retrospective study to investigate the functional association and prognostic values of four BM tests (BM biopsy, BM clot, flow cytometry (FCM), and BM smear). A total of 221 DLBCL patients were enrolled. BM involvement was detected in 17 (7.7%), 16 (7.2%), 27 (12.2%), and 34 (15.4%) patients by BM biopsy, BM clot, FCM, and BM smear, respectively. The consistency between BM biopsy and clot examination was favorable, with a κ coefficient of 0.705, whereas the consistencies among other modalities were poor. In 184 patients treated with the first-line R-CHOP (-like) regimen, BM involvement was associated with shorter progression-free survival (PFS) irrespective of the type of modality for a positive result. Intriguingly, among various single and combinatory modalities, the combination of BM biopsy and FCM had the highest hazard ratio of 3.33 and a c-index of 0.712. In conclusion, our study suggested that the combination of BM biopsy and FCM is the prognostically relevant central approach for BM involvement detection. The other BM examinations also may provide complementary information in clinical settings.

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Chromosomal abnormality variation detected by G‐banding is associated with prognosis of diffuse large B‐cell lymphoma treated by R‐CHOP‐based therapy

et al. 2018

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Diffuse large B‐cell lymphoma (DLBCL), which is the most prevalent disease subtype of non‐Hodgkin lymphoma, is highly heterogeneous in terms of cytogenetic and molecular features. This study retrospectively investigated the clinical impact of G‐banding‐defined chromosomal abnormality on treatment outcomes of DLBCL in the era of rituximab‐containing immunochemotherapy. Of 181 patients who were diagnosed with DLBCL and treated with R‐CHOP or an R‐CHOP‐like regimen between January 2006 and April 2014, metaphase spreads were evaluable for G‐banding in 120. In these 120 patients, 40 were found to harbor a single chromosomal aberration type; 63 showed chromosomal abnormality variations (CAVs), which are defined by the presence of different types of chromosomal abnormalities in G‐banding, including 19 with two CAVs and 44 with ≥3 CAVs; and 17 had normal karyotypes. No specific chromosomal break point or numerical abnormality was associated with overall survival (OS) or progression‐free survival (PFS), but the presence of ≥3 CAVs was significantly associated with inferior OS rates (hazard ratio (HR): 2.222, 95% confidence interval (CI): 1.056–4.677, P = 0.031) and tended to be associated with shorter PFS (HR: 1.796, 95% CI: 0.965–3.344, P = 0.061). In addition, ≥3 CAVs more frequently accumulated in high‐risk patients, as defined by several conventional prognostic indices, such as the revised International Prognostic Index. In conclusion, our results suggest that the emergence of more CAVs, especially ≥3, based on chromosomal instability underlies the development of high‐risk disease features and a poor prognosis in DLBCL.

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The Kyoto Prognostic Index for patients with diffuse large B-cell lymphoma in the rituximab era

Cited by 13 publications

References 14 publications

<p>Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models – A Systematic Review</p>

<p>Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models – A Systematic Review</p>

Combination of Bone Marrow Biopsy and Flow Cytometric Analysis: The Prognostically Relevant Central Approach for Detecting Bone Marrow Invasion in Diffuse Large B-Cell Lymphoma

Chromosomal abnormality variation detected by G‐banding is associated with prognosis of diffuse large B‐cell lymphoma treated by R‐CHOP‐based therapy

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