Comparing Standard IPI with Revised-IPI in Patients with Diffuse Large B-Cell Lymphoma: Which Has a More Differential Potential for Predicting the Outcomes after R-CHOP Chemotherapy.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2003-2003
Author(s):  
Deok-Hwan Yang ◽  
Jae Sook Ahn ◽  
Yeo-Kyeoung Kim ◽  
Je-Jung Lee ◽  
Young Jin Choi ◽  
...  

Abstract The utility of International Prognostic index (IPI) in the era of immunochemotherapy could not be determined by the available randomized trials. Recently, the study of British Columbia group suggested that a revised IPI (R-IPI) which redistributed the IPI factors into 3 distinct prognostic groups provided a more clinically useful prediction of outcome for patients with diffuse large B-cell lymphoma (DLBCL). We investigated the clinical outcomes of R-CHOP chemotherapy in patients with DLBCL for determining which has a more differential potential of predicting the prognosis among R-IPI or standard IPI. Patients and Methods: We analyzed a total of 348 patients with newly diagnosed DLBCL from National University Hospitals of Southern Korea (NUHSK) between September 2002 and July 2008. R-CHOP conducted standard doses of chemotherapy and rituximab (375 mg/m2) administered a 21-day interval. The limited-stage patients were treated with 3rd or 4th chemotherapy followed by involved field radiation therapy (IFRT) and the advanced-stage patients were treated with six to eight cycles of chemotherapy. Results: The median age was 61 years (range, 18–85) with 51.6% of patients aged above 60. After a median follow-up of 25 months (range, 2-66.8), 280 patients (80.5%) were alive and 76 patients (21.8%) had relapsed or progressed. 16 patients (4.6%) underwent autologous stem cell transplantation (ASCT). The 4-year probability of overall survival (OS) and progression-free survival (PFS) were 73.7 ± 3.4 % and 69.1 ± 3.6 %, respectively (Fig. 1A). The distribution of patients and 4-year OS rates according to IPI factors were followings; 16.7% patients had zero risk factor with 95.4%, 33.9% patients had 1 factor with 90.0%, 19.3% patients had 2 factors with 69.9%, 19.0% patients had 3 factors with 55.7%, 10.3% patients had 4 factors with 28.4% and 0.9% patients had 5 factors without reached 4-year OS rates (Fig. 1B). Both standard IPI and revised IPI showed a significant potential as prognostic variable in OS and PFS. However, the standard IPI distinguished clinical outcomes between patients with 3 risk factors and patients with 4–5 risk factors. In addition, there was no survival difference between patients with zero risk factor and patients with 1 risk factor (Fig. 2). Conclusion: The standard IPI had more differentiation potency in predicting prognosis than R-IPI in patients with DLBCL treated with R-CHOP chemotherapy. Fig. 1 Overall outcomes (A) and outcomes according to the number of IPI factors (B) Fig. 1. Overall outcomes (A) and outcomes according to the number of IPI factors (B) Fig. 2 Comparison of OS and PFS according to the standard IPI and revised IPI Fig. 2. Comparison of OS and PFS according to the standard IPI and revised IPI

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4306-4306
Author(s):  
Luis F. Porrata ◽  
Kay M. Ristow ◽  
Thomas M Habermann ◽  
Thomas E Witzig ◽  
Joseph P. Colgan ◽  
...  

Abstract The peripheral blood absolute lymphocyte/monocyte ratio at diagnosis (ALC/AMC-DX) predicts survival in diffuse large B-cell lymphoma (DLBCL). However, a limitation of the ALC/AMC-DX is its inability to sequentially assess the host/tumor interaction during treatment. Therefore, we studied the ALC/AMC ratio, as a surrogate marker of host immunity (i.e., ALC) and tumor microenvironment (i.e., AMC), at each RCHOP treatment cycle as a predictor for clinical outcomes. From 2002 until 20011, 107 DLBCL patients originally diagnosed, treated with six cycles of RCHOP, and followed at Mayo Clinic qualified for the study. Using the receiver operating characteristic and internally validated using the k-fold cross validation; an ALC/AMC ratio ≥ 1.1 was identified as the cut-off value at each RCHOP treatment cycle to discriminate for the binary clinical outcome of death/survival. Univariate analysis revealed the ALC/AMC ratio ≥ 1.1 at each RCHOP treatment cycle was a predictor for overall survival (OS) and progression-free survival (PFS). To explore whether the patterns of ALC/AMC ratio recovery during the RCHOP treatment cycles had a prognostic value, we performed an unsupervised hierarchical clustering on the studied ALC/AMC ratio and identified four patient clusters, A-D. Eighty percent of patients in cluster C had an ALC/AMC ratio ≥ 1.1 during all the cycles, the other 20% had an ALC/AMC ratio ≥1.1 in one cycle; in cluster D patients, the ALC/AMC ratio was ≥ 1.1 between cycles 2 and 5 and none had an ALC/AMC ratio < 1.1; in cluster A patients, 73% of patients only had an ALC/AMC ratio ≥ 1.1 in one cycle and 27% in two cycles; and cluster B patients had 85% of patients with an ALC/AMC ratio < 1.1 during all the cycles. Inferior OS and PFS were progressively observed in clusters of patients with fewer cycles achieving an ALC/AMC ratio ≥ 1.1. Patients in clusters C had superior outcomes compared with patients in clusters B. Thus, we dichotomized patients into patients with an ALC/AMC ratio ≥ 1.1 during any cycle versus patients with an ALC/AMC ratio < 1.1 during all cycles. By multivariate analysis, the stratification of patients into ALC/AMC ≥ 1.1 during any cycle versus ALC/AMC < 1.1 during all cycles was an independent predictor for OS [Hazard ratio (HR) = 0.02, 95% CI (0.006-0.08), p< 0.0001], and PFS [HR = 0.06, 95% CI (0.02-0.15, p< 0.0001] when compared with the International Prognostic index The median OS for patients with an ALC/AMC ratio ≥ 1.1 during any cycle versus patients with an ALC/ACM ratio < 1.1 during all cycles was not reached versus 1.7 years with 5 years OS rates of 97% (95% CI, 90%-99%) versus 0%, p< 0.0001, respectively. The median PFS for patients with an ALC/AMC ratio ≥ 1.1 during any cycle versus patients with an ALC/AMC ratio < 1.1during all cycles was not reached versus 0.9 years with 5 years PFS rates of 83% (95% CI, 72%-90%) versus 0%, p< 0.0001, respectively. The ALC/AMC ratio during RCHOP treatment cycles is a predictor for survival and provides a platform to develop therapeutic modalities to manipulate the ALC/AMC ratio during chemotherapy to improve clinical outcomes in DLBCL. Disclosures: No relevant conflicts of interest to declare.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18545-e18545
Author(s):  
Vijay Gandhi Linga ◽  
Raghunadharao Digumarti ◽  
Rahul Narayan Maddi ◽  
Vamshi Krishna Reddy Goteke ◽  
Sadashivudu Gundeti ◽  
...  

e18545 Background: Outside the setting of the clinical trials there is very little data of CHOP chemotherapy plus Rituximab (CHOP-R) compared with standard CHOP in Indian population. We analyzed our cohort of patients diagnosed with Diffuse Large B cell Lymphoma (DLBCL). Primary objective was to compare CHOP with CHOP-R in term of PFS and OS. Methods: All the patients aged more than 21 years diagnosed with DLBCL (CD 20+) were retrospectively analyzed from Jan 2000 to June 2011. According to institute guideline staging and International Prognostic Index (IPI) risk grouping were done. Patients were started on standard cyclophoshomide 750mg/m2, doxorubicin 50mg/m2, vincristine 1.5mg/m2 on day 1 and prednisolone 60mg/m2 day 1-5 (CHOP). Rituximab 375 mg/m2 was given on day 1 depending on the affordability/Insurance. Clinical evaluation was done after each cycle and response assessment with CT scan was done after third and sixth cycle. Progression free survival (PFS) was defined as progression during therapy, relapse, death and lost to follow up. Overall survival was defined as time till death and lost to follow up. Statistical analysis was done using Graph pad software and p value less than 0.05 was taken significant. Results: There were 67 patients in CHOP-R and 206 patients in CHOP arm. Basic characteristics and survival data are described in table 1, which are not distributed equally in two arms. The PFS in R-CHOP and CHOP arms were 40 and 9 months respectively (p=0.0008). The OS in R-CHOP and CHOP arms were 47 and 13 months respectively (p=0.007). Conclusions: There was statistical difference between the PFS and OS between the two arms. [Table: see text]


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mahmoud A. Senousy ◽  
Aya M. El-Abd ◽  
Raafat R. Abdel-Malek ◽  
Sherine M. Rizk

AbstractThe reliable identification of diffuse large B-cell lymphoma (DLBCL)-specific targets owns huge implications for its diagnosis and treatment. Long non-coding RNAs (lncRNAs) are implicated in DLBCL pathogenesis; however, circulating DLBCL-related lncRNAs are barely investigated. We investigated plasma lncRNAs; HOTAIR, Linc-p21, GAS5 and XIST as biomarkers for DLBCL diagnosis and responsiveness to R-CHOP therapy. Eighty-four DLBCL patients and thirty-three healthy controls were included. Only plasma HOTAIR, XIST and GAS5 were differentially expressed in DLBCL patients compared to controls. Pretreatment plasma HOTAIR was higher, whereas GAS5 was lower in non-responders than responders to R-CHOP. Plasma GAS5 demonstrated superior diagnostic accuracy (AUC = 0.97) whereas a panel of HOTAIR + GAS5 superiorly discriminated responders from non-responders by ROC analysis. In multivariate analysis, HOTAIR was an independent predictor of non-response. Among patients, plasma HOTAIR, Linc-p21 and XIST were correlated. Plasma GAS5 negatively correlated with International Prognostic Index, whereas HOTAIR positively correlated with performance status, denoting their prognostic potential. We constructed the lncRNAs-related protein–protein interaction networks linked to drug response via bioinformatics analysis. In conclusion, we introduce plasma HOTAIR, GAS5 and XIST as potential non-invasive diagnostic tools for DLBCL, and pretreatment HOTAIR and GAS5 as candidates for evaluating therapy response, with HOTAIR as a predictor of R-CHOP failure. We provide novel surrogates for future predictive studies in personalized medicine.


2013 ◽  
Vol 115 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Cheng-Ru Hu ◽  
Jing-Hua Wang ◽  
Rui Wang ◽  
Qian Sun ◽  
Long-Bang Chen

2015 ◽  
Vol 26 ◽  
pp. vii85
Author(s):  
Yusuke Kanemasa ◽  
Tatsu Shimoyama ◽  
Yuki Sasaki ◽  
Sawada Takeshi ◽  
Eisaku Sasaki ◽  
...  

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