Systemic reports on the descriptive epidemiology of non-Hodgkin lymphoma (NHL) from Southeast Asia are scarce. A nationwide multi-institutional registry was conducted to compare the histopathology, clinical features, and survival of Thai adult patients with NHL using large registries, especially those from Far East Asia (FEA). Using a web-based registry system, 13 major medical centers from the 4 geographic regions of Thailand prospectively collected, from 2007 to 2014, the diagnostic pathology, according to the World Health Organization classification, 2008, clinical features and survival of 4056 patients who were newly diagnosed with NHL. The median age of the patients was 56 years (range, 16-99 years). The male-to-female ratio was 1.3:1. From the total of 4056 patients, T/NK-cell lymphoma (TNKCL) accounted for 12.6% of cases, and 5.1% had human immunodeficiency virus-associated lymphoma. The four leading histological subtypes were diffuse large B-cell lymphoma, not otherwise specified (58.1%); follicular lymphoma (5.6%); extranodal mucosa-associated lymphoid tissue lymphoma (5.2%); and peripheral T-cell lymphoma, not otherwise specified (4.0%). With a median follow-up duration of 46.1 months, the median overall survival of B-cell NHL was significantly longer than that of patients with TNKCL (76.5 vs 28.8 months, P = .0001). Compared to FEA, the Thai registry had an approximately one-half lower relative frequency of TNKCL; the prevalence of extranodal mucosa-associated lymphoid tissue lymphoma was much lower than in Korea, and the frequency of extranodal TNKCL, nasal type, was strikingly low compared to China. It is concluded that while the median age of Thai patients with NHL was approximately a decade younger than for Caucasians, the long-term survival rates for most histological subtypes were comparable. While the histological distribution generally complied with the characteristic Asian features, some differences from FEA were observed.

2064 OBJECTIVE: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in Thailand. The objective of the study was to evaluate clinical features, histopathology, treatment outcomes and prognostic factors in Thai adult patients with NHL. METHODS: Using web-based registry system, we prospectively collected clinical information of newly diagnosed NHL patients from eleven major medical centers situated in various geographic regions of Thailand. All histopathological diagnoses were reviewed by consensus meeting of panels of 6 expert hematopathologists and classified according to the 2008 WHO classification of the lymphoid neoplasms. Clinical features and treatment outcomes were analyzed using STATA program. RESULTS: Between January 2007 and May 2009, there were a total of 939 NHL patients whose clinical information including follow-up data and tissue samples were readily available for analysis. The median age was 58 years (range, 15–99). Forty six percent of the patients were ≥60 years of age. Male:female was 1.18:1. The six leading subtypes were diffuse large B-cell lymphoma (67%), extranodal marginal zone lymphoma of MALT type (7%), follicular lymphoma (6%), mantle cell lymphoma (4%), peripheral T-cell lymphoma, not otherwise specified (NOS) (3%) and extranodal NK/T-cell lymphoma, nasal type (3%). T-cell lymphoma constituted 10% of all NHL. The three most common subtypes in T-cell lymphomas were peripheral T-cell lymphoma, NOS (26%), extranodal NK/T-cell lymphoma, nasal type (25%) and angioimmunoblastic T-cell lymphoma (15%). Fifty-eight percent of all patients had advanced disease (stage III, IV), 42% had B symptoms and 54% had elevated serum LDH. The IPI risk groups were 23% low, 30% low-intermediate, 30% high-intermediate and 17% high-risk. HIV-associated NHL was seen in 4.4% of the patients. Of the 801 patients who received chemotherapy, 90% were treated with anthracycline-containing regimen. Twenty-five percent of the patients received rituximab. Of the 663 evaluable patients, the rate of objective tumor response was 75% (CR+CRu, 59%). At a median follow-up time of 13 months, the 4-year projected overall survival (OS) was 73% (95% CI 69–77%). The OS of patients with T-cell lymphoma was inferior to B-cell lymphoma (58% vs. 74%, p = 0.04). With multivariate analysis, the independent adverse prognostic factors for OS in B-cell lymphoma were poor performance status (HR 2.4, 95% CI 1.7–3.5), elevated serum LDH (HR 2.1, 95% CI 1.4–3.1), stage III/IV (HR 1.6, 95% CI 1.1–2.3), WHO subtype (HR 1.1, 95% CI 1.0–1.2), no chemotherapy (HR 3.1, 95% CI 1.9–5.1) and no rituximab treatment (HR 1.7, 95% CI 1.1–2.6). The independent adverse factors for OS in T-cell lymphoma were elevated serum LDH (HR 3.7, 95% CI 1.2–11.1) and male sex (HR 3.4, 95% CI 1.3–8.8). CONCLUSIONS: This study confirmed the characteristic features of NHL among Thai population, i.e., a preponderance of diffuse large B-cell lymphoma and a low incidence of follicular lymphoma within B-cell lymphoma; a relatively high incidence of nasal NK/T-cell lymphoma within T-cell lymphoma. The IPI risk-groups and survival outcomes were comparable to most previously published reports. Disclosures: Bunworasate: Novartis Pharmaceutical: Research Funding. Off Label Use: Nilotinib is a safe and effective treatment for patients with CML. Chuncharunee:Novartis: Research Funding.

Introduction In pre-rituximab era, the IPI has been developed and widely used to predict the prognosis of aggressive lymphoma while Miller's stage modified IPI1 was reported as a better prognostic model for limited stage DLBCL. Recently, NCCN-IPI2 was stated to be a better predictor of prognosis for DLBCL in rituximab era. We aim to compare the prognostic significance between IPI, Miller's stage modified IPI, NCCN-IPI and the new proposed stage adjusted IPI (St-IPI) in limited stage DLBCL patients treated with rituximab based regimens. Methods From the 4,371 patients in a multi-institutional registry of newly diagnosed lymphoma in Thailand between 2007-2014, there were a total of 2,399 patients with DLBCL. We included patients with limited stage DLBCL receiving R-CHOP or R-CHOP-liked chemotherapy. The clinical outcomes were analyzed according to IPI, Miller's stage modified IPI, NCCN-IPI and St-IPI. To generate the St-IPI, we used 3 predictors from IPI namely, age > 60, elevated LDH and ECOG ≥ 2, classified patients into 3 risk cohorts, i.e., the low (score 0), intermediate (score 1-2), and high risk (score 3) group. Results A total of 274 patients with a median age of 58 years (range, 15-91) were included. Seventy-four percent of the cohort had stage II disease, 44% and 32% of them had elevated LDH and ECOG ≥ 2, respectively. According to St-IPI, 77, 183 and 14 patients were categorized as low (score 0), intermediate (score 1-2) and high risk groups (score 3), respectively. Most of the patients (96%) received R-CHOP regimen and one fifth of them underwent consolidation radiotherapy, contributing to a complete response rate of 76%. With a median follow up of 52 months, the 5-year progression free survival (PFS) according to St-IPI among low, intermediate and high risk groups were 79%, 66% and 22%, respectively (HR 2.48, 95%CI: 1.55-3.86). The corresponding figures for 5-year overall survival (OS) were 84%, 73% and 49%, respectively (HR 2.95, 95%CI: 1.54-4.37). The 5-year PFS and OS according to IPI, NCCN-IPI and Miller's stage modified IPI were described in Table 1. When comparing between risk models, St-IPI was able to discriminate more accurately low risk PFS than IPI, distinguished more precisely high risk PFS than NCCN-IPI and Miller's stage modified IPI (Figure 1). All risk models had no differences in predicting OS at 5 years, nevertheless, there was a trend of inferior survivals after 5 years among limited stage DLBCL patients with high risk St-IPI (Figure 2). Conclusion St-IPI is a simple and better model in predicting PFS for limited stage DLBCL treated with R-CHOP. The model is able to predict the lower risk disease more discriminately than the IPI which would suggest the tailor therapy approach to avoid unnecessary treatment related toxicities. Moreover, the St-IPI is better in predicting patients with high risk of relapses in whom more aggressive treatment is warranted to improve the cure rate of the patients. 1 Miller, et al. N Engl J Med 1998; 339: 21-6 2 Zhou, et al. Blood. 2014;123: 837-842 Table 1. 5-year PFS and OS according to risk groups categorized by St-IPI, IPI, NCCN-IPI and Miller's stage modified IPI Risk model 5-year PFS (%) HR (95%CI) P -value 5-year OS (%) HR (95%CI) P -value St-IPI (Age > 60, elevated serum LDH, ECOG ≥ 2) 2.48 (1.55-3.86) <0.001 2.95 (1.54-4.37) <0.001 Low (score 0, n= 77) 79 84 Intermediate (score 1-2, n=183) 66 73 High (score 3, n=14) 22 49 IPI (Age > 60, elevated LDH, ECOG ≥ 2, Stage ≥ III, extranodal involvement >1) 1.99 (1.43-2.78) <0.001 2.03 (1.40-2.97) <0.001 Low (score 0-1, n =203) 73 79 Low-intermediate (score 2, n=57) 61 69 High-intermediate (score 3, n=14) 22 49 High (score 4-5, n=0) - - NCCN-IPI (Age ≤40, >40-60, 60-75, >75; elevated serum LDH 1-3X, > 3X; ECOG ≥ 2, Stage ≥ III, extranodal disease in bone marrow, liver/GI tract or lung) 1.83 (1.30-2.57) <0.001 2.13 (1.45-3.13) <0.001 Low (score 0-1, n=82) 79 86 L-I (score 2-3, n=152) 67 74 H-I (score 4-5, n=40) 44 54 High (score ≥ 6, n=0) - - Miller's stage modified IPI (Age > 60, elevated serum LDH, ECOG ≥ 2, Stage II) 1.71 (1.28-2.28) <0.001 1.69 (1.22-2.35) 0.02 Low (score 0-1, n=107) 78 84 Intermediate (score 2, n=109) 65 73 High (score 3-4, n=58) 51 49 Figure 1. PFS according to risk groups categorized by St-IPI (Figure 1A), IPI (Figure 1B), NCCN-IPI (Figure 1C) and Miller's stage modified IPI (Figure 1D) Figure 1. PFS according to risk groups categorized by St-IPI (Figure 1A), IPI (Figure 1B), NCCN-IPI (Figure 1C) and Miller's stage modified IPI (Figure 1D) Figure 2. OS according to risk groups categorized by St-IPI (Figure 2A), IPI (Figure 2B), NCCN-IPI (Figure 2C) and Miller's stage modified IPI (Figure 2D) Figure 2. OS according to risk groups categorized by St-IPI (Figure 2A), IPI (Figure 2B), NCCN-IPI (Figure 2C) and Miller's stage modified IPI (Figure 2D) Disclosures Khuhapinant: Roche: Honoraria.