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

医学 国际预后指标 内科学 弥漫性大B细胞淋巴瘤 美罗华 β-2微球蛋白 肿瘤科 阶段(地层学) 淋巴瘤 人口 癌症 古生物学 环境卫生 生物
作者
Carlos Montalbán,Antonio Díaz‐López,Iván Dlouhy,Jordina Rovira,Armando López‐Guillermo,Sara Alonso,Alejandro Martı́n,Juan‐Manuel Sancho,Olga García,Jose M. Sánchez,Mario Rodríguez,Silvana Novelli,Antonio Salar,Antonio Gutiérrez,Maria J. Rodríguez‐Salazar,Mariana Bastos‐Oreiro,J. Domínguez,Rubén Caloto,Sonia González de Villambrosía,José Antonio Queizán,Raúl Córdoba,Raquel de Oña,Andrés López‐Hernandez,Julian Freue,Heidys Garrote,Lourdes López,Ana M. Martín‐Moreno,José Rodríguez,Víctor Abraira,Juan F. Garcı́a
出处
期刊:British Journal of Haematology [Wiley]
卷期号:176 (6): 918-928 被引量:70
标识
DOI:10.1111/bjh.14489
摘要

Summary The study included 1848 diffuse large B‐cell lymphoma ( DLBCL )patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index ( NCCN ‐ IPI ) and explore the effect of adding high Beta‐2 microglobulin (β2M), primary extranodal presentation and intense treatment to the NCCN ‐ IPI variables in order to develop an improved index. Comparing survival curves, NCCN ‐ IPI discriminated better than IPI , separating four risk groups with 5‐year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high‐risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III ‐ IV , and β2M as independently significant, whereas the NCCN ‐ IPI ‐selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Español de Linfomas/Trasplante de Médula ósea ( GELTAMO )‐ IPI developed here, with 7 points, significantly separated four risk groups (0, 1–3, 4 or ≥5 points) with 11%, 58%, 17% and 14% of patients, and 5‐year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN ‐ IPI . In conclusion, GELTAMO ‐ IPI is more accurate than the NCCN ‐ IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high‐risk group and is not influenced by primary extranodal presentation or treatments of different intensity.

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