A Bari1, L Marcheselli1, S Sacchi2, R Marcheselli1, S Pozzi1, P Ferri3, E Balleari4, P Musto5, S Neri6, M A Aloe Spiriti7, M C Cox7. 1. Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena. 2. Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena. Electronic address: stefano.sacchi@unimo.it. 3. Department of Public Health Sciences, University of Modena and Reggio Emilia, Modena. 4. Department of Internal Medicine, University of Genoa, Genoa. 5. Unit of Hematology and Stem Cell Transplantation, IRCCS-CROB, Oncology Referral Center of Basilicata, Rionero in Vulture, Potenza. 6. Unit of Hematology, Papardo Hospital, Messina. 7. Department of Hematology, AO Sant'Andrea, La Sapienza University, Rome, Italy.
Abstract
BACKGROUND: Improved treatment have modified survival outcome in patients with diffuse large B-cell lymphoma (DLBCL) and altered the importance of previously recognized prognostic markers. DESIGN AND METHODS: To evaluate International Prognostic Index (IPI) score before and after rituximab introduction and to validate the absolute lymphocyte count (ALC)/revised International Prognostic Index (R-IPI) model, we carried out a retrospective analysis on a total of 831 patients with DLBCL. RESULTS: Our results show that IPI lost its discriminating power with the introduction of rituximab. The analysis of our second set allowed us to validate the ALC/R-IPI model. The R-IPI and ALC/R-IPI could still be used for designing clinical trials, but both have difficulty recognizing a high percentage of poor prognosis patients, though it remains an important goal of a good prognostic model considering the modest impact of salvage treatments on survival. CONCLUSIONS: A new model on the basis of significant variables in the rituximab era and built on a large database of patients treated with rituximab is urgently needed. As prognostic models are changing with the efficacy and mechanisms of action of treatment utilized, looking for a new prognostic score is a never-ending story in which researchers are trying to hit a continuously moving target.
BACKGROUND: Improved treatment have modified survival outcome in patients with diffuse large B-cell lymphoma (DLBCL) and altered the importance of previously recognized prognostic markers. DESIGN AND METHODS: To evaluate International Prognostic Index (IPI) score before and after rituximab introduction and to validate the absolute lymphocyte count (ALC)/revised International Prognostic Index (R-IPI) model, we carried out a retrospective analysis on a total of 831 patients with DLBCL. RESULTS: Our results show that IPI lost its discriminating power with the introduction of rituximab. The analysis of our second set allowed us to validate the ALC/R-IPI model. The R-IPI and ALC/R-IPI could still be used for designing clinical trials, but both have difficulty recognizing a high percentage of poor prognosis patients, though it remains an important goal of a good prognostic model considering the modest impact of salvage treatments on survival. CONCLUSIONS: A new model on the basis of significant variables in the rituximab era and built on a large database of patients treated with rituximab is urgently needed. As prognostic models are changing with the efficacy and mechanisms of action of treatment utilized, looking for a new prognostic score is a never-ending story in which researchers are trying to hit a continuously moving target.
Authors: Qaid Ahmed Shagera; Gi Jeong Cheon; Youngil Koh; Min Young Yoo; Keon Wook Kang; Dong Soo Lee; E Edmund Kim; Sung-Soo Yoon; June-Key Chung Journal: Eur J Nucl Med Mol Imaging Date: 2019-04-02 Impact factor: 9.236
Authors: Da Jung Kim; Taeyun Kim; Jee-Yeong Jeong; Jae-Cheol Jo; Won Sik Lee; Ho-Jin Shin; Ji Hyun Lee; Ho Sup Lee Journal: Int J Hematol Date: 2020-01-06 Impact factor: 2.490