External validation and comparison of IPI, R-IPI, and NCCN-IPI in diffuse large B-cell lymphoma patients treated with R-CHOP to predict 2-year progression-free survival. Issue 1 (31st December 2022)

• Record Type: Journal Article
• Authors: Warnnissorn, Naree; Kanitsap, Nonglak; Niparuck, Pimjai; Boonsakan, Paisarn; Kulalert, Prapasri; Limvorapitak, Wasithep; Bhoopat, Lantarima; Saengboon, Supawee; Chantrathammachart, Pichika; Puavilai, Teeraya; Chuncharunee, Suporn
• Is Part Of: Hematology. Volume 27:Issue 1(2022)
• Page Start: 1237
• Page End: 1245
• Publication Date: 2022-12-31
• Subjects: Diffuse large B-cell lymphoma -- R-CHOP -- external validation -- comparison -- international prognostic index -- revised-international prognostic index -- enhanced-international prognostic index -- progression-free survival; Blood -- Diseases -- Periodicals; Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; 616.15005
• DOI: 10.1080/16078454.2022.2147916
• Languages: English
• ISSNs: 1024-5332

Abstract

ABSTRACT: Background: Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma. The standard first-line therapy for DLBCL consists of rituximab cyclophosphamide doxorubicin vincristine and prednisone (R-CHOP). About 50–70% of patients may be cured by R-CHOP. There was no data on external validation and comparison of the international prognostic index, revised-IPI (R-IPI), and enhanced-IPI (NCCN-IPI) to predict treatment outcomes in the middle-income country with a resourced-limited setting. Objectives: We aimed to externally validate and compare IPI, R-IPI, and NCCN-IPI in predicting 2-year progression-free survival (2-y PFS) of newly diagnosed DLBCL patients treated with R-CHOP. Methods: This ambispective observational study recruited consecutive patients diagnosed between 1 January 2014 and 30 June 2020, with the last follow-up on 1 July 2022 from Thammasat University Hospital and Ramathibodi Hospital. We assessed discrimination by Harrell's concordance index (c-index), calibration by calibration plot, and absolute difference in survival (ADS) between the lowest-and the highest-risk groups. Results: The cohort of 292 patients (median age 63 years and median follow-up 3.6 years) had 131 progressions and 96 deaths. The 2-y PFS was 63%. The c-indices were NCCN-IPI 0.6216, R-IPI 0.6004 ( P = 0.215), and IPI 0.6104 ( P = 0.463). The calibration plots of NCCN-IPI and R-IPI showed nearly perfect agreement (moderate strength), while IPI had miscalibrations. The ADSs were NCCN-IPI 52%, R-IPI 42%, and IPI 25%. Conclusion: NCCN-IPI is the best prognostic index compared to IPI and R-IPI in prior studies. However, the prognostic model for DLBCL patients treated with R-CHOP requires updating or integrating biomarkers to improve discrimination to the acceptable level (c-index 0.7).