The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP

Sehn, Laurie H.; Berry, Brian; Chhanabhai, Mukesh; Fitzgerald, C. P.; Gill, Karamjit; Hoskins, Paul; Klasa, Richard; Savage, Kerry J.; Shenkier, Tamara; Sutherland, Judy; Gascoyne, Randy D.; Connors, Joseph M.

doi:10.1182/blood-2006-08-038257

Cited by 1,198 publications

(928 citation statements)

References 25 publications

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“…Although patients with CNS involvement or those who received CNS prophylaxis were excluded, our patient cohort was well stratified by R-IPI. Because OS of each group was also similar to that in the original report of R-IPI by Sehn et al (94%, 79%, 55%, P < .001), 3 in which none of the DLBCL subtypes in our criteria was excluded, the DLBCL patient cohort in our study had a similar distribution in prognosis to the entire DLBCL cohort. We also chose patients who were treated only with standard R-CHOP therapy, to eliminate the influence of other therapeutic factors.…”

Section: Discussionsupporting

confidence: 83%

“…2 Although the prognosis of diffuse large B-cell lymphoma (DLBCL) is improved by the addition of rituximab, extranodal involvement is still considered a poor prognostic factor by revised IPI (R-IPI). 3 The prognostic impact of each involvement site has not yet been fully elucidated. The present study is a multicenter retrospective analysis of patients with DLBCL who underwent treatment with R-CHOP therapy.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Takahashi

Tomita

Yokoyama

et al. 2011

Cancer

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BACKGROUND:Extranodal involvement is considered a poor prognostic factor for patients with diffuse large B‐cell lymphoma (DLBCL); however, the prognostic impact of specific sites of involvement has not been fully elucidated.METHODS:The authors retrospectively analyzed 1221 patients treated uniformly with standard R‐CHOP therapy between 2003 and 2006. Patients with distinct forms of DLBCL such as intravascular lymphoma, primary effusion lymphoma, pyothorax‐associated lymphoma, primary central nervous system lymphoma, and intraocular lymphoma were also excluded. The authors evaluated 26 extranodal sites of involvement with respect to prognostic impact. The median age was 64 years (range, 15‐91 years).RESULTS:Univariate analysis revealed that patients with involvement of specific extranodal sites had significantly worse overall survival (OS) than did patients without such involvement; these sites included nasal cavity, paranasal sinus, lung, pleura, small intestine, peritoneum, liver, pancreas, stomach, spleen, adrenal gland, testis, bone, bone marrow, peripheral blood, skin, and subcutaneous tissue. Patients with Waldeyer ring involvement had significantly better OS. Multivariate analysis revealed that patients with the involvement of the pleura (P < .001), small intestine (P = .015), peritoneum (P = .002), adrenal gland (P < .001), testis (P = .005), bone marrow (P < .001), and peripheral blood (P = .002) had significantly worse OS, whereas those with Waldeyer ring involvement had significantly better OS (P = .038). Subgroup analysis with the nodal and/or Waldeyer patient group also showed prognostic impact of Waldeyer ring by multivariate analysis (relative risk, 0.3; P = .04).CONCLUSIONS:Extranodal involvement affects the prognosis of patients undergoing R‐CHOP therapy for DLBCL. Cancer 2012. © 2011 American Cancer Society.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Takahashi

Tomita

Yokoyama

et al. 2011

Cancer

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“…Using the revised International Prognostic Index (IPI) score, 44 (68%) patients were high risk (score of 3-5), predicting for a 4-year overall survival rate of 55%. 19 One patient had human immunodeficiency virus infection. LDH was elevated in 73% of patients, and 64 of 65 patients had extranodal involvement of their DLBCL.…”

Section: Resultsmentioning

confidence: 99%

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Abramson

Hellmann

Barnes

et al. 2010

Cancer

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BACKGROUND:The outcome of patients with systemic diffuse large B-cell lymphoma (DLBCL) had improved over the past decade with the addition of monoclonal antibody therapy. Unfortunately, approximately 5% of these patients still developed a secondary central nervous system (CNS) recurrence followed invariably by rapid death. This rate is substantially increased in patients with certain high-risk features. Although prophylaxis against CNS recurrence with either intrathecal or intravenous methotrexate is commonly used for such patients, to the authors' knowledge, there is no standard of care. Retrospectively evaluated was the role of high-dose systemic methotrexate combined with standard cyclophosphamide, doxorubicin, vincristine, and prednisone with rituximab (R-CHOP) chemotherapy to decrease CNS recurrence in high-risk patients. METHODS: A total of 65 patients with DLBCL and CNS risk factors were identified at the study institution between 2000 and 2008 who received intravenous methotrexate as CNS prophylaxis concurrent with standard systemic therapy with curative intent. CNS recurrence rate, progression-free survival, and overall survival were calculated. RESULTS: Patients received a median of 3 cycles of methotrexate at a dose of 3.5 gm/m 2 with leucovorin rescue. The complete response rate was 86%, with 6% partial responses. At a median follow-up of 33 months, there were only 2 CNS recurrences (3%) in this high-risk population. The 3-year progression-free and overall survival rates were 76% and 78%, respectively. Complications associated with methotrexate therapy included transient renal dysfunction in 7 patients and a delay in systemic chemotherapy in 8 patients. CONCLUSIONS: Intravenous methotrexate can be safely administered concurrently with R-CHOP and is associated with a low risk of CNS recurrence in high-risk patients. Cancer 2010;116:4283-90.

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“…Several ways are currently been tested such dose-dense and dose-intense regimens or the association of other biologics (Coiffier and Reyes, 2005;Coiffier, 2005cCoiffier, , 2006. One interesting observation was the fact that prognostic parameters such as those described in the International Prognostic index seem to loose some importance in patients treated with R-CHOP (Sehn et al, 2007). Even the new prognostic parameters described with microarray gene analyses are less important than bcl-2 or bcl-6 protein expression (Farinha et al, 2006;Mounier et al, 2006;Winter et al, 2006).…”

Section: Rituximab Therapy B Coiffiermentioning

confidence: 99%

Rituximab therapy in malignant lymphoma

2007

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The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP

Cited by 1,198 publications

References 25 publications

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Prognostic impact of extranodal involvement in diffuse large B‐cell lymphoma in the rituximab era

Intravenous methotrexate as central nervous system (CNS) prophylaxis is associated with a low risk of CNS recurrence in high‐risk patients with diffuse large B‐cell lymphoma

Rituximab therapy in malignant lymphoma

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