Construction and Validation of a Novel Nomogram for Predicting the Recurrence of Diffuse Large B Cell Lymphoma Treated with R-CHOP

Abstract

Purpose To explore recurrence-risk factors of diffuse large B cell lymphoma (DLBCL) and construct a risk nomogram for predicting recurrence. Patients and Methods A retrospective analysis was performed on 228 DLBCL patients who achieved complete remission after R-CHOP treatment between January 2015 and December 2019. Univariate and multivariate analyses were applied to identify recurrence-related risk factors from the pretreatment evaluation factors covering patients’ demographic characteristics, clinical manifestations, serological indicators, pathological and immunohistochemical results. A nomogram was developed based on the above results and validated by the concordance index (C-index), the receiver operating characteristic (ROC) curve, and the calibration curve. Results The training and validation cohorts consisted of 160 and 68 patients (randomized by 7:3). Of the whole cohort, 50 of 228 (21.9%) cases recurred during follow-up. Three recurrence-risk factors including BCL2 expression (P = 0.027), CD10 expression (P = 0.021), LDH level (P = 0.004) were identified from multivariate analysis and entered the final nomogram. The C-index of the nomogram was 0.815 in training cohort and 0.797 in the validation cohort, higher than that of IPI system (0.699) and NCCN-IPI system (0.709). And the 1-year, 2-year, 3-year, and 4-year areas under ROC (AUC) were 0.812, 0.850, 0.837, and 0.801, respectively. The calibration curves also showed a good discrimination capability and accuracy. Conclusion The novel nomogram incorporating the three independent risk factors (BCL2 expression, CD10 expression and LDH level) provided a valuable tool for predicting DLBCL recurrence.

Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country

“…27 Relapse rate in our study was 48.6%, which is higher than the documented relapse risk from Western data (30%-40%). 28,29 The possible reasons are lack of IHC on most samples resulting in missing out on high-grade B-cell lymphoma, nonavailability of rituximab in large number of patients, and use of CT scan for remission assessment after treatment. The OS and DFS were better in enhanced-resource groups, and this highlights the importance of provision of necessary facilities.…”

Clinical and Therapeutic Profile of Non-Hodgkin’s Lymphoma: A Retrospective Study From a Najran Oncology Center

“…Elevation of LDH is a valuable biomarker and is associated with a higher tumor burden and more aggressive behavior of NHL, as well as an increased risk of central nervous system (CNS) relapse [ 26 , 27 ]. LDH is used in the IPI system and other prognostic nomogram models for aggressive B-cell lymphomas, as well as in other malignancies such as melanoma, prostate, and renal cell carcinomas as an independent prognostic factor [ 27 ]. Compared to late-relapsed, higher LDH levels, IPI scores, and stages (III-IV) were observed in early-relapsed cases.…”