A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification: population-based analysis from the Danish Lymphoma Registry

Abstract

The introduction of rituximab and generally improved health among elderly patients have increased the survival of patients with diffuse large B-cell lymphoma (DLBCL). The International Prognostic Index (IPI) from 1992 is based on pre-rituximab data from clinical trials including several lymphoma subtypes. We applied IPI factors to a population-based rituximab-treated cohort of 1990 patients diagnosed 2000-2010 and explored new factors and the optimal prognostic age cut-off for DLBCL. Multivariate-analyses (MVA) confirmed the prognostic value of all IPI factors except the presence of > 1 extranodal lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate dehydrogenase (LDH), stage and albumin level, and (2) a separate age-adjusted DLBCL-PI for patients ≤ 70 years including PS, LDH, albumin level and > 1 extranodal lesion, however excluding stage.

The Rituximab Biosimilar CT-P10 in Rheumatology and Cancer: A Budget Impact Analysis in 28 European Countries

“…In DLBCL, FL, and CLL, all case incidence rates per 100,000 population were 3.81 (95% confidence interval 3.73–3.89), 2.18 (2.12–2.24), and 4.92 (4.83–5.01), respectively [47]. To calculate weightings in our model, we assumed thatThe percentage of incident patients treated with RTX was 95% for DLBCL [48, 49], 80% for FL [50], and 78% for CLL [51]. …”

“…The percentage of incident patients treated with RTX was 95% for DLBCL [48, 49], 80% for FL [50], and 78% for CLL [51]. …”

Validation of the NCCN‐IPI for diffuse large B‐cell lymphoma (DLBCL): the addition of β2‐microglobulin yields a more accurate GELTAMO‐IPI

“…On the other hand, the specific prognostic influence of extranodal dissemination is controversial, with discordant data in different studies. The involvement of ≥1 extranodal involvement was not significant in any of the NCCN series (Zhou et al , ), the German study (Habermann et al , ), or a Danish study of 1990 patients (Gang et al , ). Conversely, in the Danish‐Canadian series (El‐Galaly et al , ), which identified extranodal involvement with PET/CT, the number of involved extranodal sites was strongly correlated with the prognosis, indicating that the involvement of >2 extranodal sites seems to be a better cut‐off than the involvement of ≥1, as considered in the IPI, the involvement of >3 sites selects a very high‐risk population, and modifying the scoring based on the number of involved sites improves the accuracy of the NCCN‐IPI.…”

Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma – Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007–2015

“…The impact of age on DLBCL treatment patterns and outcomes is well-recognized [34]. Although the International Prognostic Index (IPI) utilized an age cutoff of 60 years in the pre-rituximab era, more recent findings have suggested that age 70 years may be of greater prognostic value based upon post-rituximab era data [35,36]. Series of very old DLBCL patients are limited [31,[37][38][39][40].…”