Outcome prediction by extranodal involvement, IPI, R‐IPI, and NCCN‐IPI in the PET/CT and rituximab era: A Danish–Canadian study of 443 patients with diffuse‐large B‐cell lymphoma. Issue 11 (November 2015)

• Record Type: Journal Article
• Authors: El‐Galaly, Tarec Christoffer; Villa, Diego; Alzahrani, Musa; Hansen, Jakob Werner; Sehn, Laurie H.; Wilson, Don; de Nully Brown, Peter; Loft, Annika; Iyer, Victor; Johnsen, Hans Erik; Savage, Kerry J.; Connors, Joseph M.; Hutchings, Martin
• Is Part Of: American journal of hematology. Volume 90:Issue 11(2015:Nov.)
• Page Start: 1041
• Page End: 1046
• Publication Date: 2015-11
• Subjects: Hematology -- Periodicals; 616.15
• DOI: 10.1002/ajh.24169
• Languages: English
• ISSNs: 0361-8609

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>18F‐fluorodeoxyglucose PET/CT (PET/CT) is the current state‐of‐the‐art in the staging of diffuse large B‐cell lymphoma (DLBCL) and has a high sensitivity for extranodal involvement. Therefore, reassessment of extranodal involvement and the current prognostic indices in the PET/CT era is warranted. We screened patients with newly diagnosed DLBCL seen at the academic centers of Aalborg, Copenhagen, and British Columbia for eligibility. Patients that had been staged with PET/CT and treated with R‐CHOP(‐like) 1<sup>st</sup> line treatment were retrospectively included. In total 443 patients met the inclusion criteria. With a median follow‐up of 2.4 years, the 3‐year overall (OS) and progression‐free survival (PFS) were 73% and 69%, respectively. The Ann Arbor classification had no prognostic impact in itself with the exception of stage IV disease (HR 2.14 for PFS, <italic>P</italic><0.01). Extranodal involvement was associated with a worse outcome in general, and in particular for patients with involvement of >2 extranodal sites, including HR 7.81 (<italic>P</italic> < 0.001) for PFS for >3 sites. Bone/bone marrow involvement was the most commonly involved extranodal site identified by PET/CT (29%) and was associated with an inferior PFS and OS. The IPI, R‐IPI, and NCCN‐IPI were predictive of PFS and OS, and the two latter could identify a very good prognostic subgroup with 3‐year PFS and OS of 100%. PET/CT‐ascertained extranodal involvement in DLBCL is common and involvement of >2 extranodal sites is associated with a dismal outcome. The IPI, R‐IPI, and NCCN‐IPI predict outcome with high accuracy. Am. J. Hematol. 90:1041–1046, 2015. © 2015 Wiley Periodicals, Inc.</p> </abstract>