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Chen M, Rong J, Zhao J, Teng Y, Jiang C, Chen J, Xu J. PET-based radiomic feature based on the cross-combination method for predicting the mid-term efficacy and prognosis in high-risk diffuse large B-cell lymphoma patients. Front Oncol 2024; 14:1394450. [PMID: 38903712 PMCID: PMC11188321 DOI: 10.3389/fonc.2024.1394450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Objectives This study aims to develop 7×7 machine-learning cross-combinatorial methods for selecting and classifying radiomic features used to construct Radiomics Score (RadScore) of predicting the mid-term efficacy and prognosis in high-risk patients with diffuse large B-cell lymphoma (DLBCL). Methods Retrospectively, we recruited 177 high-risk DLBCL patients from two medical centers between October 2012 and September 2022 and randomly divided them into a training cohort (n=123) and a validation cohort (n=54). We finally extracted 110 radiomic features along with SUVmax, MTV, and TLG from the baseline PET. The 49 features selection-classification pairs were used to obtain the optimal LASSO-LASSO model with 11 key radiomic features for RadScore. Logistic regression was employed to identify independent RadScore, clinical and PET factors. These models were evaluated using receiver operating characteristic (ROC) curves and calibration curves. Decision curve analysis (DCA) was conducted to assess the predictive power of the models. The prognostic power of RadScore was assessed using cox regression (COX) and Kaplan-Meier plots (KM). Results 177 patients (mean age, 63 ± 13 years,129 men) were evaluated. Multivariate analyses showed that gender (OR,2.760; 95%CI:1.196,6.368); p=0.017), B symptoms (OR,4.065; 95%CI:1.837,8.955; p=0.001), SUVmax (OR,2.619; 95%CI:1.107,6.194; p=0.028), and RadScore (OR,7.167; 95%CI:2.815,18.248; p<0.001) independently contributed to the risk factors for predicting mid-term outcome. The AUC values of the combined models in the training and validation groups were 0.846 and 0.724 respectively, outperformed the clinical model (0.714;0.556), PET based model (0.664; 0.589), NCCN-IPI model (0.523;0.406) and IPI model (0.510;0.412) in predicting mid-term treatment outcome. DCA showed that the combined model incorporating RadScore, clinical risk factors, and PET metabolic metrics has optimal net clinical benefit. COX indicated that the high RadScore group had worse prognosis and survival in progression-free survival (PFS) (HR, 2.1737,95%CI: 1.2983, 3.6392) and overall survival (OS) (HR,2.1356,95%CI: 1.2561, 3.6309) compared to the low RadScore group. KM survival analysis also showed the same prognosis prediction as Cox results. Conclusion The combined model incorporating RadScore, sex, B symptoms and SUVmax demonstrates a significant enhancement in predicting medium-term efficacy and prognosis in high-risk DLBCL patients. RadScore using 7×7 machine learning cross-combinatorial methods for selection and classification holds promise as a potential method for evaluating medium-term treatment outcome and prognosis in high-risk DLBCL patients.
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Affiliation(s)
- Man Chen
- Department of Hematology, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jian Rong
- The Key Laboratory of Broadband Wireless Communication and Sensor Network Technology (Ministry of Education), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jincheng Zhao
- Department of Hematology, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yue Teng
- Department of Nuclear Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Chong Jiang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianxin Chen
- The Key Laboratory of Broadband Wireless Communication and Sensor Network Technology (Ministry of Education), Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jingyan Xu
- Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Jelicic J, Juul‐Jensen K, Bukumiric Z, Runason Simonsen M, Roost Clausen M, Ludvigsen Al‐Mashhadi A, Schou Pedersen R, Bjørn Poulsen C, Ortved Gang A, Brown P, El‐Galaly TC, Larsen TS. Revisiting beta-2 microglobulin as a prognostic marker in diffuse large B-cell lymphoma. Cancer Med 2024; 13:e7239. [PMID: 38888359 PMCID: PMC11184650 DOI: 10.1002/cam4.7239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Several clinical prognostic models for diffuse large B-cell lymphoma (DLBCL) have been proposed, including the most commonly used International Prognostic Index (IPI), the National Comprehensive Cancer Network IPI (NCCN-IPI), and models incorporating beta-2 microglobulin (β2M). However, the role of β2M in DLBCL patients is not fully understood. METHODS We identified 6075 patients with newly diagnosed DLBCL treated with immunochemotherapy registered in the Danish Lymphoma Registry. RESULTS A total of 3232 patients had data available to calculate risk scores from each of the nine considered risk models for DLBCL, including a model developed from our population. Three of four models with β2M and NCCN-IPI performed better than the International Prognostic Indexes (IPI, age-adjusted IPI, and revised IPI). Five-year overall survival for high- and low-risk patients were 43.6% and 86.4% for IPI and 34.9% and 96.2% for NCCN-IPI. In univariate analysis, higher levels of β2M were associated with inferior survival, higher tumor burden (advanced clinical stage and bulky disease), previous malignancy and increased age, and creatinine levels. Furthermore, we developed a model (β2M-NCCN-IPI) by adding β2M to NCCN-IPI (c-index 0.708) with improved discriminatory ability compared to NCCN-IPI (c-index 0.698, p < 0.05) and 5-year OS of 33.1%, 56.2%, 82.4%, and 96.4% in the high, high-intermediate, low-intermediate and low-risk group, respectively. CONCLUSION International Prognostic Indices, except for NCCN-IPI, fail to accurately discriminate risk groups in the rituximab era. β2M, a readily available marker, could improve the discriminatory performance of NCCN-IPI and should be re-evaluated in the development setting of future models for DLBCL.
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MESH Headings
- Humans
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/blood
- beta 2-Microglobulin/blood
- Male
- Female
- Prognosis
- Middle Aged
- Aged
- Biomarkers, Tumor/blood
- Adult
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Young Adult
- Denmark/epidemiology
- Adolescent
- Neoplasm Staging
- Registries
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Affiliation(s)
- Jelena Jelicic
- Department of HematologyOdense University HospitalOdenseDenmark
| | | | - Zoran Bukumiric
- Faculty of MedicineInstitute for Medical Statistics and Informatics, University of BelgradeBelgradeSerbia
| | - Mikkel Runason Simonsen
- Department of Hematology, Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
| | | | - Ahmed Ludvigsen Al‐Mashhadi
- Department of Hematology, Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
- Department of HematologyAarhus University HospitalAarhusDenmark
| | | | - Christian Bjørn Poulsen
- Department of HematologyZealand University HospitalRoskildeDenmark
- Department of Clinical MedicineUniversity of CopenhagenKobenhavnDenmark
| | - Anne Ortved Gang
- Department of Clinical MedicineUniversity of CopenhagenKobenhavnDenmark
- Department of HematologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Peter Brown
- Department of Clinical MedicineUniversity of CopenhagenKobenhavnDenmark
- Department of HematologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Tarec Christoffer El‐Galaly
- Department of HematologyOdense University HospitalOdenseDenmark
- Department of Hematology, Clinical Cancer Research CenterAalborg University HospitalAalborgDenmark
| | - Thomas Stauffer Larsen
- Department of HematologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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3
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Jelicic J, Juul-Jensen K, Bukumiric Z, Roost Clausen M, Ludvigsen Al-Mashhadi A, Pedersen RS, Poulsen CB, Brown P, El-Galaly TC, Stauffer Larsen T. Prognostic indices in diffuse large B-cell lymphoma: a population-based comparison and validation study of multiple models. Blood Cancer J 2023; 13:157. [PMID: 37833260 PMCID: PMC10575851 DOI: 10.1038/s41408-023-00930-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
Currently, the International Prognostic Index (IPI) is the most used and reported model for prognostication in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). IPI-like variations have been proposed, but only a few have been validated in different populations (e.g., revised IPI (R-IPI), National Comprehensive Cancer Network IPI (NCCN-IPI)). We aimed to validate and compare different IPI-like variations to identify the model with the highest predictive accuracy for survival in newly diagnosed DLBCL patients. We included 5126 DLBCL patients treated with immunochemotherapy with available data required by 13 different prognostic models. All models could predict survival, but NCCN-IPI consistently provided high levels of accuracy. Moreover, we found similar 5-year overall survivals in the high-risk group (33.4%) compared to the original validation study of NCCN-IPI. Additionally, only one model incorporating albumin performed similarly well but did not outperform NCCN-IPI regarding discrimination (c-index 0.693). Poor fit, discrimination, and calibration were observed in models with only three risk groups and without age as a risk factor. In this extensive retrospective registry-based study comparing 13 prognostic models, we suggest that NCCN-IPI should be reported as the reference model along with IPI in newly diagnosed DLBCL patients until more accurate validated prognostic models for DLBCL become available.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Vejle Hospital, Sygehus Lillebaelt, Vejle, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Karen Juul-Jensen
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Zoran Bukumiric
- Institute for Medical Statistics and Informatics, University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | - Ahmed Ludvigsen Al-Mashhadi
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Peter Brown
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Liang X, Hu R, Li Q, Wang C, Liu Y. Prognostic factors for diffuse large B-cell lymphoma: clinical and biological factors in the rituximab era. Exp Hematol 2023:S0301-472X(23)00071-1. [PMID: 36933759 DOI: 10.1016/j.exphem.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Xiping Liang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing, China
| | - Renzhi Hu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing, China
| | - Qiying Li
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing, China
| | - Chaoyu Wang
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing, China
| | - Yao Liu
- Department of Hematology-Oncology, Chongqing University Cancer Hospital, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing, China.
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Lee YP, Hong JY, Yoon SE, Cho J, Shim JH, Bang Y, Kim WS, Kim SJ. Real-World, Single-Center Data for Lenalidomide Plus Rituximab in Relapsed or Refractory Diffuse Large B-Cell Lymphoma and Transformed Follicular Lymphoma. Cancer Manag Res 2021; 13:4241-4250. [PMID: 34093038 PMCID: PMC8168964 DOI: 10.2147/cmar.s309092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background This study explored the efficacy of lenalidomide plus rituximab for patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) including cases of secondary central nervous system (CNS) involvement and transformed follicular lymphoma (FL) in real-world context because of anti-tumor effect and blood–brain barrier permeability of lenalidomide. Methods Twenty-four patients including relapsed or refractory DLBCL (n = 21) including seven patients with secondary CNS involvement and transformed FL (n = 3) were retrospectively analyzed. Results Based on the best response, the complete response (CR) rate was 21% (5/24) and the overall response rate (ORR) was 38% (9/24). However, as all cases of transformed FL (n = 3) did not respond, all responders had DLBCL, and the CR and ORR rates of DLBCL were 24% (5/21) and 43% (9/21), respectively. The median number of treatment cycles was only two (range: 1–7) due to frequent occurrence of early progression, and 18 patients died and the cause of death was disease progression. The response rate was not significantly different among patients with and without secondary CNS involvement. The median post-treatment overall and progression-free survival were 7.3 and 1.8 months, respectively. Hematologic toxicities were common adverse events, but most hematologic toxicities were manageable. There were no serious infectious complications or treatment-related mortality. Conclusion Lenalidomide plus rituximab might be a salvage therapy for relapsed or refractory DLBCL, especially in case of secondary CNS involvement. However, the addition of other agents should be considered to prolong the duration of response.
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Affiliation(s)
- Yong-Pyo Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yong Hong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junhun Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Joon-Ho Shim
- Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Yeonghak Bang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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6
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Hwang HS, Kim M, Park CS, Yoon DH, Suh C, Huh J, Go H. Prognostic Impact of Age at the Time of Diagnosis in Korean Patients with Diffuse Large B-cell Lymphoma in the Rituximab Era: A Single Institution Study. Cancer Res Treat 2020; 53:270-278. [PMID: 32972046 PMCID: PMC7812004 DOI: 10.4143/crt.2020.626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose In contrast to the Western diffuse large B-cell lymphoma (DLBCL), prognostic impact of age in a Korean population with DLBCL has not been fully evaluated. Materials and Methods Six hundred and eight DLBCL patients treated with rituximab-containing chemotherapeutic regimens from January 2002 to March 2012 in Asan Medical Center were enrolled. Survival models using the restricted cubic spine–transformed age variable were constructed to evaluate non-linear relationships between age and survival outcome. Finally, age was categorized according to the conventional international prognostic index (IPI), National Comprehensive Cancer Network (NCCN)-IPI, and Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea (GELTAMO)-IPI schemes and the prognostic implications were evaluated. Results The relative hazard did not change significantly during the first to fifth decades, but began to increase exponentially in patients aged over 62 years. This pattern or relationship was also retained in a multivariate model fitted to the age-adjusted IPI and relative dose intensity. Multivariate survival analysis revealed that age > 75 years, but not age > 60 years, was associated independently with poor overall and progression-free survival when the relative dose intensity and age-adjusted IPI were taken into account. Conclusion The outcome of DLBCL in Korean populations may deteriorate rapidly as age exceeds 62 years. Therefore, a consensus cutoff value for age in Korean DLBCL patients should be determined to better predict prognosis.
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Affiliation(s)
- Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Meejeong Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heounjeong Go
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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7
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Jelicic J, Larsen TS, Frederiksen H, Andjelic B, Maksimovic M, Bukumiric Z. Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models - A Systematic Review. Clin Epidemiol 2020; 12:537-555. [PMID: 32581596 PMCID: PMC7266947 DOI: 10.2147/clep.s244294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background and Aim Based on advances in the diagnosis, classification, and management of diffuse large B-cell lymphoma (DLBCL), a number of new prognostic models have been proposed. The aim of this study was to review and compare different prognostic models of DLBCL based on the statistical methods used to evaluate the performance of each model, as well as to analyze the possible limitations of the methods. Methods and Results A literature search identified 46 articles that proposed 55 different prognostic models for DLBCL by combining different clinical, laboratory, and other parameters of prognostic significance. In addition, six studies used nomograms, which avoid risk categorization, to create prognostic models. Only a minority of studies assessed discrimination and/or calibration to compare existing models built upon different statistical methods in the process of development of a new prognostic model. All models based on nomograms reported the c-index as a measure of discrimination. There was no uniform evaluation of the performance in other prognostic models. We compared these models of DLBCL by calculating differences and ratios of 3-year overall survival probabilities between the high- and the low-risk groups. We found that the highest and lowest ratio between low- and high-risk groups was 6 and 1.31, respectively, while the difference between these groups was 18.9% and 100%, respectively. However, these studies had limited duration of follow-up and the number of patients ranged from 71 to 335. Conclusion There is no universal statistical instrument that could facilitate a comparison of prognostic models in DLBCL. However, when developing a prognostic model, it is recommended to report its discrimination and calibration in order to facilitate comparisons between different models. Furthermore, prognostic models based on nomograms are becoming more appealing owing to individualized disease-related risk estimations. However, they have not been validated yet in other study populations.
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Affiliation(s)
- Jelena Jelicic
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Thomas Stauffer Larsen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Frederiksen
- Department of Hematology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bosko Andjelic
- Department of Haematology, Blackpool Victoria Hospital, Lancashire Haematology Centre, Blackpool, UK
| | - Milos Maksimovic
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Zoran Bukumiric
- Department of Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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8
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Gutierrez A, Bento L, Diaz‐Lopez A, Barranco G, Garcia‐Recio M, Lopez‐Guillermo A, Dlouhy I, Rovira J, Rodriguez M, Sanchez Pina JM, Baile M, Martín A, Novelli S, Sancho J, García O, Salar A, Bastos‐Oreiro M, Rodriguez‐Salazar MJ, Fernandez R, de la Cruz F, Queizan JA, González de Villambrosia S, Cordoba R, López A, Luzardo H, García D, Sastre‐Serra J, Garcia JF, Montalban C, Cabanillas F, Rodríguez J. Evaluation of the MD Anderson tumor score for diffuse large B-cell lymphoma in the rituximab era. Eur J Haematol 2020; 104:400-408. [PMID: 31804029 PMCID: PMC7217048 DOI: 10.1111/ejh.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Diffuse large B-cell lymphoma (DLBCL) is an aggressive heterogeneous lymphoma with standard treatment. However, 30%-40% of patients still fail, so we should know which patients are candidates for alternative therapies. IPI is the main prognostic score but, in the rituximab era, it cannot identify a very high-risk (HR) subset. The MD Anderson Cancer Center reported a score in the prerituximab era exclusively considering tumor-related variables: Tumor Score (TS). We aim to validate TS in the rituximab era and to analyze its current potential role. METHODS From GELTAMO DLBCL registry, we selected those patients homogeneously treated with R-CHOP (n = 1327). RESULTS Five-years PFS and OS were 62% and 74%. All variables retained an independent prognostic role in the revised TS (R-TS), identifying four different risk groups, with 5-years PFS of 86%, 71%, 50%, and very HR (28%). With a further categorization of three variables of the original TS (Ann Arbor Stage, LDH and B2M), we generated a new index that allowed an improvement in HR assessment. CONCLUSIONS (a) All variables of the original TS retain an independent prognostic role, and R-TS remains predictive in the rituximab era; (b) R-TS and additional categorization of LDH, B2M, and AA stage (enhanced TS) increased the ability to identify HR subsets.
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Affiliation(s)
- Antonio Gutierrez
- Lymphoma UnitDepartment of HematologyHospital Universitari Son Espases/IdISBaPalmaSpain
| | - Leyre Bento
- Lymphoma UnitDepartment of HematologyHospital Universitari Son Espases/IdISBaPalmaSpain
| | - Antonio Diaz‐Lopez
- Department of Translational ResearchMD Anderson Cancer CenterMadridSpain
| | - Gilberto Barranco
- Department of Translational ResearchMD Anderson Cancer CenterMadridSpain
| | - Marta Garcia‐Recio
- Lymphoma UnitDepartment of HematologyHospital Universitari Son Espases/IdISBaPalmaSpain
| | | | | | | | | | | | - Monica Baile
- Hospital Clinico Universitario de Salamanca (CAUSA/IBSAL)SalamancaSpain
| | - Alejandro Martín
- Hospital Clinico Universitario de Salamanca (CAUSA/IBSAL)SalamancaSpain
| | - Silvana Novelli
- Department of HematologyHospital de la Santa Creu I Sant PauBarcelonaSpain
| | | | - Olga García
- Hospital Universitari Germans Trias i PujolBarcelonaSpain
| | - Antonio Salar
- Department of HematologyHospital del MarBarcelonaSpain
| | - Mariana Bastos‐Oreiro
- Department of HematologyGregorio Marañón General University Hospital (HGUGM)MadridSpain
| | | | | | | | | | | | - Raul Cordoba
- Department of HematologyFundación Jimenez DíazMadridSpain
| | | | - Hugo Luzardo
- Hospital Dr. NegrinLas Palmas de Gran CanariaMadridSpain
| | | | | | - Juan Fernando Garcia
- Department of Translational ResearchMD Anderson Cancer CenterMadridSpain
- Department of PathologyMD Anderson Cancer CenterMadridSpain
| | - Carlos Montalban
- Department of Translational ResearchMD Anderson Cancer CenterMadridSpain
| | | | - Jose Rodríguez
- Department of Translational ResearchMD Anderson Cancer CenterMadridSpain
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9
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Bento L, Díaz-López A, Barranco G, Martín-Moreno AM, Baile M, Martín A, Sancho JM, García O, Rodríguez M, Sánchez-Pina JM, Novelli S, Salar A, Bastos M, Rodríguez-Salazar MJ, González de Villambrosia S, Córdoba R, García-Recio M, Martínez-Serra J, Del Campo R, Luzardo H, García D, Hong A, Abrisqueta P, Sastre-Serra J, Roca P, Rodríguez J, Gutiérrez A. New prognosis score including absolute lymphocyte/monocyte ratio, red blood cell distribution width and beta-2 microglobulin in patients with diffuse large B-cell lymphoma treated with R-CHOP: Spanish Lymphoma Group Experience (GELTAMO). Br J Haematol 2019; 188:888-897. [PMID: 31782146 DOI: 10.1111/bjh.16263] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
Abstract
The International Prognostic Index (IPI) is the most widely used score for non-Hodgkin lymphoma but lacks the ability to identify a high-risk population in diffuse large B-cell lymphoma (DLBCL). Low absolute lymphocyte count and high monocytes have proved to be unfavourable factors. Red-cell distribution width (RDW) has been associated with inflammation and beta-2 microglobulin (B2M) with tumour load. The retrospective study included 992 patients with DLBCL treated with R-CHOP. In the multivariate analysis, age, Eastern Cooperative Oncology Group performance status (ECOG-PS), stage, bulky mass, B2M, RDW, and lymphocyte/monocyte ratio (LMR) were independently related to progression-free survival (PFS). A new prognosis score was generated with these variables including age categorized into three groups (0, 1, 2 points); ECOG ≥ 3-4 with two; stage III/IV, bulky mass, high B2M, LMR < 2·25 and RDW > 0·96 with one each; for a maximum of 9. This score could improve the discrimination of a very high-risk subgroup with five-year PFS and overall survival (OS) of 19% and 24% versus 45% and 59% of R (revised)-IPI respectively. This score also showed greater predictive ability than IPI. A new score is presented including complete blood cell count variables and B2M, which are readily available in real-life practice without additional tests. Compared to R-IPI, it shows a more precise high-risk assessment and risk discrimination for both PFS and OS.
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Affiliation(s)
- Leyre Bento
- Hospital Universitario Son Espases, IdISBa, Palma de Mallorca, Spain
| | | | | | | | - Mónica Baile
- Hospital Clínico Universitario Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - Alejandro Martín
- Hospital Clínico Universitario Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | - Juan M Sancho
- ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Olga García
- ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | | | | | - Mariana Bastos
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - M García-Recio
- Hospital Universitario Son Espases, IdISBa, Palma de Mallorca, Spain
| | - J Martínez-Serra
- Hospital Universitario Son Espases, IdISBa, Palma de Mallorca, Spain
| | | | - Hugo Luzardo
- Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Azueg Hong
- Hospital General Lanzarote, Lanzarote, Spain
| | | | - Jorge Sastre-Serra
- Grupo Multidisciplinar de Oncología Traslacional, IUNICS, Palma de Mallorca, Spain
| | - Pilar Roca
- Grupo Multidisciplinar de Oncología Traslacional, IUNICS, Palma de Mallorca, Spain
| | | | - Antonio Gutiérrez
- Hospital Universitario Son Espases, IdISBa, Palma de Mallorca, Spain
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10
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Salas MQ, Mercadal S, Domingo Domenech E, Oliveira AC, Encuentra M, Climent F, Andrade Campos M, Aguilera C, Fernández de Sevilla A, Sureda A, González-Barca E. Validation of the NCCN-IPI and the GELTAMO-IPI for diffuse large B-Cell lymphoma treated with R-CHOP in a large cohort of patients from a single institution. Leuk Lymphoma 2019; 61:575-581. [PMID: 31684781 DOI: 10.1080/10428194.2019.1683733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The discriminative power of International Prognostic Index (IPI) in diffuse large B-cell lymphoma (DLBCL) decreased with the addition of rituximab to chemotherapy. The National Comprehensive Cancer Network (NCCN)-IPI and the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO)-IPI were developed to improve the risk prediction for DLBCL patients. We aim to validate the NCCN-IPI and GELTAMO-IPI in a large and homogeneous cohort of 337 DLBCL patients treated with curative intent with R-CHOP/R-CHOP-like immunochemotherapy. The IPI stratifies patients in two independent risk groups and the estimated 5-year overall survival (OS) of the high-risk (HR) group was 43%. NCCN-IPI discriminated four risk groups and GELTAMO-IPI three risk groups of patients. The predicted 5-year OS of the HR group was 38% and 29%, respectively. NCCN-IPI and GELTAMO-IPI are more accurate prognostic indices than IPI in DBLCL patients treated with immunochemotherapy. GELTAMO-IPI demonstrated enhanced discrimination than NCCN-IPI for the higher-risk population.
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Affiliation(s)
- María Queralt Salas
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Santiago Mercadal
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Eva Domingo Domenech
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Ana Carla Oliveira
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Maite Encuentra
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Fina Climent
- Department of Pathology, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Marcio Andrade Campos
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Carmen Aguilera
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | | | - Anna Sureda
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
| | - Eva González-Barca
- Department of Clinical Haematology, Institut Català Oncologia (ICO)-Hospitalet, Barcelona, Spain
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11
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Jelicic J, Larsen TS, Maksimovic M, Trajkovic G. Available prognostic models for risk stratification of diffuse large B cell lymphoma patients: a systematic review. Crit Rev Oncol Hematol 2018; 133:1-16. [PMID: 30661646 DOI: 10.1016/j.critrevonc.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/28/2018] [Indexed: 12/12/2022] Open
Abstract
The International Prognostic Index (IPI) has been used for risk stratification for a long time in diffuse large B cell lymphoma (DLBCL). Based on new clinical and biological prognostic markers, many new prognostic models have been described. This review aims to present the progress in development and validation of these prognostic models. A comprehensive literature review was performed to identify studies that proposed a new prognostic model in DLBCL. A total of 38 studies met the inclusion criteria. The IPI, revised IPI (R-IPI), and National Comprehensive Cancer Network (NCCN)-IPI were the most studied prognostic indexes, externally validated and commonly used to compare to other models. Despite an increasing number of prognostic models have been proposed lately, most of them lack external validation. Further studies, that combine biological and clinical markers with prognostic significance, are needed to determine the optimal prognostic tool for more personalized treatment approach to DLBCL patients.
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Affiliation(s)
- Jelena Jelicic
- Clinic for Haematology, Clinical Centre of Serbia, Dr Koste Todorovica 2, 11000, Belgrade, Serbia
| | - Thomas Stauffer Larsen
- Department of Haematology, Odense University Hospital, Sdr. Boulevard 29, Indgang 85 Pavillon, 5000, Odense C, Denmark.
| | - Milos Maksimovic
- Clinic for Ophthalmology, Clinical Centre of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Goran Trajkovic
- Department of Statistics, Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11 000, Belgrade, Serbia
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12
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Montalbán C, Díaz-López A, Martín A, Baile M, Sanchez JM, Sancho JM, García O, Novelli S, Monter-Rovira A, Salar A, Bastos M, Gutiérrez A, Bento L, Córdoba R, Arquero T, González de Villambrosia S, Barranco G, De Oña R, López Guillermo A, Rodriguez Salazar MJ, Domínguez JF, Fernández R, Queizan JA, Rodríguez J, Abraira V, García JF. Differential prognostic impact of GELTAMO-IPI in cell of origin subtypes of Diffuse Large B Cell Lymphoma as defined by the Hans algorithm. Br J Haematol 2018; 182:534-541. [DOI: 10.1111/bjh.15446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/14/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Carlos Montalbán
- Department of Haematology; MD Anderson Cancer Center; Madrid Spain
| | - Antonio Díaz-López
- Department of Pathology; Translational Research; MD Anderson Cancer Center; Madrid Spain
| | - Alejandro Martín
- Department of Haematology; Hospital Universitario de Salamanca and IBSAL; CIBERONC; Salamanca Spain
| | - Mónica Baile
- Department of Haematology; Hospital Universitario de Salamanca and IBSAL; CIBERONC; Salamanca Spain
| | - José M. Sanchez
- Department of Haematology; Hospital Universitario; 12 de Octubre Madrid Spain
| | - Juan M. Sancho
- Department of Haematology; ICO-IJC-Hospital Germans Trías I Pujol; Badalona Spain
| | - Olga García
- Department of Haematology; ICO-IJC-Hospital Germans Trías I Pujol; Badalona Spain
| | - Silvana Novelli
- Department of Haematology; Hospital de la Santa Creu I Sant Pau; Barcelona Spain
| | - Anna Monter-Rovira
- Department of Haematology; Hospital de la Santa Creu I Sant Pau; Barcelona Spain
| | - Antonio Salar
- Department of Haematology; Hospital del Mar; Barcelona Spain
| | - Mariana Bastos
- Department of Haematology; Hospital Gregorio Marañón; Madrid Spain
| | - Antonio Gutiérrez
- Department of Haematology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - Leyre Bento
- Department of Haematology; Hospital Universitari Son Espases; Palma de Mallorca Spain
| | - Raul Córdoba
- Department of Haematology; Fundación Jiménez Díaz; Madrid Spain
| | - Teresa Arquero
- Department of Haematology; Fundación Jiménez Díaz; Madrid Spain
| | | | - Gilberto Barranco
- Department of Pathology; Translational Research; MD Anderson Cancer Center; Madrid Spain
| | - Raquel De Oña
- Department of Haematology; MD Anderson Cancer Center; Madrid Spain
| | | | | | | | - Rubén Fernández
- Department of Haematology; Hospital de Cabueñes; Gijón Spain
| | - José A. Queizan
- Department of Haematology; Hospital General de Segovia; Segovia Spain
| | - José Rodríguez
- Department of Haematology; MD Anderson Cancer Center; Madrid Spain
| | - Victor Abraira
- Hospital Universitario Ramón y Cajal; Fundación IRYCIS; Madrid Spain
| | - Juan F. García
- Department of Pathology; Translational Research; MD Anderson Cancer Center; Madrid Spain
- Department of Pathology; MD Anderson Cancer Centre; Madrid Spain
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