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Clinical Prognostic Models in Diffuse Large B Cell Lymphoma Patients are Still Essential in the Rituximab Era

Costa RO, Neto AH, Siqueira S, Lage LAPC, Paula HM, et al.

Introduction: To evaluate a new enhanced IPI proposal by the National Comprehensive Cancer Network (NCCNIPI) in DLBCL patients, we compared the IPI, R-IPI, and NCCN-IPI in DLBCL patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone (R-CHOP).

Methods: From June 2008 to January 2012, we retrospectively evaluated 146 DLBCL patients treated with RCHOP- 21 referred for cancer treatment in a single institution in Brazil. Patients' clinical data were assessed to calculate the IPI, R-IPI, and NCCN-IPI.

Results: Patients' median age was 58.9 years (range 16-86); 85 (57.8%) were female. According to IPI, risk categories were low (n=41, 28.1%), low-intermediate (n=43, 29.5%), high-intermediate (n=37, 25.3%), and high (n=25, 17.1%). Using R-IPI, risk categories were very good (n=19, 13%), good (n=65, 44.5%), and poor (n=62, 42.5%). According to NCCN-IPI, risk categories were low (n=12/147, 8.2%), low-intermediate (n=52/147, 35.6%), high-intermediate (n=62/147, 42.5%), and high (n=20/147, 13.7%). The median follow up was 42.8 months (0.6-71.2) with an overall survival (OS) at 48 months of 73.8% and 84.3% of PFS. Using IPI, the OS at was higher for low and low- intermediate risk than high and high-intermediate risk patients (85.9% vs. 59.2% p<0.001). The RIPI showed significant differences in OS (100% vs. 83.2% vs. 57.5% p<0.001) but not for PFS (p=0.67) among very good, good and poor risk groups. The NCCN-IPI demonstrated significant differences in OS (p<0.001) among lowintermediate, high-intermediate, and high-risk groups, with the high-risk group exhibiting worse OS (35% at 48 months) but not for PFS (0.166). According to IPI, the OS in high-intermediate and high-risk patients was 59.2%. Conclusion: In our study, the NCCN-IPI (but not the IPI or R-IPI) was able to discriminate a group of patients of higher risk of DLBCL treated with R-CHOP with worse median OS.