Validation of clinical prognostic indices for diffuse large B-cell lymphoma in the National Cancer Data Base

Olszewski, Adam J.; Winer, Eric S.; Castillo, Jorge J.

doi:10.1007/s10552-015-0610-8

Cited by 16 publications

(14 citation statements)

References 36 publications

(57 reference statements)

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“…Five-year OS rates ranged from 86% in IPI ‘low-risk’ patients to 45% in IPI ‘high-risk’ patients. Our OS rates were higher than the 5-year OS rates reported for patients in a large validation study by Olszewski et al those authors reported 5-year OS of 74, 58, 49, and 33% for ‘low-risk’, ‘low-intermediate’, ‘high-intermediate’ and ‘high-risk’ patients, compared with 86, 67, 58, and 45%, respectively, in the present study ( 23 ). Five-year OS rates in our study were higher in all three R-IPI categories compared with the validation study (‘very good’ prognosis: 96% vs. 87%; ‘good’ prognosis: 73% vs. 64%; ‘poor’ prognosis: 51% vs. 41%, respectively), differences that may have been due to the characteristics of the two patient populations.…”

Section: Discussioncontrasting

confidence: 87%

Diffuse large B-cell lymphoma: 10ï¿½years' real-world clinical experience with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone

et al. 2018

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Treatment with rituximab plus a regimen of cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) for patients with diffuse large B-cell lymphoma (DLBCL) has proven efficacy in clinical trials. The present study investigated its application in clinical practice. This single-center, retrospective database analysis included patients with DLBCL treated at the Slovenian Institute of Oncology Ljubljana between 2004 and 2013. Overall survival (OS) and progression-free survival (PFS) were assessed according to International Prognostic Index (IPI) and revised IPI (R-IPI) categories. Overall, 573 patients with DLBCL were included in the study (median follow-up, 45.3 months; range, 0.1–143.0). Patients were categorized as IPI ‘low’ (n=170; 30%), ‘low-intermediate’ (n=134; 23%), ‘high-intermediate’ (n=129; 23%) and ‘high’ (n=140; 24%) risk. R-IPI groups were indicated with ‘very good’ (n=59; 10%), ‘good’ (n=245; 43%) and ‘poor’ (n=269; 47%) prognosis. Ten-year OS and PFS rates were 51 and 72%, respectively; median OS was 124 months and median PFS was not reached. Ten-year OS rates were 80 and 87% in low-risk and ‘very good’ prognosis groups, respectively, and 30 and 37% in high-risk and poor prognosis patients, respectively. This analysis of patients with DLBCL indicated that many patients treated with R-CHOP and R-CHOP-like regimens in the real-world setting have excellent outcomes.

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Section: Discussioncontrasting

confidence: 87%

Diffuse large B-cell lymphoma: 10ï¿½years' real-world clinical experience with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone

et al. 2018

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“…Such a model, incorporating disease-specific risk factors, as well as sociodemographic indicators of general mortality, has been shown in DLBCL and PTCL to provide a better stratification of OS using cancer registry data than the IPI. (Olszewski et al, 2015; Petrich et al, 2015) Model sensitivity to the proportional hazard assumption was evaluated by plotting smoothed scaled Schoenfeld residuals versus time. All estimates are presented with 95% confidence intervals (95%CI).…”

Section: Methodsmentioning

confidence: 99%

Time to treatment is an independent prognostic factor in aggressive non‐Hodgkin lymphomas

2018

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In aggressive lymphomas, discrepancies in survival reported from experimental and observational studies may reflect selective non-enrolment of high-risk patients in trials. We examined the association between time from diagnosis to chemotherapy and overall survival in diffuse large B-cell (DLBCL), Burkitt (BL), mantle cell (MCL) and peripheral T-cell lymphoma (PTCL), using National Cancer Data Base records of 130 549 patients treated in 2004-2014. Across the histologies, patients who started chemotherapy within 7 days of diagnosis had more often high International Prognostic Index (IPI) or advanced-stage disease. The discrepancy in 3-year survival between groups treated within 7 or >30 days from diagnosis ranged from 14% in BL to 30% in MCL. After adjusting for the IPI, time to treatment was significantly associated with shorter overall survival. Using the group treated >30 days from diagnosis as reference, patients treated within 7 days had a hazard ratio of 1·38 [95% confidence interval (CI), 1·28-1·48] in DLBCL, 1·42 (95% CI, 1·22-1·66) in BL, 2·23 (95% CI, 1·79-2·78) in MCL and 1·46 (95% CI, 1·18-1·81) in PTCL. Time from diagnosis to treatment may reflect high-risk features uncaptured by standard prognostic assessments. Clinical trials should accommodate patients who need urgent therapy to improve external validity and detect treatment effects in high-risk groups.

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“…Prognosis in DLBCL has been historically assessed using clinical features comprising the International Prognostic Index (IPI), but in the era of rituximab-based immunochemotherapy the IPI explains less than 25% of variation in overall survival (OS) and poorly separates the highest-risk subgroups [9, 12]. The enhanced IPI (which improved on the specification of age and lactate dehydrogenase [LDH] as non-binary variables) has identified involvement of CNS, liver/gastrointestinal (GI) tract, lung, or marrow as additional unfavorable prognostic factors [9].…”

Section: Assessment Of Prognosis In Dlbclmentioning

confidence: 99%

Extranodal Diffuse Large B Cell Lymphoma: Molecular Features, Prognosis, and Risk of Central Nervous System Recurrence

Ollila

Olszewski

2018

Curr. Treat. Options in Oncol.

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Diffuse large B cell lymphoma (DLBCL) arises from extranodal organs in about 30% of cases. Its prognosis and risk of recurrence in the central nervous system (CNS) vary according to the primary site of origin. Recent studies begin to clarify these differences using molecular classification. Testicular, breast, and uterine DLBCL (as well as possibly primary cutaneous DLBCL, leg-type) share a high prevalence of the non-germinal center B cell (non-GCB) phenotype and the MYD88/CD79B-mutated (MCD) genotype. These biologic features, which resemble primary CNS lymphoma, may underlie their stage-independent propensity for CNS involvement. Management of these lymphomas should involve CNS prophylaxis, preferably using systemic high-dose methotrexate to prevent intraparenchymal recurrence. Involvement of the kidneys, adrenal glands, ovary, bone marrow, lung, or pleura usually indicates disseminated disease, conferring worse prognosis. Involvement of these sites is often associated with high CNS-International Prognostic Index (IPI), concurrent MYC and BCL2 or BCL6 rearrangements, or intravascular lymphoma-risk factors warranting CNS prophylaxis. In contrast, craniofacial, thyroid, localized bone, or gastric lymphomas have a variable prevalence of the non-GCB phenotype and lack MYD88 mutations. Their outcomes with standard immunochemotherapy are excellent, and the risk of CNS recurrence is low. We recommend individualized consideration of CNS prophylaxis based on the CNS-IPI score and anatomical proximity in cases of epidural, orbital, or skull involvement. Rituximab-containing immunochemotherapy is a standard approach for all extranodal DLBCLs. Surgery is no longer required for any primary site, but routine consolidative radiation therapy is recommended for testicular lymphoma. Radiation therapy also appears to be associated with better progression-free survival in primary bone DLBCL. Future studies should better distinguish primary from secondary sites of extranodal involvement, and investigate the association of newly identified genotypes with the risk of CNS or systemic recurrence.

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Validation of clinical prognostic indices for diffuse large B-cell lymphoma in the National Cancer Data Base

Cited by 16 publications

References 36 publications

Diffuse large B-cell lymphoma: 10ï¿½years' real-world clinical experience with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone

Diffuse large B-cell lymphoma: 10ï¿½years' real-world clinical experience with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisolone

Time to treatment is an independent prognostic factor in aggressive non‐Hodgkin lymphomas

Extranodal Diffuse Large B Cell Lymphoma: Molecular Features, Prognosis, and Risk of Central Nervous System Recurrence

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