Relevance of prognostic index with β2-microglobulin for patients with diffuse large B-cell lymphoma in the rituximab era

Jihoon Kang; Shinkyo Yoon; Cheolwon Suh

doi:10.5045/br.2017.52.4.276

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Original Article

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Blood Res 2017; 52(4):

Published online December 31, 2017

https://doi.org/10.5045/br.2017.52.4.276

Relevance of prognostic index with β2-microglobulin for patients with diffuse large B-cell lymphoma in the rituximab era

Jihoon Kang, Shinkyo Yoon, and Cheolwon Suh^*

Author Info. +

Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to : Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. csuh@amc.seoul.kr

Received: May 15, 2017; Revised: July 16, 2017; Accepted: August 8, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Background

The International Prognostic Index (IPI) has been a useful tool for predicting the prognosis of aggressive non-Hodgkin lymphoma in the last 20 years. Herein, we aimed to develop a new prognostic model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era.

Methods

Between March 2004 and June 2012, patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy regimen were identified in the database of the Asan Medical Center (AMC) Lymphoma Registry. The primary and secondary endpoints were a new prognostic index for DLBCL and validation of the National Comprehensive Cancer Network-International Prognostic Index in our cohort, respectively.

Results

The AMC cohort comprised 621 patients. The median follow-up duration was 43.3 months (range, 6.2?122.5 mo). Univariate analysis revealed that age (≤60 vs. >60 yr), lactate dehydrogenase (LDH; within normal vs. increased), Eastern Cooperative Oncology Group performance status (ECOG PS; 0 or 1 vs. ≥2), advanced stage (Ann Arbor stage I/II vs. III/IV), extra-nodal involvement (≤1 vs. >1), B symptoms (no vs. yes), and beta-2 microglobulin (β2MG, ≤2.5 vs. >2.5) can be used to predict overall survival (OS). In multivariate analysis, only age, LDH, ECOG performance status, and β2MG were significantly associated with OS, and we developed a new prognostic model with these 4 factors. The new prognostic model showed better discriminative power compared with the classic IPI.

Conclusion

Our new prognostic index model for DLBCL in the rituximab era has good discriminative power and is convenient to use.

Keywords Diffuse large B-cell lymphoma, Prognostic index, NCCN-IPI, β2-microglobulin

Article

Original Article

Blood Res 2017; 52(4): 276-284

Published online December 31, 2017 https://doi.org/10.5045/br.2017.52.4.276

Relevance of prognostic index with β2-microglobulin for patients with diffuse large B-cell lymphoma in the rituximab era

Jihoon Kang, Shinkyo Yoon, and Cheolwon Suh^*

Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to:Cheolwon Suh, M.D., Ph.D. Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. csuh@amc.seoul.kr

Received: May 15, 2017; Revised: July 16, 2017; Accepted: August 8, 2017

Abstract

Background

Methods

Results

Conclusion

Our new prognostic index model for DLBCL in the rituximab era has good discriminative power and is convenient to use.

Keywords: Diffuse large B-cell lymphoma, Prognostic index, NCCN-IPI, β2-microglobulin

Abstract

Fig 1.

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Figure 1.

Overall survival and relapse-free survival of (A) AMC cohort and (B) PROCESS cohort. Our model was found to have high prognostic capability in the multicenter prospective cohort (PROCESS).

Abbreviations: H, high-risk group; H-I, high-intermediate; L, low; L-I, low-intermediate.

Blood Research 2017; 52: 276-284https://doi.org/10.5045/br.2017.52.4.276

Fig 2.

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Figure 2.

Overall survival and relapse-free survival according to (A) classic IPI, (B) NCCN-IPI, and (C) modified IPI.

Abbreviations: H, high-risk group; H-I, high-intermediate; IPI, International Prognostic Index; L, low; L-I, low-intermediate; NCCN-IPI, National Comprehensive Cancer Network-International Prognostic Index; RFS, relapse-free survival.

Blood Research 2017; 52: 276-284https://doi.org/10.5045/br.2017.52.4.276

Table 1 Baseline characteristics of the patients in AMC and PROCESS cohorts.

Abbreviation: ECOG PS, Eastern Cooperative Oncology Group performance status..

Table 2 Univariate analysis of clinical prognostic factors for overall survival.

^a)Lymphomatous involvement in bone marrow, CNS, liver/GI tract, or lung..

Abbreviation: ECOG PS, Eastern Cooperative Oncology Group performance status..

Table 3 Clinical prognostic factors of 5-year overall survival from multivariate analysis in AMC cohort.

Abbreviation: ECOG PS, Eastern Cooperative Oncology Group performance status..

Table 4 Comparison of classic IPI, NCCN-IPI, and modified prognostic model for risk stratification and outcomes of 5-year OS and RFS in AMC and PROCESS cohorts.

Table 5 Time-independent AUC and calibration slope in classic IPI, NCCN-IPI, and modified prognostic model.

Abbreviations: AUC, area under the curve; CI, confidence interval; IPI, International Prognostic Index; NCCN-IPI, National Comprehensive Cancer Network-International Prognostic Index..