High Ki67 Index and Bulky Disease Remain Significant Adverse Prognostic Factors in Patients with Diffuse Large B Cell Lymphoma before and after the Introduction of Rituximab

Abstract

The aim of this study was to evaluate the impact of clinical variables and biologic features on response rate (RR), overall survival (OS) and progression-free survival (PFS) in 111 patients with de novo diffuse large B cell lymphoma (DLBCL). Fifty-three patients were treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) and 58 patients were treated with R-CHOP (rituximab + CHOP). The variables predictive of RR in the CHOP group were B symptoms, age, clinical stage, bone marrow involvement, bulky disease, International Prognostic Index (IPI) and Bcl-2; in the R-CHOP group, these variables were bulky disease, bone marrow involvement, IPI and Ki67 expression >80%. Multivariate analysis showed that in patients treated with CHOP, the independent prognostic factors associated with PFS were age, bulky disease, IPI and Bcl-2 and those associated with OS were performance status, clinical stage, IPI and bone marrow involvement. In contrast, in patients treated with R-CHOP, the variable shown by multivariate analysis to be an independent prognostic factor associated with PFS was bulky disease, whereas Ki67 expression >80% was associated with OS and PFS. Our data show that a high Ki67 expression and bulky disease could represent possible predictive factors of poor prognosis, which would help to identify a high-risk subgroup of newly diagnosed DLBCL.

Prognostic Significance of Pretreatment ¹⁸F-FDG PET/CT in Patients with Relapsed/Refractory B-Cell Non-Hodgkin's Lymphoma Treated by Radioimmunotherapy Using ¹³¹I-Rituximab

“…Recent studies have also pointed out a bulky lesion as a significant prognostic factor after rituximab plus CHOP or CHOP [19,20]. RIT paves the new way to treatment outcome improvements in lymphoma because cross-fire radiation can kill cells in the proximate environment that are not accessible to monoclonal antibody [21].…”

Infiltration of effector regulatory T cells predicts poor prognosis of diffuse large B-cell lymphoma, not otherwise specified

“…A cutoff of $80% was used to define a high proliferation index. 17,18 We immunostained the LNs with the EnVision system kit using primary antibodies for FOXP3 (236A/E7; Abcam, Cambridge, United Kingdom). We also performed FOXP3/CTLA-4 (H-126; Santa Cruz Biotechnology, Santa Cruz, CA) dual staining to detect FOXP3/ CTLA-4 double-positive cells using the EnVision system kit and EnVision, G/2 system/AP ( …”

Distribution of Ki67 Proliferative Indices among WHO Subtypes of Non-Hodgkin's Lymphoma: Association with other Clinical Parameters

“…While the role of Ki67 index as a prognostic and predictive factor is extensively evaluated in several studies (Erlanson et al, 1999;Hadzi-Pecova et al, 2007;Gaudio et al, 2011), its significance has not been widely studied in our population. Therefore we aimed to determine distribution of Ki67 index in various WHO subtypes of non-hodgkins lymphoma in our setup and its association with other clinical parameters like age at diagnosis and extra-nodal involvement.…”