Re-Assessment of the Prognostic Value of International Prognostic Index (IPI) and Revised IPI (R-IPI) in Patients with Diffuse Large B-Cell Lymphoma Treated with or without Rituximab in Chinese Populations: A Retrospective Multicenter Study by Shanghai Lymphoma Research Group

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2649-2649
Author(s):  
Honghui Huang ◽  
Fei Xiao ◽  
Fangyuan Chen ◽  
Ting Wang ◽  
Junmin Li ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Survival Rates ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Prognostic Groups

Abstract Abstract 2649 Background: The International Prognostic Index (IPI) is a widely accepted prognostic factor system for diffuse large B cell lymphoma (DLBCL) patients treated with chemotherapy. However, the prognostic value of IPI has been a focal point of the debate in the era of immuno-chemotherapy. 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 DLBCL. In order to reassess the value of IPI and R-IPI in unselected Chinese population, we conducted this study. Methods: A multicenter retrospective analysis of DLBCL patients treated with CHOP-like chemotherapy alone or plus rituximab was performed by Shanghai Lymphoma Research Group. In total, 438 patients of newly diagnosed DLBCL treated at 6 participated hospitals were included during the period of 1997–2008. The prognostic value of IPI and R-IPI at diagnosis with regards to overall survival (OS) and progression-free survival (PFS) was evaluated. Results: The median age at diagnosis was 50 years (range, 18–83 years), and the median follow-up was 34 months (range, 3–145 months). Among them, 241 patients received CHOP-like regimen, whereas 197 had rituximab (R)-CHOP-like regimen. While IPI remained predictive in CHOP-like group, it could not distinguish between each prognostic category in the R-CHOP-like group (Fig.1). Redistribution of the IPI factors into a R-IPI identified three distinct prognostic groups with significantly different outcomes both in the patients treated with and without rituximab. In R-CHOP-like arm, these three risk groups had distinctly different rates of 3-year progression-free survival rates of 96%, 84.3% and 67.5% (P<0.001), respectively, and 3-year overall survival rates of 96%, 87.6% and 71.1% (P<0.001), respectively (Fig.2). Conclusions: Our study underscores the power of R-IPI as a simplified and more clinically relevant predictor of the disease outcomes than the standard IPI in Chinese DLBCL populations in the rituximab era, and it deserves a further study in larger population-based prospective study. Disclosures: No relevant conflicts of interest to declare.

Significance of c-myc Rearrangements in Diffuse Large B-Cell Lymphoma.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2030-2030
Author(s):  
Philip Bierman ◽  
Fausto Loberiza ◽  
Bhavana Dave ◽  
Warren Sanger ◽  
R. Gregory Bociek ◽  
...  
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Large B Cell ◽  
Overall Survival Rates

Abstract Rearrangements of the c-myc oncogene can be seen in 5–10% of patients with diffuse large B-cell lymphoma. However, studies examining the significance of this finding have yielded conflicting results. Therefore, we performed a retrospective analysis to determine the clinical significance of c-myc rearrangements in diffuse large B-cell lymphoma. The results of classical cytogenetic studies and FISH analyses were used to identify diffuse large B-cell lymphoma cases in the database of the Nebraska Lymphoma Study Group with or without c-myc rearrangements. Patients who were HIV positive and those with post-transplant lymphoproliferative disease were excluded. We identified 16 patients with diffuse large B-cell lymphoma and c-myc rearrangements. All patients were initially treated with doxorubicin- or mitoxantrone-containing chemotherapy regimens. The median age of these 16 patients was 61 years (range 40 to 80), and 5 (31%) were males. The International Prognostic Index (IPI) was 0–2 at diagnosis in 9 patients (56%), and 3–5 in 7 patients (44%). Eleven patients (69%) had bulky disease (≥ 5 cm) at diagnosis. No significant differences in outcome were identified when the 16 c-myc positive patients were compared with 97 c-myc negative diffuse large B-cell lymphoma patients in the same age range. The actuarial 5-year progression-free survival for the c-myc positive patients was 23% (95% CI 6% to 46%), as compared with 38% (95% CI 29% to 48%) for c-myc negative patients (p=0.17). The actuarial 5-year overall survival rates were 36% (95% CI 14% to 59%) and 47% (95% CI 36% to 56%), respectively (p=0.19). Classical cytogenetics and FISH analyses were also used to examine the 16 c-myc positive cases for bcl-2 rearrangements. Eight (50%) cases had rearrangements of bcl-2 in addition to c-myc rearrangements. These patients were similar to the c-myc positive/bcl-2 negative patients except for a higher likelihood of an elevated LDH level at diagnosis (88% vs. 25%; p=0.03). The actuarial 5-year progression-free survival for c-myc positive/bcl-2 positive patients was 0%, as compared to 33% (95% CI 6% to 66%) for patients with rearrangements of c-myc alone, and 37% (95% CI 28% to 47%) for c-myc negative patients. The actuarial 5-year overall survival rates were 12% (95% CI 1% to 42%), 47% (95% CI 12% to 76%), and 41% (95% CI 31% to 51%), respectively. A multivariate analysis, adjusting for IPI score, demonstrated that the relative risk (RR) of treatment failure was significantly worse for the c-myc positive/bcl-2 positive patients, as compared to the c-myc negative patients (RR 2.86, 95% CI 1.32–6.23; p=0.008). Similarly, mortality was also significantly worse for the c-myc positive/bcl-2 positive patients, as compared to the c-myc negative patients (RR 2.69, 95% CI 1.18–6.11; p=0.02). In contrast, no significant differences in treatment failure or overall survival were demonstrated when c-myc positive/bcl-2 negative patients were compared with c-myc negative patients. Our results demonstrate that the c-myc rearrangement is not associated with poorer survival in patients with diffuse large B-cell lymphoma. However, patients with rearrangements of bcl-2 in addition to c-myc had significantly worse progression-free survival and overall survival.

A Prognostic Nomogram for Diffuse Large B Cell Lymphoma Incorporating the International Prognostic Index with Interim-PET Findings,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3664-3664
Author(s):  
Annie W.S. Chow ◽  
Teck Siew ◽  
Michael Phillips ◽  
Mitchell Steve Ward ◽  
Bradley Augustson ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Blood Pool ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Interim Pet ◽  
Prognostic Accuracy ◽  
Large B Cell Lymphoma

Abstract Abstract 3664 Background: Positron Emission Tomography scans performed during chemotherapy (Interim-PET) have been used prognostically in patients with Diffuse Large B-cell Lymphoma (DLBCL) and as a tool in response-adapted therapy trials. However, evidence on the predictive role of interim-PET in DLBCL has been limited by study heterogeneity in lymphoma subtypes and treatment regimens. Although earlier studies reported positive interim-PET predicted poorer outcome, a systematic review (Terasawa et al. J Clin Oncol 2009; 27(11):1906–14) could not draw reliable conclusions due to heterogeneity. Recent studies, which maintained a homogeneous patient group with regards to lymphoma subtype (DLBCL) and treatment (Rituximab-CHOP), showed conflicting results (Vitolo et al, Blood 2010; 116: Abs. 2819. Yang et al, Blood 2010; 116: 1799. Gonzalez-Barca et al Blood 2010; 116: Abs. 2793.) Aim: To evaluate the prognostic value of interim-PET in DLBCL patients receiving R-CHOP, without the confounding effect of therapy change based on interim-PET result. We seek to improve our prognostic ability by combining the International Prognostic Index (IPI) with Interim-PET results. Methods: We reviewed retrospectively consecutive DLBCL patients treated with R-CHOP as frontline therapy from 2005 to 2010 at a single institution. Interim-PET images were re-examined by a nuclear medicine physician blinded to the IPI and clinical outcomes. The PET results were classified as Negative or Positive, based on qualitative assessment of the relative intensity of FDG uptake of the area of disease compared to the adjacent mediastinal blood pool or aorta/IVC. Interim-PET was categorised as positive if the uptake was more than mildly above the blood pool intensity. One hundred patients commenced R-CHOP (14 or 21) therapy for DLBCL; 24 patients did not receive interim-PET for logistics reasons and were excluded. Progression free survival (PFS) and overall survival (OS) were analysed by the Cox proportional hazards model and prognostic accuracy was assessed using Harrell's C statistics. Results: In 76 patients analysed, the median age was 61 years (range 16–87); 59% were males. The IPI distribution was: IPI 0 (n=10), 1 (19), 2 (21), 3 (13), 4 (12), 5 (1). The median time of the interim-PET was after cycle 3. Eleven patients (14%) were positive and 65 patients (86%) were negative at Interim-PET. With a median follow-up of 32.5 months, 2-year OS and 2-year PFS (figures 1 and 2) were 70.8% and 60.0% respectively in the PET-negative group, 36.4% and 36.4% for the PET-positive group (log-rank p-value 0.003 for OS, 0.011 for PFS). Correlation analysis showed that the IPI and Interim-PET were minimally associated (rho=0.0873) and were both independent prognostic factors for survival. Cox regression analysis showed that interim PET and IPI were both significant indicators of PFS (p < 0.001 and p=0.002 respectively). The PET result makes a significant contribution to prognostication if IPI is greater than 2 (p<0.0001) and we found the contribution to vary by IPI when the score was greater than 2 (data not shown). In isolation, the prognostic accuracy of a negative PET result is poor (C = 0.63) as it is for IPI (C = 0.75), but when the two indicators are combined the predictive accuracy is improved (C = 0.81). A nomogram utilising the IPI and interim-PET results in the prediction of the 24 month relapse-free survival was created (Figure 3). Conclusion: In our hands, IPI and PET provide independent prognostic information; we found interim PET to have a negative predictive value that varies according to the IPI at diagnosis. By combining the two, a more powerful predictive model may be created as a nomogram. This should be readily testable in larger patient populations where PET data is available, and then ideally prospectively in randomised clinical trials. Example of using the Sir Charles Gairdner Hospital Nomogram: a patient with an IPI of 2 will receive a score of 33; if their interim-PET result is positive, this will produce a score of 70, resulting in a total score of 103. On the lower 2 panels, a total of 103 points is estimated to give rise to a 40% probability of Relapse-free survival at 24 months. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic value of age-adjusted international prognostic index in patients with relapsed or refractory diffuse large b-cell lymphoma - a single centre experience

2019 ◽  
Vol 72 (1-2) ◽  
pp. 25-29
Author(s):  
Maja Popovic ◽  
Gorana Matovina-Brko ◽  
Dragana Petrovic ◽  
Bojana Vranjkovic ◽  
Jelena Radic ◽  
...  
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Late Relapse ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Introduction. The research aimed to evaluate the impact of age-adjusted international prognostic index and time to the first relapse on overall survival and progression-free survival from the beginning of the second line of treatment in patients with relapsed/ refractory diffuse large B-cell lymphoma. Material and Methods. The research included 36 patients with relapsed/refractory diffuse large B-cell lymphoma treated at the Oncology Institute of Vojvodina, Serbia, from January 2013 to December 2015. Patients were stratified according to age-adjusted international prognostic index score at the time of relapse into patients with low risk (score 0 - 1) and patients with high risk (score 2 - 3), as well as according to the time of the first relapse: early relapse (? 12 months) and late relapse (> 12 months). Results. In the group of patients with a score of 0 - 1, the median overall survival was 44 months compared with 6 months in patients with score of 2 - 3, hazard ratio 0,4 (confidence interval 0,16 - 0,99), p = 0,03. In patients with early relapse, the median overall survival was 7 months compared with 25 months in patients with late relapse, hazard ratio 0,55 (confidence interval 0,25 - 1,19), p = 0,12. In patients with early relapse, median progression-free survival was 0 months compared with 10 months in patients with late relapse, hazard ratio 0,34 (confidence interval 0,12 - 1,00), p = 0,0017. Conclusion. The impact of age-adjusted international prognostic index score significantly affects overall survival in patients with relapsed diffuse large B-cell lymphoma. The time to the first relapse impacts progression-free survival calculated from the time of the second-line treatment initiation.

SUVmax reduction improves early prognosis value of interim positron emission tomography scans in diffuse large B-cell lymphoma

Blood ◽  
2011 ◽  
Vol 118 (1) ◽  
pp. 37-43 ◽  
Author(s):  
René-Olivier Casasnovas ◽  
Michel Meignan ◽  
Alina Berriolo-Riedinger ◽  
Stéphane Bardet ◽  
Anne Julian ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Prognostic Value ◽  
Cell Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Emission Tomography ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Positron Emission ◽  
Large B Cell

AbstractThe prognostic value of interim positron emission tomography (PET) interpreted according to visual criteria is a matter of debate in diffuse large B-cell lymphoma (DLBCL). Maximal standardized uptake value reduction (ΔSUVmax) may better predict outcome. To compare the prognostic value of both methods, we analyzed PET done at baseline (PET0) and after 2 (PET2) and 4 (PET4) cycles in 85 patients with high-risk DLBCL enrolled on a prospective multicenter trial. All images were centrally reviewed and interpreted visually according to the International Harmonization Project criteria and by computing ΔSUVmax between PET0 and PET2 (ΔSUVmaxPET0-2) or PET4 (ΔSUVmaxPET0-4). Optimal cutoff to predict progression or death was 66% for ΔSUVmaxPET0-2 and 70% for ΔSUVmaxPET0-4. Outcomes did not differ significantly whether PET2 and PET4 were visually positive or negative. Inversely, ΔSUVmaxPET0-2 analysis (> 66% vs ≤ 66%) identified patients with significantly different 2-year progression-free survival (77% vs 57%; P = .0282) and overall survival (93% vs 60%; P < .0001). ΔSUVmaxPET0-4 analysis (> 70% vs ≤ 70%) seemed even more predictive for 2-year progression-free survival (83 vs 40%; P < .0001) and overall survival (94% vs 50%; P < .0001). ΔSUVmax analysis of sequential interim PET is feasible for high-risk DLBCL and better predicts outcome than visual analysis. The trial was registered at http://clinicaltrials.gov as NCT00498043.

scholarly journals Increased Malat1 Expression Predicts Poor Prognosis in Primary Gastrointestinal Diffuse Large B-cell Lymphoma

2021 ◽  
Author(s):  
Zhengzi Qian ◽  
Leiyuan Chen ◽  
Xinyuan Wang ◽  
Yutian Kan ◽  
Yafei Wang ◽  
...  
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Kaplan Meier ◽  
Exact Effect ◽  
Large B Cell

Abstract Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been involved in the pathogenesis and progression of several cancers. However, the exact effect of MALAT1 in primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) has not been elucidated. This study aimed to explore the prognostic value of MALAT1 in PGI-DLBCL patients. Quantitative real-time Polymerase Chain Reaction (qRT-PCR) was performed to detect the expression of MALAT1 in 90 patients with PGI-DLBCL. MALAT1 was remarkably up-regulated in PGI-DLBCL tissues as compared to that of paired adjacent non-tumor tissues (P<0.001), and the area under the ROC curve (AUC) was 0.838. MALAT1 expression was further increased in the non-germinal center B-cell-like (non-GCB) group, advanced stage (stages IIE-IV) group and International Prognostic Index (IPI) score (3-5) group (P=0.01, P<0.001and P<0.001, respectively). Furthermore, Kaplan-Meier analysis showed that elevated MALAT1 expression was correlated with inferior Overall survival (OS) and progression free survival (PFS) in PGI-DLBCL patients (P<0.001and P<0.001, respectively), and multivariate analysis suggested that up-regulation of MALAT1 and high IPI score (3-5) were two unfavorable prognostic factors of PGI-DLBCL. In conclusion, our results demonstrates that MALAT1 might serve as a novel prognostic biomarker and an ideal therapeutic target for PGI-DLBCL patients in the future.

scholarly journals Effects of Concurrent Expression of Myc and Bcl-2 on the Treatment and Prognosis in Extranodal Diffuse Large B Cell Lymphoma

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 34s-34s
Author(s):  
M. Sonmez ◽  
C. Konca
Keyword(s):  
Overall Survival ◽  
B Cell ◽  
Cell Lymphoma ◽  
Survival Rates ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
Free Survival ◽  
Large B Cell Lymphoma ◽  
Large B Cell ◽  
Overall Survival Rates

Aim: We aimed to investigate the effects of immunohistochemical and molecular presence of double-hit lymphomas (DHL) (combined expression of myc and bcl-2) on overall and progression-free survival rates of patients with extranodal diffuse large B-cell lymphoma (DLBCL). Methods: A total of 31 patients (17 female, 14 male; mean age 57 years) with diagnosis of extranodal DLBCL were included into the study. Patients transforming from low grade B cell lymphoma, and patients with HIV positivity were not included. In a retrospective manner, patient characteristics were noted (age at diagnosis, sex, sites of extranodal involvement, stage, high-risk group, histopathological diagnosis, IPI score, LDH level at diagnosis, bone marrow involvement, and treatment modalities). Histopathological specimens underwent immunohistochemical (bcl-6, bcl-2, myc, CD10, Mum-1) and molecular (bcl-2 and myc, by means of PCR) analysis. All patients was treatment with R-CHOP protocol. Results: DHL was observed immunohistochemically in only one patient, while molecular studies found 6 cases. Three-month overall survival rates were 50% and 88% in DHL positive and negative groups, respectively. Six-month overall survival rates were 16% and 76% in DHL positive and negative groups, respectively. Progression-free 3-month survival rates were 51% and 88% in DHL positive and negative groups, respectively. Progression-free 6-month survival rates were 33% and 76% in DHL positive and negative groups, respectively. No relation with histopathological type of the disease was noted. Conclusion: We conclude that DHL presence in patients with extranodal DLBCL was an independent factor leading to shortened overall or progression-free survival.

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