In a nutshell
This study discussed an updated method for predicting outcome in patients with diffuse large B-cell lymphoma (DLBCL). This study concluded that this new method was more accurate.
Some background
The International Prognostic Index (IPI) has been used to predict outcome in DLBCL patients for more than 20 years. It takes five patient characteristics into account. These are age, number of tumor sites, stage of disease, performance status (the ability of the patient to function in daily life), and lactate dehydrogenase levels (LDH). LDH is an indicator in the blood of tissue or cell damage. These factors are used to assign patients to one of four risk groups. Patients in the highest risk group had a 5-year survival rate of 26%.
The IPI was developed before rituximab (Rituxan) became a standard treatment option for patients with DLBCL. Trials have shown a 50% five-year survival rate for high-risk patients treated with rituximab. With these improvements in treatment options, new methods for predicting outcome are needed.
Methods & findings
The current study explored new methods of predicting outcome in DLBCL. Information on 1650 patients included in a cancer patient database (the NCCN) was used. This information was used to find characteristics at diagnosis that predicted outcome. Once the characteristics were chosen, the prediction method (the NCCN-IPI) was tested using information on 1138 different patients. These patients were included in a separate cancer database. Patient information was examined for roughly a 3-year period.
Five factors were determined to be predict outcome. These were age, LDH level, tumor stage, performance status, and presence of lymphoma in other areas. These areas included bone marrow, the central nervous system, the liver or gastrointestinal tract, or the lung. Points were assigned based on the category. The number of points determined whether a patient was low or high risk.
The NCCN-IPI better predicted 5-year survival than the IPI. When tested on the data from the second database, the NCCN-IPI included 12% of patients in the low-risk group, compared to 33% for the IPI. The NCCN-IPI included 14% in the high-risk group, compared to 21% for the IPI.
5-year overall survival (time from treatment until death from any cause) for the low-risk group was 96% (NCCN-IPI) versus 84% (IPI). 5-year overall survival for the high-risk group was 38% (NCCN-IPI) versus 43% (IPI).
The bottom line
This study concluded that the NCCN-IPI was better able to separate risk groups and predict outcomes in patients treated with rituximab.
Published By :
Blood
Date :
Feb 06, 2014
